Women make up 70% of the healthcare workforce but continue to be led by men. What is stopping more women from becoming global health leaders?
MSI Reproductive Choices Africa runs ‘women in leadership’ programmes that empower women to take up leadership roles.
Photo: MSI Reproductive Choices Africa
Healthcare remains stubbornly a sector delivered mainly by women but led by men, according to a 2019 World Health Organisation (WHO) report. Even when women run health systems, the report shows, they “do not have an equal say with men in their design and delivery”.
These issues have been addressed more recently by Global Health 50/50’s 2021 report Gender Equality: Flying blind in a time of crisis, which concludes that “gender norms continue to determine career trajectories in global health”. Although the health sector ought to lead in justice and fairness, the authors say, “male privilege pervades, and is compounded by geographical under-representation”.
Indeed, in Global Health 50/50’s sample, just 5% of global health leaders were women from low- and middle-income countries (LMICs). “We did not see representative diversity in global health leadership, or sufficient attention from organisations to address this,” say the report’s authors.
As Sapna Kedia, assistant director for gender and social development at the International Center for Research on Women (ICRW), explains: “A lot of health policies focus on women’s health—how will we know what women need and what is working and what isn’t if women don’t have a seat at the table?”
"Quotas are not the complete solution—you need an environment with gender training, supportive colleagues, implementation and monitoring of policies, and informal supportive groups and practices."
Barriers to leadership begin in childhood
In India, on average, just 28% of leadership roles in national healthcare organisations are held by women, according to research by Women in Global Health. The exception is the Nursing Council, which has a majority of female members and women in 75% of the leadership roles.
New research by ICRW probes deeper into the barriers Indian women face in advancing their careers in healthcare organisations. While the analysis is still underway, the results are likely to confirm that gender inequality in healthcare leadership in India remains a huge problem.
ICRW’s study shows that gender barriers to leadership start in childhood when girls are told they are inferior to boys, which impacts their self-confidence and self-belief; they are entrusted with unpaid care work at home, which impedes their ability to work outside the home. “There are many other issues, too, such as access to education, safe travel, and healthcare,” Kedia says.
For women who secure an education and career that may lead to healthcare leadership positions, a newer set of barriers often emerges, mostly related to assumptions about motherhood, Kedia explains. “Although women are entitled to 26 weeks’ paid maternity leave, organisations can have hiring biases against newly married or pregnant women,” she says. “While this is governed by norms around women’s role in society, the lack of, or limited funds within an organisation also fuels such practices.”
She says employers need additional money to fund maternity leave, not least because “the laws only apply to those on the payroll and not those who work part-time or on contracts”.
While quotas are often an effective way to boost the ranks of women in leadership positions, Kedia says more needs to be done to foster an inclusive environment. “Quotas are not the complete solution—you need an environment with gender training, supportive colleagues, implementation and monitoring of policies, and informal supportive groups and practices.”
ICRW’s research found that healthcare organisations rooted in global and social movements, including grassroots NGOs, were among those tackling gender inequality effectively. “Even if they don’t have formal policies in place, they have created an environment where women feel supported,” Kedia says.
But, overall, progress is slow in India. For the research, ICRW spoke to 19 organisations in the health sector, but less than half were willing to share written policies. “How are we going to collect the data and evidence to push for change?” Kedia says.
It is no different in Nepal, where a study by the Centre for Research on Environment Health and Population Activities (CREHPA) found that only 10 out of 30 (or 33%) NGOs in the country were led by women. Among international organisations based in Nepal, 23 out of 45 were headed by women, and only two of the 10 secretaries at the Ministry of Health in the past five years were women. Only 17% of organisations had a gender equality policy.
CREHPA co-director Dr Mahesh Puri says the report found major barriers to gender equality in leadership, including “deeply rooted patriarchal norms and attitudes” and the fact that policies, even when available, were not binding.
Getting women a seat at the table
Despite the challenges, a growing number of initiatives are helping elevate more women to senior global healthcare positions.
Dr Banchi Dessalegn, Africa director of the reproductive health charity MSI Reproductive Choices, says the organisation, which provides contraception and safe abortion services across 37 countries, actively supports the elevation of women to leadership positions by removing the barriers in their way. Its global board has a female majority, as do most of its Africa country programme boards.
