WASHINGTON DC / LONDON, Mar 16 (IPS) – Women health workers make up more than two-thirds of the health workforce and represent 90% of the world’s top health workers, yet hold less than a quarter of senior leadership roles – a situation that is inequitable and a significant risk to global health security.
Despite five years of ad hoc commitments, our new report Status of women and leadership in global health shows few and isolated gains, while overall progress in women’s representation in global health governance has remained largely unchanged.
The report, launched on March 16, evaluated global data along with deep dives into case studies from India, Nigeria and Kenya. It found that women lost significant ground in health leadership during the Covid-19 pandemic.
A Women in Global Health study calculated that 85% of 115 national task forces for covid-19 had majority male membership. At the global level, at the January 2022 World Health Organization Board meeting, only 6% of government delegations were led by women (down from a peak of 32% in 2020).
It seems that during emergencies such as the pandemic, outdated gender stereotypes are re-emerging with men being seen as “natural leaders”.
An important and worrying finding in the report was that women who belong to a socially marginalized race, class, caste, age, ability, ethnicity, sexual orientation, gender identity or migrant status face much greater barriers to accessing and maintaining formal health leadership positions .
Without women of diverse backgrounds in decision-making positions, health programs lack the insight and professional experience of women health workers who largely provide the health systems in their countries.
Expanding the representation of diverse leaders in health is not only a matter of equity, it also contributes to better decision-making by bringing in a wider range of knowledge, talent and perspectives.
Furthermore, the report shows that there is a “broken pipeline” between women working in national health systems and those working in global health. As long as men are the majority of health leaders at the national level and the systemic bias against women continues, global health leadership will continue to usher more men into positions of global decision-making power.
The issues women face in national health systems are then reproduced at the global level where women are excluded from political processes and marginalized from the highest appointments.
A deep dive into case studies in India, Nigeria, and Kenya confirms that women are held back from health leadership by cultural gender norms, discrimination, and ineffective policies that do not address historical inequities.
The similarities in the barriers faced by female health workers from very different socio-economic and cultural contexts are striking, suggesting widespread systemic bias across the global health workforce.
The consequences of excluding women from leadership represent a matter of morality and justice, and also a strategic loss for the health sector. Through the pandemic, we saw how safe maternity and sexual and reproductive health services were de-prioritized and removed from essential services in some countries, with disastrous consequences for women and girls.
We saw female health workers unpaid or underpaidand we saw dangerous conditions escalate when community health workers were sent to enforce lockdowns, do contact tracing or provide services in unsafe conditions with no thought to providing safety.
The results of our report show that systemic change goes beyond numbers in gender equality leadership. What is needed is a transformative framework for action that involves all genders from institutional, to national and global levels.
Recommendations for driving transformative approaches include:
- Men must “lean out” and become visible role models in challenging stereotypes to make room for qualified women
- Normalization of paternity leave to change gender norms and reduce the care burden for women
- Governments taking targeted action to accelerate the number of diverse women in health leadership roles through quotas and all-women shortlists, especially for senior global health leadership roles that have never been held by a woman
- Institutions must be intentional about creating and maintaining a pipeline for women to enter leadership
- Measurable measures such as mentoring, shadowing/pairing and deputizing should be created and monitored to ensure that women are visible for promotion.
- Zero tolerance to discrimination against pregnancy
- Supported flexible working opportunities for all parents and carers
Investing in women is not only the right thing to do, it’s also good business. When we get it right, we can unlock a “triple gender payoff in health” that includes more resilient health systems, improved economic well-being for families and communities, and progress toward gender equality.
The lessons of the pandemic have taught us a lot about the value of health workers and even more about the value of health workers. They are mostly women. It is time for them to take their rightful roles in leadership.
Dr. Roopa Dhatt is executive director and co-founder of Women in Global Health, Washington, DC and Dr. Ebere Okereke is Snr Health Adviser Tony Blair Institute London & incoming CEO Africa Public Health Foundation, Nairobi
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