Washington DC / London — Women health workers are more than two thirds of the health workforce and represent 90% of the world’s frontline health workers, yet hold less than a quarter of senior leadership roles – a situation which is unfair and a significant risk for 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 gains, while overall progress on women’s representation in global health governance has remained largely unchanged.
The report, launched on March 16, assessed global data together with deep dives into country 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 COVID-19 task forces had majority male membership. At global level, during the World Health Organisation’s Executive Board meeting in January 2022 just 6% of government delegations were led by women (down from a high point of 32% in 2020).
It appears that during emergencies like the pandemic, outdated gender stereotypes resurface with men seen as ‘natural leaders’.
A key and disturbing finding in the report was that women belonging to a socially marginalized race, class, caste, age, ability, ethnicity, sexual orientation, gender identity or with migrant status, face far greater barriers to accessing and retaining formal leadership positions in health.
Without women from diverse backgrounds in decision-making positions, health programs lack insight and professional experience from the women health workers who largely deliver the health systems in their countries.
Expanding the representation of diverse leaders in health 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.
Further, the report shows 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 national level and systemic bias against women continues, the global health leadership pipeline will continue to funnel more men into positions with 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 most senior appointments.
A deep dive of case studies in India, Nigeria and Kenya confirms that women are held back from health leadership by cultural gender norms, discrimination and ineffectual policies which don’t redress historic inequalities.
The similarities in the barriers faced by women health workers from very different socio-economic and cultural contexts are marked, indicating widespread systemic bias right across the global health workforce.
The consequences of locking women out of leadership represents a moral and justice issue, and also a strategic loss to the health sector. Through the pandemic, we saw how safe maternity and sexual and reproductive health services were deprioritized and removed from essential services in some countries, with catastrophic consequences for women and girls.
We saw women health workers unpaid or underpaid, and we saw dangerous conditions escalate as community health workers were sent to enforce lockdown, do contact tracing or provide services in unsafe conditions with no forethought given to providing security.
The findings of our report show that systemic change goes beyond numbers in gender parity leadership. What is needed is a transformative framework for action involving all genders from institutional, to national and global level.
Recommendations to drive transformative approaches include:
● Men must ‘lean 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 the burden of care of women
● Governments taking targeted actions to fast track the number of diverse women in health leadership roles through quotas and all-women shortlists, particularly 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 move into leadership
● Measurable actions such as mentorship, shadowing / pairing and deputizing opportunities should be created and monitored to ensure women are visible for promotion opportunities
● A zero tolerance of discrimination towards pregnancy
● Supported flexible working options for all parents and carers
Investing in women is not only the right thing to do, but it also makes good business sense. When we get it right, we can unlock a “triple gender dividend in health” that includes more resilient health systems, improved economic welfare for families and communities, and progress towards gender equality.
The lessons of the pandemic have taught us much about the value of the health workforce and even more about the value of health workers. They are mostly women. It’s time for them to take their rightful roles in leadership.
Dr Roopa Dhatt is Executive Director and Co-Founder 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
IPS UN Bureau