Transforming Health Systems: ADB’s Push for Gender Equality in Asia and the Pacific

The ADB’s Gender Equality in Health Tool Kit outlines how Asia-Pacific health systems can become gender-transformative by integrating sex- and gender-based data, tackling inequities in access, workforce, and services, and addressing GBV, digital gaps, and climate risks. It positions gender equality not only as a health imperative but as a foundation for resilience, universal care, and sustainable development.

The Asian Development Bank (ADB), supported by insights from the World Health Organization (WHO), UNAIDS, UNICEF, the Food and Agriculture Organization (FAO), and the World Economic Forum, has released a groundbreaking Gender Equality in Health Tool Kit to guide countries in Asia and the Pacific toward health systems that truly integrate gender. At its core, the report emphasizes that both sex and gender are fundamental determinants of health and cannot be ignored if universal health care is to be achieved. Despite women living longer on average than men, their access to health care remains constrained by financial barriers, distance to services, cultural restrictions, and their unequal caregiving responsibilities. The challenges are even sharper for older women, those with disabilities, and those in rural or Indigenous communities.

Crisis and Inequality in the Health Landscape

The toolkit situates its recommendations in the context of global crises that have laid bare systemic inequalities. The COVID-19 pandemic disrupted maternal and reproductive health services, exposed health workers to extreme stress, and fueled spikes in gender-based violence (GBV). Lockdowns further increased women’s unpaid care work, while conflicts and climate change added layers of vulnerability. The report notes that in several parts of Asia and the Pacific, maternal mortality ratios remain unacceptably high, contraceptive use is uneven, and adolescent pregnancies are increasing. These realities, it argues, demand health systems that respond not only to clinical needs but also to the structural inequalities shaping who can seek and receive care.

Closing Data Gaps and Addressing Gendered Health Burdens

One of the most urgent priorities identified is the chronic lack of sex-, age-, and disability-disaggregated health data. A global review cited in the toolkit found that less than half of studies on health interventions reported sex-disaggregated outcomes, making it nearly impossible for policymakers to design equitable systems. The ADB calls for stronger government investment in gender-sensitive data, training health professionals in statistics, and embedding gender analysis into national health planning. Without accurate data, women’s health burdens remain invisible, from maternal mortality to the rising prevalence of noncommunicable diseases such as diabetes and hypertension. At the same time, the toolkit highlights gendered differences in health behavior, men face higher risks of early death from tobacco, alcohol, and suicide, while women’s mental health is worsened by the dual pressures of unpaid caregiving and limited access to services. Case studies from China, Samoa, and Pakistan show how gender-responsive interventions, from improved hospital care to maternal mental health programs, can transform outcomes.

Tackling Violence, Workforce Inequities, and the Digital Divide

Gender-based violence emerges in the toolkit as both a health and human rights crisis. Rates in the Pacific are among the highest in the world, with over 60% of women in some countries reporting lifetime intimate partner violence. Survivors frequently suffer depression, reproductive complications, and suicide risks, while intergenerational cycles of violence perpetuate trauma. The toolkit stresses that health systems must integrate GBV screening, referral, and treatment into primary care, and link them to justice and social protection services. At the same time, attention turns to women in the health workforce, who make up 70% of global staff but remain clustered in low-paid positions, underrepresented in leadership, and vulnerable to harassment. The ADB recommends leadership quotas, scholarships for women in medicine, and fair wages for unpaid health workers. A third frontier is digital health, where women are disadvantaged by lower mobile ownership and internet use. Programs such as Timor-Leste’s SMS-based maternal health support and Tonga’s gender-sensitive digital strategies demonstrate that inclusive design can narrow the gap, but only if women’s needs are deliberately prioritized.

Preparing for Pandemics and Climate Pressures

The COVID-19 pandemic revealed how health crises intensify inequalities, with women less likely to be vaccinated in some settings, health workers overwhelmed, and reproductive services interrupted. The toolkit points to innovations such as mobile vaccination units that combine HPV and COVID-19 vaccines, and hotlines that connect GBV survivors with health and legal support, as examples of good practice. It also widens the lens to climate change, which threatens women’s health disproportionately through extreme heat, air pollution, and food insecurity. Studies cited show rising temperatures correlate with spikes in intimate partner violence, while care burdens during disasters further exhaust women’s mental and physical health. The toolkit calls for gender-responsive climate adaptation, including heat action plans tailored to pregnant and elderly women, and early-warning systems that account for women’s mobility constraints.

ADB’s Gender Equality in Health Tool Kit is more than a technical guide, it is a manifesto for change. By weaving gender considerations into every aspect of health systems, data, service delivery, workforce policies, digital innovation, and climate preparedness, the toolkit provides governments with a blueprint for resilience and equity. It insists that universal health care will remain elusive without confronting the social norms and power structures that dictate who can seek care, who provides it, and who benefits. In positioning gender-transformative health systems at the center of sustainable development, the report argues that inclusive health is not simply a moral imperative but a strategic necessity for building societies that can withstand crises and secure prosperity for all.