Structural Barriers and Health System Determinants of Healthcare Access among Transgender Populations in a Multi-Country Public Health Systems Analysis

Background Transgender people all over the world continue to have to face discrimination related to the public healthcare they receive. This is in part due to the structural weaknesses in the national public health systems. Although the need for health services specific for transgender people is increasingly acknowledged, there is still little access to the needed basic health services in many countries. Objectives This study looks at the impact of the five main components of public health systems (governance, financing, service delivery, health workforce, and health information systems) on the availability of healthcare for transgender people in different countries. Methods Quantitative and qualitative analyses were conducted using a convergent parallel mixed methods design. Quantitative data were derived from the World Health Organization’s Global Health Expenditure Database and the World Bank’s World Development Indicators for the years 2010–2024 for 32 countries. Qualitative data were collected from peer-reviewed journals, national documents, and global health reports. The WHO Health System Building Blocks Framework was used for the analyses of descriptive data, the Pearson correlation, and the multivariable linear regression. Results Compared to non-inclusive policies, countries with transgender-inclusive health policies had higher UHC service coverage, greater government health expenditure, lower out-of-pocket spending, and higher density of health workers. Transgender-inclusive policies and increased public financing for health were both separately important for greater access to health care, while the COVID-19 related disruptions to the health system caused less access to care. Conclusion Incorporating financing policy will be necessary for improving access to healthcare in a socially equitable manner. In order for health policies to reinforce the financing of health systems in an equitable manner, they need to address, equity, Universal Health Coverage and the third Sustainable Development Goal.