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Time to build back equal in global health leadership

By guest contributors Roopa Dhatt, Ann Keeling and Rachel Thompson (Women in Global Health)

This is part 2 of a two-part series written by contributors from Women in Global Health. You can read part 1 here.

Globally, women hold around 70% of health worker jobs, over 80% of nursing and over 90% of midwifery roles and deliver the majority of unpaid care and domestic work in families and communities. Yet at the start of the COVID-19 pandemic in 2020 women held only 25% of leadership roles in global health. This global situation is experienced as a day-to-day reality for women health workers around the world. In the first part of this blog, our colleagues from India, Kenya and Nigeria described the findings of a new policy report: The State of Women and Leadership in Global Health. We now look at the implications of this new research, and outline the actions needed to end what we call the ‘male bonus syndrome’, where the career of male health workers benefit from women being handicapped by rules and policies because they were designed for men.  

Global commitments towards gender equality, including the Sustainable Development Goals (SDGs) build on Conventions and agreements dating back over 70 years. However, our research confirmed that these commitments are not being implemented fast enough or with enough accountability at national level. WGH’s research on trends over time predicts that some countries may take over 100 years to reach gender parity in their WHA delegations, if current trends continue.  The gender imbalance in health leadership will not change fast enough with time alone. Nor will the wider issues around lack of diversity in global health leadership change without intentional action, for example to support women community health workers who are typically excluded from formal leadership opportunities.

Women in our research, however, are asking for more than simply policy measures that enable them to work more easily within existing gendered roles. They are asking for gender transformative policies measures, for example, family friendly policies that will intentionally, enable more equal sharing of work and childcare between men and women so that both can fulfil their potential at work.

In our report we describe a framework for action including seven recommendations: 

Action area  Recommendations
Enable diverse women to leadCreate tailored leadership opportunities for women from marginalized backgrounds who may have missed out on formal education and qualifications. Recognize and reward women who are leading in their communities informally and providing opportunities for advancing into formalized career pathways.   
Fast track actions to redress gender inequality in global health leadershipPromote gender quotas and all-women shortlists, particularly for senior global health leadership roles that have never been held by a woman. Intentional, collective action by global organizations, especially to increase representation of the many talented and qualified women from the Global South.
Increase the visibility of women working in healthCivil society and women’s professional networks, including WGH, can support potential women leaders by creating lists and databases of women in health.   
Mobilize men to lean out and step up as allies, and end ‘male bonus syndrome’Educate men and boys: include gender equality as a subject in school curricula and training in workplaces. Normalize paternity leave and other family friendly policies that shift gender norms to share the burden of care work equally between women and men.  
End the ‘default man’ biasImplement organizational policies to drive gender equality including parental leave for all parents and paid maternity leave and job security for women.Establish legal frameworks to ensure zero discrimination against women in the workplace, including protection for women from losing their jobs as a result of pregnancy or motherhood. Flexible working options for all parents and carers, to enable women to return to work after having a child. Safe spaces for lactating mothers, recognizing that the default woman worker, unlike the default man, may need support for breastfeeding, as well as personal protective equipment (PPE) that allows for management of menstruation and menopause. Strong legislation for addressing sexual harassment in employment with accountability measures to ensure enforcement.
Support women’s movements to accelerate collective actionDonors should provide targeted funding in support of women’s organizations, both for national and cross-border movements, and support the establishment of networks for women and allies, recognizing them as essential contributors to health for all.Employers should promote peer support networks among women at all levels and for women from all backgrounds.Laws should support trades unions and collective bargaining in line with global conventions and best practice.
Deepen understanding and the evidence base for policy with more research and data.All future research should take an intersectional approach, starting by generating more disaggregated data to understand the way different disadvantages intersect with sex and gender identity in different contexts and manifest in leadership journeys.  Governments should collect and publish sex-disaggregated data on health leadership at all levels, and among different cadres. Further country studies to document and compare the state of women in health leadership in more countries. Implementation research to explore why policies are not working for women and to identify gaps e.g. on issues such as management of menstruation, menopause and breastfeeding, for further action.Targeted research with men to understand why bias persists and how to effectively communicate the need for gender transformative leadership and to mobilize allyship more effectively. Continue to build the evidence base on how sexual exploitation, abuse and harassment adversely impacts women and leadership.Collect data and strengthen the evidence to build a robust business case for gender equality as a sound investment in health as part of realizing the ‘triple gender dividend’.

Women working in health are being denied their right to equal leadership, while health systems are being denied the expertise of leaders who know them best. The answer is not to ‘fix women’ to fit into workplace systems and cultures that favor men for leadership but to fix the systemic bias that creates barriers for women. Without urgent action, another generation of women in the health sector will be disadvantaged in their careers.

Enabling women to access health leadership equally will also increase the morale and reduce attrition amongst women health workers. Finally, gender equal leadership in health will have a “gender triple dividend”: a health dividend strengthening health systems’ decision making and aiding recruitment and retention; a gender dividend since women will gain both income and agency; and an economic dividend since stronger health systems and new health jobs created and filled will drive economic growth. The findings from our research have provided us with a renewed energy and call to arms: it is time to build back equal in global health leadership.

PLOS Global Public Health welcomes submissions in Gender and Health, Global Health Delivery, Policy and Finance, and more. You can learn about our entire scope here, and you can submit your original research today.

About the authors:

Dr. Roopa Dhatt is the Executive Director and Co-founder of Women in Global Health. Dr. Dhatt is a passionate advocate for gender equality in global health and a leading voice in the movement to correct the gender imbalance in global health leadership. She is also a practicing Internal Medicine physician at Georgetown University Hospital in Washington, D.C, and has faculty appointments as an Assistant Professor at Georgetown University and the University of Miami.

Ann Keeling, Women in Global Health’s Senior Fellow, is a British citizen whose 40-year career in global health and social development has included posts in Pakistan, Papua New Guinea, Indonesia, the Caribbean, Belgium, the USA, and her home country, the UK. She held the post of Head of Gender Equality Policy with the UK Government and is currently the Chair of the NGO Age International and Senior Fellow of Women in Global Health. Ann Keeling has been CEO of two global health NGOs, was UNFPA Country Representative Pakistan, and Director Commonwealth Secretariat leading on Health, Education, and Gender.

Rachel Thompson, Women in Global Health Policy and Research Associate, has over a decade of experience across humanitarian, global health, and development sectors. She has worked with the Red Cross Movement and several NGOs in program roles across Africa and Asia. More recently Rachel has returned to the UK where she has worked as a researcher at Chatham House and as a policy advisor at the World Obesity Federation. With Women in Global Health, Rachel has led several research projects, including most recently The State of Women and Leadership in Global Health.

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.

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