Universal (Inclusive) Health Coverage Including the Transgender Population in the UHC dialogue
By Naina Qayyum, Data Analyst, Greater Newark Healthcare Coalition
Alisha succumbed to eight bullet wounds at a hospital in Peshawar, Pakistan. The cause of her death was not just the fatal injury but how she was treated; the emergency staff could not decide whether to keep her in the male or the female ward, and the people present at the occasion kept passing derogatory remarks at Alisha and her attendants. Alisha’s unfortunate fate exacerbated because she was a transgender.
As the world commemorates 12 December 2018 as UHC Day, it becomes pertinent to ensure that the UHC umbrella covers everyone, including the transgender population.
Pakistan spends about 3% of its GDP on health, which translates into $16 per capita and poses as a challenge for the country to achieve UHC for its over 200 million people, including the transgender population. The dearth of reliable data on the transgender community of Pakistan provides an incomplete picture of the demographics and the health needs of this marginalized group. Due to the lack of an identity card, transgender people cannot access social services, let alone regular employment. It was only in 2009 that the transgender population got its official recognition on the national identity card, however, the positive impact of that is yet to be seen at scale.
A documentary by Real Stories on experiences of transgender in Pakistan comprehensively covered the ordeals of the ostracized population. Most transgender individuals, considered as a source of shame, are shunned by their family and society. Being deprived of basic education and healthcare, many of them revert to sex work, dancing at weddings or panhandling to make ends meet, and often suffer mental and sexual abuse.
The barrier to healthcare for the transgender population manifests in various forms: systemic discrimination, health service provider biases, and lack of individual’s knowledge. Shockingly, members of the transgender community lack knowledge of sexually transmitted illnesses and resort to self-injecting hormones and performing castration on each other, instead of seeking proper medical servicesThe lack of knowledge amongst the transgender population, despite being highly vulnerable to STIs, inevitably puts their health at risk.
The issues for this population go well beyond Pakistan. The World Bank’s Global Monitoring Report on UHC published in 2017 does not include the term ‘transgender’. This speaks to the fact that marginalized groups are excluded in UHC discussions. At the micro-level, many healthcare providers do not exercise empathy and understanding in dealing with transgender patients. In the US, where UHC is still an unrealized dream, according to a Tedx Talk by Dr. Kristie Overstreet, 72% of healthcare providers are not well-informed about the healthcare needs of the LGBTQ community.
Discussions around UHC in the policy and the data landscape must give special focus to the fringe communities like transgender and give them the preventative and curative health services they need to live a healthy life. Some steps could be to have an accurate account of transgender in the national census, conduct population specific needs assessment and provide responsive health services, reduce financial barriers in healthcare access by hosting free clinics and referrals, and cultivate special efforts to provide health awareness. In the spirit of inclusivity, UHC should consider the needs of every group, including the transgender community. It should strive to make healthcare a safe space where anyone can get access to dignified health services, which is a basic human right.
Naina Qayyum, from Pakistan, is currently a Global Health Corps fellow serving the role of a data analyst at the Greater Newark Healthcare Coalition, New Jersey. Her interest and research focuses on design thinking, vaccine strategies, maternal and child health, minority health, and the role of non-clinical providers in complex care models. Naina did her undergraduate in Economics and Global Health from Middlebury College and Masters of Global Affairs as a Schwarzman Scholar from Tsinghua University.
