Gender, Equity, and Quality in Health Care: Enhancing Health System Performance through Policy and Indicators Development in Greece

Abstract

Background: The HEALTH-IQ project addresses critical gaps in quality, equity, and gender responsiveness in Greece’s healthcare system. Persistent challenges—including fragmented services, inadequate quality standards, and inequitable access—limit progress toward universal health coverage. This national initiative, aligned with Sustainable Development Goals and WHO standards, seeks to establish a standardized framework for quality assessment that incorporates evidence-based strategies, gender-sensitive indicators, and rights-based policies.
Methods: A comprehensive situational analysis, guided by the WHO Gender, Equity, and Human Rights (GER) framework, explored gender disparities in healthcare access, utilization, and outcomes. The study combined desk reviews of scientific literature, policy documents, statistical reports, and grey literature with mapping exercises to identify systemic barriers. Data were examined with a focus on vulnerable and marginalized groups, including migrants, low-income populations, LGBTQ+ individuals, people with disabilities, older adults, and rural residents, considering intersecting determinants such as socioeconomic status, geography, and discrimination.
Results: Seven priority indicators were developed to measure gender equity and service quality: gender gaps in healthcare access, life expectancy, gender-based violence and related services, mental health access, work-life balance impacts on women’s health, public expenditure on gender-sensitive services, and accessibility for women from vulnerable groups. Additional indicators were proposed for future research, including cancer screening rates, maternal mortality, healthcare workforce gender distribution, gender pay gaps, chronic disease prevalence, and pandemic impacts. Findings revealed significant data limitations, particularly in gender-disaggregated and intersectional statistics, hindering effective monitoring and intervention.
Conclusions: Integrating gender and rights perspectives into healthcare measurement and governance is essential to achieving equitable, high-quality services in Greece. This requires embedding gender-sensitive indicators in health information systems, training providers to address implicit bias, and designing inclusive policies responsive to the needs of diverse populations. Community engagement and culturally competent care are critical for empowering underserved groups and improving service uptake. By institutionalizing these approaches, the HEALTH-IQ project offers a replicable model for rights-based health reform, positioning Greece as a leader in equitable health system quality and ensuring that universal health coverage is both inclusive and sustainable.