Global health – women largely deliver while men largely lead

Women who are 90% of frontline health workers and 70% of the overall global health workforce – remain just as overlooked for senior leadership roles as they were five years ago, according to a report just published from Women in Global Health.

The State of Women and Leadership in Global Health documents a XX Paradox in global health, where women hold just 25% of senior leadership roles in a sector they largely deliver. The report highlights the impacts of continuing systemic bias against women in leadership and lacklustre implementation of policy initiatives to advance greater gender equity.

"It is more and more evident that locking women out of senior leadership positions is severely impacting global health delivery and global health security," said Dr Roopa Dhatt, Executive Director of Women in Global Health.

"Current leadership structures are failing to address issues of low or no pay, procedures and protective equipment are tailored to male measurements and sexual abuse and harassment is too common in the workplace, with the result that women are increasingly leaving the health workforce.

"The pandemic brought surging workloads and increased risks to women health workers but no improvement in an unequal playing field characterized by a lack of respect, recognition and reward."

The continued segregation of women into health jobs accorded lower status and lower pay is not only a violation of women’s basic human rights, but also a clear manifestation of the widespread discrimination in the health sector, the report states.  Findings include:

1. Women have lost ground in health leadership during the COVID-19 pandemic
2. Women from marginalized backgrounds are most excluded from health leadership
3. Across contexts and cultures, women in health experience common challenges accessing leadership - countries have made commitments to gender equality at national level but implementation is slow
4. There is a ‘broken pipeline’ between women working in national health systems and global health leaders
5. The barriers to leadership faced by women are systemic, action is needed to fix
   systems not women

As well as reviewing evidence at global level, researchers also examined country case studies in Nigeria, India and Kenya. They found that women face barriers to leadership from cultural gender norms, discrimination and ineffectual policies that are not working fast enough to redress historic inequalities. The lack of a clear path from national to global leadership roles perpetuates the male-dominated status quo, representing a “broken pipeline” for women since national health systems feed leadership roles in global health.

"This is a crisis," said Dr. Dhatt. "The 10 million global health worker shortage at the start of the pandemic gets worse every day as exhausted and demoralized women health workers resign from their jobs.

Why should they continue to wait? It is a tragedy for them and a tragedy for us all if we lose committed and highly skilled women health workers.  If we truly want to build health systems that serve everyone, we need to redress the inequality that has side-lined women from leadership and start listening to women." 

The report strikes a positive note by acknowledging that if recommendations and reforms are actually implemented progress towards greater equity is possible. In this scenario, if the gross inequity is corrected, the health sector, employing 234 million health and care workers globally, could then serve as an exemplar sector to generate learnings for the rest of the economy.

Collective action for gender equity emerges as the main mechanism able to disrupt the systems that perpetuate men’s leadership. Women leaders bring diverse perspectives, expertise and knowledge that enriches decision making. The report cites innovative measures from countries including Argentina, India and the UK showing that affirmative action measures such as gender quotas and all-women shortlists are succeeding in increasing women’s representation in leadership.

"Change is possible when intentional action is taken," said Dr Dhatt. "When we get this right, the benefits of gender equity in the health workforce will drive stronger health systems, delivering better health for all.

For press enquiries, contact: 

Joan Bolger - Women in Global Health 

e: joan.bolger@womeningh.org t: +353 85-285-6977

Editor's notes

1. While the proportion of Fortune 500 healthcare companies led by women has increased between 2018 and 2022 (from 5% to 12%), the number of female ministers of health has decreased from 31 to 25%.
2. The proportion of World Health Assembly (WHA - the highest decision making body in health) member state delegations led by women has fallen from 27% to 23%. Previous WGH analysis reveals how 83% of delegations to the WHA over the last seven decades were composed of a majority of men, and no WHA had more than 30% of women Chief Delegates.
3. During the COVID-19 pandemic, women were excluded and even lost ground in decision-making: a WGH study in 2020 found 85% of 115 national COVID-19 task forces had majority male membership.
4. The UN reports that at the current lack of progress, it will take 140 years for women to achieve equal representation in leadership positions in the workplace.
   

About Women in Global Health

Women in Global Health (WGH) is the fast-growing women-led movement demanding gender equity in global health. While women represent 70% of the workforce and about 90 percent of front-line health workers, they hold just a quarter of leadership positions. Now with supporters in more than 90 countries and 47 official chapters predominantly in low-income countries, Women in Global Health campaigns for equal representation for women in health leadership; equitable pay and ending unpaid work for women health workers; protection and safe and decent work; and the prevention of sexual exploitation, abuse and harassment. These are the essential foundations for strong health systems, Universal Health Coverage and global health security.

The organisation campaigns to address gender inequity as a systemic health care problem with grave impacts on health care delivery around the world. Its canon of evidence, such as today’s report, works to prove that decisive measures to ensure greater representation of women in global health leadership will pay off longer term in better health outcomes.