The recent UN HLM on 'Universal Health Coverage: Expanding Our Vision for Health and Well-being in a Post-COVID World' which took place 21 September, represents a significant milestone in acknowledging the importance of addressing NCDs to achieve UHC. The resulting political declaration recognised the importance of ensuring health coverage for individuals throughout their entire lifespan and across the continuum of care. This recognition is particularly important for women and girls who are Paying the Price for the lack of adequate NCD healthcare and services, and are experiencing challenges in getting timely diagnosis, treatment and care.

Women are disproportionately affected by NCDs due to exposure to persistent social, gender and economic inequalities. Furthermore, the inadequate allocation of financial resources to tackle NCDs increases caregiving responsibilities, which disproportionately fall on women of various ages lacking sufficient training and providing care without remuneration.

Women who develop NCDs during pregnancy are particularly vulnerable and require immediate care and attention. Antenatal care presents a crucial opportunity to identify and address health issues like anaemia, diabetes, and high blood pressure that may otherwise go unnoticed. Additionally, women generally have longer lifespans compared to men. The demographic trend of population ageing translates to more women living longer, often in poor health due to NCDs and disabilities over extended periods of time. Therefore, it is necessary to take a life course approach to the healthcare needs of women of all ages that goes beyond their reproductive years.

However, the realities of many women’s experiences of access to health, including for NCDs, are invisible due to lack of data. Health systems often fail to collect sex, age, and disability-disaggregated data, and as a result do not capture the barriers that women often experience in achieving better health outcomes. For example, the current UHC indicators on NCDs perpetuate gaps in the data on older women by using age-capped data sources, that exclude women over 50 and men over 55, despite NCDs contributing to 89% of years lived with disability in women 55 and over.

Steps towards gender responsive UHC

Fortunately, the UHC Political Declaration highlighted the need to incorporate a gender perspective when designing, implementing, and monitoring health policies. It stresses the critical role of primary healthcare, community-based services, and the need to enhance community health worker training and recruitment. Additionally, it underscores the significance of women's participation in the healthcare workforce and their empowerment, including their involvement in decision-making positions.

‘Communities are not mere recipients of UHC but the co-architects, with their inclusion, particularly those most affected by health inequities, leading to impactful, meaningful and sustainable UHC’. – Nupur Lalvani, Founder, Blue Circle Diabetes Foundation, NCD Alliance Advisory Group

In low- and middle-income countries (LMICs), female frontline health workers (FFHWs) play a pivotal role in delivering community-level healthcare. For example, India's Accredited Social Health Activists (ASHA) are vital in this regard. Recognising the potential of antenatal care, The George Institute for Global Health and Oxford University have collaborated to develop SmartHealth Pregnancy, a cost-effective smartphone-based system that helps female community health workers identify pregnant and postpartum women with high-risk conditions like heart disease and diabetes. This system facilitates referrals to primary healthcare facilities, enables two-way communication between healthcare providers and the community, and ensures timely follow-up and adherence to medical advice.

An opportunity for all

While political declarations can pave the way for international collaboration and funding, they are insufficient as a tool for change, without comprehensive strategies and integrated service delivery tailored to the needs of women and girls of all ages. Governments must invest in NCD responses that consider gender-specific challenges to effectively equip healthcare systems. Such policies should provide women at all life stages with education, tools, and access to services needed for managing NCDs to create a more equitable and inclusive environment.

Looking ahead, the Commission on the Status of Women, the Global NCD Alliance Forum in Kigali, the Financing Dialogue on NCDs in 2024, and the High Level Meeting on NCDs in 2025 offer opportunities to highlight gender-responsive solutions in building resilient and equitable health systems capable of addressing NCDs effectively. By endorsing the global call-to-action launched at Women Deliver 2023 and committing to its priority actions, individuals can contribute to promoting gender equality in NCD responses. Share your efforts through the 'Women and NCDs' Community of Practice on the WHO Knowledge Action Portal.

Women in Global Health (WGH), in collaboration with UHC 2030, are actively seeking input on how to make health systems more gender-responsive, expediting progress towards achieving Universal Health Coverage. By sharing insights, you can hold leaders accountable for accountable for integrating gender considerations into the health workforce and the design, delivery, financing, and governance of health systems.

Global unity is paramount in ensuring gender equity and rights in the prevention and control of NCDs.