The emergence of global movements and women’s marches have set gender equality at the forefront of the global agenda. We are now in the era of deep reflection and discussions, and there is a recognized need for doing things differently. The health workforce is a great example of the need for change. Women are the majority of frontline health workers, delivering health care to their communities worldwide and in crisis; and yet global health leadership remains skewed towards men. Women remain an untapped pool of talent and brainpower in global health leadership, largely ignored by both men and women, reflecting the subtle biases that are prevalent in the field. Moreover, women are more represented in overburdened cadres, not to mention unpaid work. Thus, what remains alarming is that despite momentum to make advancements to achieve gender equality, progress remains slow.
Global Symposium on Health Systems Research
During the Fifth Global Symposium on Health Systems Research, HRH2030, Research in Gender & Ethics (RinGs): Building Stronger Health Systems, and Women in Global Health (WGH) collaborated to host an event on “Deconstructing Gender Bias in the Health Workforce: why few women attain leadership positions”. The session included research conducted in Kenya, Cambodia, and Jordan on women’s leadership within the health system, exploring barriers and enablers to women’s career progression and leadership development, methodological challenges to conducting research on women’s leadership, and future research needs and questions.
The participatory session engaged health systems policymakers, researchers, and practitioners in dialogue, exploring structures of power and privilege that favour men in leadership roles. Research in Cambodia explored gender norms and how they shape the journey of health workers in their careers; research in Kenya looked at mid-level health care managers to understand career trajectories and leadership experiences of male and female health leaders; the research in Jordan was the first national comprehensive study on perceptions of women’s leadership in health care settings; and global research is underway to better understand the impact of women’s leadership as favourable to achieving Universal Health Coverage.
Barriers and enablers to women’s career progression
Despite differences in the cultural contexts of these studies, there were many similarities in barriers facing women:
- Women face gender discrimination in promotions and lack of clear promotion criteria e.g. positions not advertised in transparent ways or male bosses encouraging other men to apply
- Lack of women in line management positions which becomes a cyclical problem e.g. as a result policies that respond to women’s realities are not implemented
- Intersections of gender and race especially
- Unfair division of labour at home with women having greater caring responsibilities that affects their work-life balance.
- Lack of female role models and networking opportunities
These barriers in the workforce must be understood using an intersectional lens to explore how gender intersects with other social stratifiers such as age, race, religion, and professional cadre to influence individual women’s leadership experiences. For example, in Cambodia, women are opting out of becoming specialists as it may take six to ten years of education and could delay their marriage or child birth. They are instead enrolling in nursing courses that could be completed in a shorter time period of four years. This occupational segregation of women in certain jobs leads to a gender pay gap and exacerbates gender inequities in the health workforce.
Enablers of women’s advancement
Key enablers to women’s career advancement included:
- Female role models, mentors, sponsors, and networks in the workforce that help advance women’s career by providing access to opportunities that are traditionally reserved for male networks.
- Creation of supportive environments starting from the home, where both men and women share caring roles and have provision to seek domestic help.
- Creating safe spaces for women to network, meet potential collaborators or sponsors, and engage in meaningful ways are important enabling factors, as is having male allies and engaging them in conversations on gender diversity.
- Maternity policies are important for women to take time off without penalization, but it is likewise important to recognize paternity policies and change the dialogue from child-care being solely a woman’s responsibility.
- Provide capacity building for those in decision making roles to those in line management positions e.g. on how gender barriers impact on their daily work.
Methodological challenges to conducting research on women’s leadership
Research on women’s leadership is methodologically challenging. Firstly, the factors influencing women’s careers are longitudinal, interlinked and interconnected; at times the boundaries are blurred in relation to what exactly helps or hinders women’s career progression and entry into leadership. While interviewees often point to individual characteristics or actions which influence their career progression, it can be difficult to distinguish individual actions from wider system level determinants and norms that contribute to gender bias at different stages along a woman’s career path.
At the same time, measuring systematic factors and identifying larger trends compared to collecting individual stories and experience is challenging. Within such research it is also difficult to isolate variables that contribute to leadership and success; we often look at the specific initiatives that contributed to a greater number of women in leadership, while it is a combination of factors which influence women’s career progression and leadership experiences. Careful attention to these issues is needed when conducting similar studies.
Looking to the future
Future research needs to make the case for why women in leadership matters, and this needs to be grounded in empirical evidence of the effectiveness of women’s leadership, as well as the benefit (to society as a whole) of having gender equity in health leadership. As much as there is a lot of positive energy and momentum around increasing women’s leadership, in some contexts there continues to be backlash, with some people feeling that women are not ‘truly competent’ but are just ‘handed/given’ leadership positions to tick a box. This is especially the case in settings where there is a constitutional requirement to have women in leadership positions.
Sentiments like this undermine women’s power and authority in the spaces where they are not only qualified but are required to provide leadership. Participatory and innovative research methods, including Photovoice and Appreciative Inquiry, could be a powerful means of presenting how gender norms shape career trajectories of female health workers and leaders.
Going forward, more evidence is needed to guide policy and practice. Applying a gender lens to global health system research has the potential to stimulate discussions on addressing gender gaps. There is need to shift the narrative from fixing women to shifting structures and systems that limit women’s career advancements. Addressing gender gaps in global health leadership is not only a human rights issue but also a smart strategy as evidence shows that gender equity in leadership leads to better decision-making and outcomes. If global health systems are to achieve the Universal Health Coverage and the goal of ‘leaving no one behind’, then women must be equitably represented within health system leadership.
By Mehr Manzoor, Kui Muraya, Sreytouch Vong, Samantha Law and Rosemary Morgan