Left Behind at the Margins: Advancing Trans-Inclusive Universal Health Coverage in Ireland

Objective

This fellowship investigates how Ireland’s Universal Health Coverage (UHC) system includes—or excludes—transgender and gender-diverse (TGD) people, and identifies policy levers for change. Despite UHC being a recognised health right, TGD populations remain disproportionately excluded due to stigma, fragmented services, and intersecting vulnerabilities. In Ireland, gender-affirming care is centralised, waitlists are long, and commitments under UHC remain misaligned with lived realities. The study applies a mixed-methods, intersectional case study across five hubs (Dublin, Cork, Limerick, Galway, Waterford). SO1 foregrounds TGD experiences through 30 semi-structured interviews and a descriptive online survey (n 75). SO2 uses Intersectionality-Based Policy Analysis (IBPA) of Sláintecare/HSE/EU instruments (2017–2025) and ~10 policymaker interviews, triangulating with SO1 to map barriers and enablers. SO3 convenes a participatory workshop with TGD organisations, providers, policymakers, and academics to co-produce feasible recommendations. Expected outputs include a UHC-aligned gap analysis, joint displays linking lived experience to policy, a validated Policy Recommendations Guideline, two open-access articles, a policy brief, a closing roundtable, and public-facing outputs (webpage, briefs, webinars, media). Impact spans science (transferable UHC/TGD methods), policy (Sláintecare-ready levers), society (reduced unmet need), and economy (resource optimisation). Hosted at UCD’s School of Nursing, Midwifery & Health Systems under Dr John Gilmore, the fellowship combines methodological rigour, Open Science, GDPR-compliant data management, and co-production. It contributes to the EU LGBTIQ Equality Strategy, the European Pillar of Social Rights, and SDG 3.8, while equipping the researcher with Horizon Europe–ready skills and strengthening career prospects across academia, health systems, and policy.