The State of the World for women in health: Pushing back under the weight of unsustainable burdens

Dr Roopa Dhatt, Executive Director and co-founder of Women in Global Health

As we enter the fourth year since the start of the COVID-19 pandemic, we asked women health workers from across our global movement how they are experiencing their vital roles in delivering health, at this moment in 2024. We had reason to do it, knowing from our recent Great Resignation report that women health workers everywhere are saying no to the astonishing sacrifices being demanded of them – and leaving the profession in high numbers.

What came back is an inspiring set of personal accounts, from reflections on inequities in leadership, unsustainable burdens, the mental toll of being a healthcare worker and staying determined on the frontline of conflict. These extraordinary women are ringing the alarm on the injustices that put our health systems at risk, but they are also our reason to be hopeful. Their leadership is exactly what is needed for us to achieve the outcomes we aspire to, for women and health systems alike.

Patricia Maritim, Zambia

As a Kenyan-born health researcher in Lusaka, I think about what constitutes good leadership often. As Rochelle Burgess writes, when you are from the Global South you develop an understanding of power, “as somebody whose body has felt its unrelenting effects and consequences from the time you come into this world.”

Gender transformative leadership creates room to think differently about power. It destabilizes existing logics of who is defined as a leader, whose work is considered meaningful, who gets paid. It challenges gendered institutions, the structures of oppression which Audre Lorde describes as, “the mockeries of separation that have been imposed upon us and which we often accept as our own.” I like its focus on productive power at individual and systemic levels, using strategies that won’t have us waiting over 100 years to live in a gender equal society. It forces us to look at the resources we have (often so limited) and use them to change our collective experience.

Rooting my own leadership practice in African feminist principles is the most natural approach. I have built peer support networks rooted in critical pedagogy to navigate African academia via journal clubs, writing groups and peer mentorship. I am also pushing for gender equity through facilitated discussion on gender transformative leadership, including CPHIA. I am excited at what the future holds for us.

Maria Emilia Caro, Argentina

In Argentina, we are at a pivotal moment of economic and political volatility. This setting underscores a remarkable demographic shift: over 85% of new entrants in medical schools and more than 70% of healthcare professionals are women. This doesn’t sadly translate into leadership roles.

Worse still, the experience of leaders like me shows that challenging times often lead to women being offered leadership roles in less desirable or more precarious situations – the so-called ‘glass cliffs.’ These positions offer the chance to make a significant impact, but carry the risk of career setbacks. While we step into these roles driven by a commitment to positive change, they are not ideal circumstances for long-term leadership growth. An equitable approach in offering leadership opportunities, recognizes women not just as interim solutions in times of crisis, but as valued leaders, steering through both challenges and stability.

Women leaders like myself will drive necessary reforms and contribute our unique perspectives. We will fundamentally transform the future of healthcare, ensuring it values the strengths inherent in women’s leadership.

Dr Duha Shellah, Palestine

I never wanted to lead, but I found myself leading. As a little girl, I aspired, dreamed to be a scientist helping people by discoveries, innovation and research, but dreams do not always align with your context. I grew up in a challenging context. Being a young female leader in a conflict setting is a heavy burden. You have to face the challenges all women have to face: unequal opportunities, less recognition, labeling, and competition. On top of that you must survive in a conflict zone. Planning activities everyday knowing that circumstances might force you to cancel.

Emerging women leaders in health and science have no supporting environment nor infrastructure to build on, nor possibilities for personal development or recognition. Amid war, you focus on surviving, the mind is too distracted to work, write or plan the future. But, when you are passionate, determined about what you do, with a visionary picture of what the end result of your battle would be, you never stop nor get tired. The inner cause fuels you, and keeps you alive.

“Are you willing to live for a cause?”

Dr Pura Angela Wee-Co, Philippines

I am a healthcare worker. I am also a daughter, a wife and a mother. 

The pandemic created additional responsibilities for me, like many others. At work, I had to be agile in adjusting systems. At home, my children had to be supported to face the stresses of the pandemic. My husband, a healthcare frontliner, contracted COVID-19 and suffered long-term effects. My mother suffered ill-health and needed my support in accessing health and other types of care. 

I am privileged to get support at work and at home. For others in my country and globally, systems are lacking in terms of fair pay and support. In the Philippines, baranggay health workers are key to primary healthcare, but their stipend is minimal. A new law will provide additional compensation and benefits. In the meantime, nurses in and outside of the country face poor working conditions, amidst additional workload and insufficient pay. 

Women in Global Health Philippines want platforms in place to discuss these issues. In 2023, we were privileged to speak at the 74th Regional Committee Meeting hosted by the WHO-Western Pacific Regional Office on the plight of women healthcare workers during the pandemic. After the meeting, a fellow woman healthcare worker came up to us and said, “Thank you for shedding light to what many of us experienced.” 

Dr Olga Wdowiczak, Poland

As a fifth-year medical student, I witnessed firsthand the devastation and trauma the COVID-19 pandemic inflicted on patients and healthcare workers. After almost a year of restricted access to hands-on medical training, my internship in the ICU of a hospital in western Poland coincided with the highest daily increase in COVID-19 cases since the beginning of the pandemic. Watching the hospital units shut down one by one to accommodate the growing number of patients, limited access to life-saving therapies, and the high mortality rate among ICU patients weighed heavily on me. The mental toll was immense and felt disproportionate to responsibilities. Anxiety, nightmares, and guilt of not being able to handle the stress, became my constant companions. A feeling that came in waves for six years of medical school and further intensified during my clerkship year, and left me wondering if this is a constant in the life of a physician.

Studies show that the prevalence of mental health issues among female physicians, particularly depression, anxiety, and sleep disturbances, is staggering. COVID-19 further exacerbated psychological distress in women and younger healthcare workers^[1].^[2] The stigma and fear around the mental health and well-being of medical staff often keep them away from seeking professional help or reaching out for peer support^[3]. 

I vividly remember a question asked by a female doctor online whose struggles made her resign from her clinical career amidst the pandemic. “Should women go above and beyond to deliver health at the cost of their own?” 

Dr Somia Iqtadar, Pakistan

My healthcare leadership journey required resilience, as well as mentorship from both male and female colleagues, opening avenues for expanding expertise. My experience has taught me that balancing familial duties as a woman and mother demands policy reforms to ensure women can have a fair share of leadership.

Pakistan is ranked 142 out of146 countries on the global gender gap 2023, where women constitute 80% of medical school graduates, less than 5% occupy senior healthcare roles. This mirrors a global trend. Addressing this requires flexible working arrangements, mentorship programs, and robust anti-harassment policies.

My journey heading the Department of Medicine at King Edward Medical University; serving as the founder Secretary General of the Pakistan Society of Internal Medicine; chairing the Dengue Expert Advisory Group and an advisory board member of Women in Global Health Pakistan Chapter, mirrors the experiences of many women in healthcare. In order to mentor the next generation of aspiring female leaders in healthcare, I brought the Global Women Leaders program to Pakistan in collaboration with the Royal College of Physicians London. It remains imperative for the healthcare community to support and foster the development of future female leaders, ensuring their successful navigation towards leadership roles.

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[1] https://www.frontiersin.org/articles/10.3389/fgwh.2021.614723/full#:~:text=Moreover%2C%20with%20regards%20to%20the,colleagues%20(3%2C%208).

[2] https://www.bmj.com/content/369/bmj.m1642

[3] https://www.frontiersin.org/articles/10.3389/fpubh.2021.679397/full