But achieving substantive equality in health also requires improvements in the quality of services as well as broader attitudinal and institutional change to address stereotyping, stigma and violence head-on. The section therefore goes on to examines how the delivery of health care can be transformed to enable all women and girls' to have access to services, to address their specific health needs and to give them greater voice in the health system. Each of these mechanisms has different implications for access to health services, for equity and for protection from the financial consequences of illness. In many countries, those living in poverty incur higher OPPs than other groups of the population because they are more often affected by sickness.