The NSW Women's Health Sector Model of Service Delivery

Abstract

Background and introduction The women's health sector (WHS) was established in the early 1970s, at a time when the state and the women's health movement (WHM) shared common goals for advancing women's health. The early 2000s, however, ushered in a new era with the adoption by the state of New Public Management (NPM) principles and values more akin to the private sector. The early WHM challenged the treatment of women by medical professions, claiming it was not only unresponsive to women's health needs, but was actively harming women. High on the WHM's agenda was male violence and abuse against women, women's poorer mental and emotional health outcomes, and their misunderstood and mismanaged sexual and reproductive health. Since the emergence of the NPM, understandings and representations of 'women's health' and the role that gender inequality plays in shaping it have diverged in health policy settings from that previously shared with the WHS. The NPM has fostered a 'gender-neutral' conception of health, shifting the focus from gender (women's social circumstances) to sex (biological and physiological differences in relation to men). Understandings in policy settings have therefore narrowed to perspectives more aligned with biomedical perspectives. A social approach to women's health care is supported by current international research evidence into the social determinants of health, and research into the complexity of women's health needs due to gender inequality. Women's most pressing health needs globally remain related to male violence and abuse, and their poorer psycho-social outcomes, which have been linked to the development of chronic illnesses. Women's continuing subordinate status provides evidence that a social model for advancing women's health is as relevant today as it was in the 1970s. In the context of a mature NPM culture in the Ministry of Health (MoH), and continuing demand for WHS services, the MoH commissioned a state-wide study in 2016-7 of the WHS in NSW. The aim of the study was to learn more about the WHS in NSW to inform greater alignment of the WHS services to policy goals, as part of the Partnerships for Health reform. The WHS survey reported here was conducted within the same time-frame, to generate evidence regarding the contribution of the WHS model of service delivery to women's health and well-being, and to the broader health system.