WASHINGTON DC/LONDON, March 16 (IPS) – Female healthcare workers make up more than two-thirds of the healthcare workforce and represent 90% of the world’s frontline healthcare workers, but hold less than a quarter of senior leadership positions – a situation that is unfair and has a significant risk to global health security.
Despite five years of ad hoc commitments, our new report The state of women and leadership in global health shows few and isolated benefits, while overall progress in women’s representation in global health governance has remained largely unchanged.
Launched on March 16, the report assessed global data along with in-depth country case study 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 the 115 national COVID-19 task forces were predominantly male. At the global level, at the January 2022 World Health Organization Board meeting, only 6% of government delegations were led by women (up from a high of 32% in 2020).
It seems that during emergencies like the pandemic, outdated gender stereotypes are resurfacing with men seen as “natural leaders.”
An important and disturbing finding in the report was that women belonging to socially marginalized race, class, caste, age, ability, ethnicity, sexual orientation, gender identity or migrant status face much greater barriers to accessing formal leadership positions and keep them in health.
Without women from diverse backgrounds in decision-making positions, health programs lack insight and professional experience from the female health professionals who largely deliver their country’s health systems.
Increasing the representation of diverse health leaders is not just a matter of fairness, 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 women working in global health care. As long as men make up the majority of health leaders nationally and the systemic bias towards women continues, the global health leadership pipeline will continue to funnel more men into positions of global decision-making power.
The problems faced by women in national health systems are then replicated at the global level, where women are excluded from political processes and marginalized in the highest appointments.
A thorough analysis of 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 fail to correct historic inequalities.
The similarities in the barriers faced by female health workers from widely different socio-economic and cultural contexts are apparent, indicating widespread systemic bias within the global health workforce.
The consequences of excluding women from leadership are a moral and justice issue, as well as a strategic loss to the health sector. During the pandemic, we have seen safe maternity and sexual and reproductive health services prioritized and removed from essential services in some countries, with catastrophic consequences for women and girls.
We saw female health workers unpaid or underpaid, and we saw dangerous conditions escalate as community health workers were sent to enforce lockdowns, trace contacts or provide services in unsafe conditions without thinking ahead about providing safety.
Our report findings show that systemic change goes beyond numbers in gender equality leadership. What is needed is a transformative framework for action involving all genders, from institutional to national and global levels.
Recommendations to encourage transformative approaches are:
- ? Men need to ‘stretch out’ and become visible role models in challenging stereotypes to make way for qualified women? Normalization of paternity leave to shift gender norms and reduce women’s burden of care? Governments taking targeted action to rapidly track the number of diverse women in health leadership positions through all-female quotas and shortlists, particularly for senior global health leadership roles that have never been held by a woman lined? Institutions should be intentionally creating and maintaining a pipeline for women to progress to leadership? Measurable actions such as mentoring, shadow/matching and vicarious opportunities should be created and monitored to ensure women are visible for advancement opportunities ? A zero tolerance for pregnancy discrimination? Supported flexible work options for all parents and carers
Investing in women is not only a good thing to do, it also makes good business sense. If we get it right, we can unlock a “triple gender dividend in health” that includes more resilient health systems, improved economic prosperity for families and communities, and advancements in gender equality.
The lessons of the pandemic have taught us a lot about the value of the healthcare workforce and even more about the value of the healthcare workforce. They are mostly women. It is time for them to assume their rightful role in leadership.
Dr. Roopa Dhatt is executive director and co-founder of Women in Global Health, Washington, DC and Dr Ebere Okereke is Senior Health Advisor Tony Blair Institute London & upcoming CEO Africa Public Health Foundation, Nairobi
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