Gender blind to gender transformative: empowering women as leaders in the global health workforce

Gender equality is fundamental to progress towards UHC, and the COVID-19 pandemic is reinforcing the importance of gender-balanced leadership. This blog from the Global Health Workforce Network’s Gender Equity Hub describes evidence and actions that are needed to ensure that in the International Year of Health and Care Workers progress on gender equity in the health and care workforce is made.

With 70% of the global health and social care workforce being women, it is shocking that 75% of leadership positions are held by men. 

Urgent action is needed in the health and social care sectors to address gender inequities and strengthen the health workforce to reach universal health coverage (UHC) and the Sustainable Development Goals (SDGs). Notably, SDG 5, achieve gender equality and empower all women and girls, calls for women’s full and effective participation and equal opportunities for leadership, including in health systems.

WHO’s landmark report, ‘Delivered by Women, Led by Men: A Gender and Equity Analysis of the Global Health Workforce’ shows that workplace gender biases, discrimination and inequities are systemic and gender disparities among health and social care workers are persistent.  Encouragingly, a WHO analysis of 104 countries shows that, in younger age cohorts, more women are entering medicine and gaining access to higher status specialties. But some areas remain static, for example only 10% of nurses around the world are men.

Empower women in the health and social care workforce and reap the benefits

Women hold only 25% of senior roles in the global health workforce and mainly occupy lower status, lower paid jobs. Women are experts in the health systems in which they deliver services, so health delivery is undermined by marginalising their expertise and talent. Empowering women while investing in the health workforce leads to a triple dividend. First, a health dividend, by helping to develop a more effective and responsive workforce to meet growing health care demands and demographic changes. Second, a gender equality dividend: women will gain income, education and autonomy, leading to improvements in education, health, and other aspects of development. Third, an economic dividend: new jobs will be created, fueling economic growth.

Address social norms and stereotypes for more equitable leadership and pay

In addition to men holding most senior roles in health, gender inequality is compounded by disadvantage based on race, caste, class, disability and other stratifiers of personal identity. Stereotyping and occupational segregation also contribute significantly to the high gender pay gap among health workers. The estimated 28% gender pay gap in health in favour of men is higher than the average for other sectors. In fact, the actual pay gap is much higher, since approximately half of the US$3 trillion contributed by women in health to the global Gross Domestic Product is in the form of unpaid work and not included in employment statistics or gender pay gap analyses.  

Keep health workers safe

Many women health workers experience harassment from male colleagues, patients and members of the community, but it is often unreported and unrecorded. Around one third of countries lack laws against sexual harassment that are the foundation for gender equality, dignity and safety at work. This is particularly relevant during the COVID-19 pandemic as women health workers have faced violence at work are at higher risk of COVID-19 infection, compounded by exhaustion and mental stress.

Enact gender transformative policies

Many health and social care organizations expect women health workers to fit into systems which are designed for the life patterns of men or are blind to gender roles. For example, a lack of paid maternity leave for women can have detrimental effects on their continued economic participation. Policies can be gender transformative if rolled out intelligently. For example, the take up by men of parental leave, even when offered, is often low. It increases when the policy offers paternity leave dedicated for fathers rather than parental leave that women can transfer to men.

The gender balance will not equalize on its own

The World Health Assembly declared 2020 the Year of the Nurse and Midwife, not knowing when they did so that nurses and midwives would be stretched to the limit saving lives on the frontlines of a global pandemic. Recognising their outstanding contribution, 2021 has been designated the International Year of Health and Care Workers and this will be an opportune time to address the gender inequities that have put obstacles in the way of women workers and health systems in this pandemic.

Countries and the global health system must take specific and targeted policy action that addresses underlying causes of gender inequity. Without explicit and gender transformative action workplace gender equality will take another 202 years to achieve.  Gender transformative policy changes are urgently needed to address work policies and culture, create decent work for women and close gender gaps in leadership and pay.

Ignoring the gender aspects of leadership, especially as they relate to the COVID-19 outbreak, hinders prevention and response management. UHC2030’s recent State of UHC Commitment review called for national political leaders to ‘empower women, who are proving to be highly effective leaders in health emergencies’. This is crucial if countries are to attain Universal Health Coverage and the Sustainable Development Goals. Gender inequality is both bad for women and bad for everybody’s health.

Blog authors:

Dr. Mwenya Kasonde, Co-chair, Global Health Workforce Network’s Gender Equity Hub

Dr. Roopa Dhatt, Executive Director, Women in Global Health and Co-chair, Global Health Workforce Network’s Gender Equity Hub

Ms. Ann Keeling, Senior Policy Fellow, Women in Global Health

Dr. Bismah Nayyer, Project Manager, Global Health Workforce Network’s Gender Equity Hub

Dr. Michelle McIsaac, Labour Economist, Health Workforce Department WHO Geneva and Co-chair, Global Health Workforce Network’s Gender Equity Hub

Photo: WHO/Noor/Sebastian Liste

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