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Health and care at the crossroads: evidencing gender impacts, campaigning for equality

4 April 2023

Care worker with patient wearing masks

This IKD Gender and Social Policy forum is organised in celebration of International Women’s Day, 2023, highlighting the nature of pervasive, persistent and deeply-entrenched gender inequalities that characterise the state of the world today. The title of the forum, “Health and care at the crossroads: evidencing gender impacts, campaigning for equality”, speaks to a strong current in social and economic policy – that of the devalorisation of care in all its forms, its lasting legacies, and ways in which it is being addressed through research, campaigning and policy-making. Our focus reflects growing attention internationally on care and the sorts of investments needed to close the yawning care gaps that disproportionately adversely impact upon women, on their health and wealth.

The Forum showcases new and recent original empirical social policy research by colleagues in, or affiliated with, the IKD network. Presenters from the Department of Economics and Department of Social Policy & Criminology focus on developments in international organisations and a wide array of country contexts, with particular reference to sub-Saharan African countries (Nigeria and Tanzania). Collectively, they present research that has been commissioned by international organisations or UK research councils and which has strong policy-engagement components to their studies.  All make particular reference to the ways in which care is a women’s rights issue, how gender inequalities intersect with other axes of social division, the outcomes of policy initiatives as much as the initiatives themselves, and how gender discrimination is reconfigured through the initiatives.  

Dr Julia Chukwuma’s presentation focused on the controversies surrounding Nigeria’s on-going healthcare sector reform process, paying particular attention to the contestations accompanying the implementation of a novel health financing mechanism, the Basic Health Care Provision Fund (BHCPF). The BHCPF, put into place in 2014 with the adoption of Nigeria’s 2014 National Health Act, was created to provide sustainable public resources to fund the provision of a minimum package of healthcare services in view of fast-tracking Universal Health Coverage in Nigeria. However, the implementation of the BHCPF has been hampered by a diversity of factors, dynamics and interests, which allow for poor health outcomes and significant health inequities in Nigeria to materialise.

Dr Roosa Lambin and Dr Milla Nyyssölä’s presentation “Two decades of Tanzanian health policy - examining policy developments and opportunities through a gender lens” focused on the evolution of Tanzania’s health policy over the past two decades (2000–21). It highlighted the extant gaps in financial protection for working-age women, and particularly female-headed households and rural women in the informal sector. Given the government plans to launch a mandatory universal health insurance scheme in July 2023, the presentation also discussed options for gender-responsive health insurance expansion, drawing on evidence from other countries in sub-Saharan Africa. It was stressed that future reforms must account for women’s lower contribution capacity through tapered and government-subsidised insurance premiums, and that equitable access can only be ensured through gender-mainstreamed policy investments across benefit packages, awareness-raising campaigns and service quality.

Dr Jerome De Henau presented his recent research, carried out on behalf of the International Labour Organization, which devised an open-source care policy investment simulation tool “Simulating the gender impacts of investing in transformative care policy packages across 82 economies”. The simulator calculates the investment costs and the employment benefits of investing in various care policy packages such as parental leave, childcare services and long-term care services. Several policy parameters can be chosen by the user to construct scenarios of universal high-quality care services and well-paid childcare-related leave entitlements. The tool then calculates the gendered employment effects in terms of employment creation in care and the wider economy and changes to maternal employment patterns. It also simulates potential return on investment that can be used as economic argument to foster political enthusiasm in investing public money in the care sector. A short overview of the tool and a few results and potential applications were presented, of use to researchers, campaigners and policy makers alike. Data and calculations for 82 economies from all income levels and continents are available from the International Labour Organization website.

In a further example of social action-oriented academic research, Nicola Yeates presented some key findings from her UKRI-funded research grant on the experiences of migration health care workers during the Covid-19 pandemic. She highlighted key impacts of the pandemic on migrant health care workers and collective responses to those impacts as far as this group of the health workforce is concerned. A key point she made was how the pandemic and responses to it are migrant rights and women’s rights issues, and, even more fundamentally, human rights issues.

Morning session: Chair: Lorena Lombardozzi; Jerome de Henau (minutes 00:02:50); Nicola Yeates (minutes 00:29:14); Discussion (minutes 01:08:30)
Afternoon session: Chair: Nicola Yeates (minutes 01:36:20); Roosa Lambin and Miilla Nyssola (minutes 01:39:10); Julia Chukwuma (minutes 02:19:18)
Apologies for missing Julia's presentation recording on slide 9-12. If you are interested in finding out more, please contact the organiser or the speaker.


Dr Julia Chukwuma is a Lecturer in Economics at The Open University. Her research seeks to generate new insights into how social policy takes form in an African context, with a particular focus on the political economy of Universal Health Coverage reform processes.

Dr Jerome De Henau is a Senior Lecturer in Economics at The Open University in the UK. His research interests are in gender analysis of fiscal and social policy, including within-household inequality impacts. He has recently led projects on the employment and fiscal effects of investing in formal care provision, in various OECD and emerging economies. He is also a member of the policy advisory group of the UK Women's Budget Group, an independent think tank scrutinising the UK government’s economic policies for their gender impacts.

Dr Roosa Lambin is a visiting Research Fellow at The Open University. Her work is focused on social policy developments in the sub-Saharan African region, and the role and functions of philanthropic donor agencies in development, particularly in the area of health policy.

Dr Milla Nyyssölä is a Chief Researcher at the Labour Institute for Economic Research, Labore in Helsinki, Finland. She has two main fields of study, labour economics and development economics with the aim of generating new insights supporting global sustainable and equitable development.

Professor Nicola Yeates is Chair of Social Policy in the Faculty of Arts and Social Sciences at The Open University. Her research interests focus on the transnationalisation of health, care and welfare systems in all their dimensions and at different levels and scales of globality.

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