Issues of gender equity: a case study of decentralized health care system of District Nawabshah, Sindh

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


Gender is the social construction given to the biological differences between men and women and equity is about looking at the gains of the poorest populations. Equity is about reducing disparities, for it is relative term and needs a reference point. Women's health is a blend of physical, emotional, social, cultural and spiritual wellbeing. Why is gender important to consider the causes and consequences of inequity in health? Inequity between the health status of rich and poor was recognized in early nineteenth century, yet attention to heath equity, on the basis of economic class, caste or race has not spilled over to an effective consideration of gender. With Local Government Ordinance (LGO) 2001, Pakistan adopted decentralization system. This system seeks to increase citizen participation in local decision-making, strengthen accountability and thereby improve service delivery to every citizen. We intended to identify the perception of providers, recipients, local politicians and policy makers, on gender-equity based delivery of health care services in decentralization system of Pakistan. In this research key informants interviews, focus group discussion and field observation were used to collect the required data. The results of this study highlights that there is no gender equity in existing decentralized health system and there is no gender sensitive budgeting at district. Access to health care facility is big issue in both rural and urban setting. Unavailability of trained staff at Basic Health Unit (BHU), Rural Health Centre (RHC) and Taluka level hospitals was common finding for the reproductive health services. We found that women suffers more due to lack of access, unavailability of Emergency Obstetrical Care (EmOC) services throughout the district, lack of proper facilities for referral and limited EmOC facility at tertiary care hospital. There is need of trainings for doctors and other staff for proper functioning of decentralized system with the collaboration of Zila Nazim and District Health Department with aim to provide health care services on gender-equity basis. There is also need to activate the non-functional health care units (BHU, RHC and Taluka Hospitals) to improve the quality of health facilities. Further, there is strong need for capacity building of lady councilors through effective trainings for useful participation in decision-making processes at district level to lessen the gender inequities in health.

This document is available in the relevant AKU library