“In the healthcare space on the African continent, but also beyond Africa, women, regardless of their socio-economic status, are among the most marginalised by the healthcare system that is supposed to work for them. Hence, in the push to create an equitable health system, it is essential to have women among the leaders redesigning these systems,” Dessalegn says.
"The number of women in our senior leadership roles has increased over the past four years to 47%. Having your colleagues and superiors cheering you on and encouraging you is so crucial when you’re aiming for leadership positions."
Towards this end, MSI Reproductive Choices Africa runs ‘women in leadership’ programmes. The initiative began in Zimbabwe in 2020 and nearly every country programme in Africa has participated in it. The workshops empower women to take up leadership roles and, as a result, the African country programmes now have more women leaders.
A key part of the women in leadership programme involves participants committing to follow up research on the external and internal barriers to female progression and identifying potential solutions and boosting opportunities for success. The findings are presented to the senior leadership team, with insights into women’s experiences and perspectives. To ensure continued engagement and learning, question-and-answer sessions are held with senior leaders.
“This is the [sort of] deliberate action that organisations need to take to make a change,” Dessalegn says. “The number of women in our senior leadership roles has increased over the past four years to 47%. Having your colleagues and superiors cheering you on and encouraging you is so crucial when you’re aiming for leadership positions.”
Committing to diversity at the top
At global public health non-profit PATH, the leadership team is 60% female, half of the board of directors is female, and 54% of all staff identify as women. To achieve these figures PATH has undertaken a number of initiatives, including appointing its first diversity and inclusion director, and devising its first diversity, equity, and inclusion strategy.
Key parts of the strategy include setting up a ‘people diversity dashboard’, regular pay equity analyses, flexible working arrangements, remote and hybrid options to help women balance work and personal responsibilities, and formation of employee resource groups that encourage women to discuss issues in the workplace.
Levis Nderitu, director of global diversity, equity, and inclusion at PATH, says inclusive practices include training recruiters and managers to recognise and guard against unconscious bias, use of gender-neutral job descriptions, and setting high standards for event sponsoring, planning, and speaking.
PATH also organises mentorship and sponsorship programmes for talent development and leadership acceleration, including for Asian, Black, and Hispanic leaders. “The programme provides tailored leadership development training suited to each participant’s specific professional needs, while leveraging PATH’s executive team influence and advocacy power to support the programme’s participants,” Nderitu says.
Likewise, at global impact firm Palladium, which operates in 90 countries, 37% of senior executive roles are held by women and 53% of all corporate senior managers are women. Prior to 2016, there were no women in the organisation’s most senior executive roles.
"A gender balance at senior leadership team and board level has a positive impact on organisational efficiency, financial stability, and the working environment."
Chief diversity officer Rosanna Duncan says leaders are held accountable for progress on equity, diversity, and inclusion KPIs (key performance indicators), with a focus on increasing diversity in candidate pools and improving staff engagement. Senior leaders’ pay is linked to progress on these KPIs, alongside a requirement to report on the progress in quarterly staff forums.
Duncan believes that one of the biggest hurdles is the perception that diversity is a bolt-on to HR, and of little strategic value to merit serious commitment. “What gets measured gets done and diversity is no exception. Improving the quality of metrics at Palladium has had a huge impact and, as data science continues to increase in popularity, more companies will choose to equip their leaders with ever more data and set more ambitious KPIs.”
An across-the-board approach
It is clear that an organisation-wide approach is key to getting more women into senior healthcare positions. The UN-backed Medicines Patent Pool (MPP), which has offices in Switzerland and India, has increased the number of women in its senior leadership team from 33% in 2017 to 50% in 2023. The board currently has five women and three men, up from a 50:50 split in 2017
An organisation-wide approach is key to getting more women into senior healthcare positions.
“A gender balance at the senior leadership team and board level has a positive impact on organisational efficiency, financial stability, and the working environment,” says head of operations and resources Jane Caldwell.
She explains that a newly hired executive director in 2018 initiated a determined, and ultimately successful, effort to improve female representation at the senior leadership team level. “There was a recognition that gender parity required a ‘whole organisation’ approach that covered policy, process, and culture in order to embed equality as a guiding, living principle at a structural and individual level.”
MPP has a specific clause in its code of ethics covering gender equity and equality, which commits to providing a workplace free of discrimination, where individuals are treated equally in respect of their rights, responsibilities, and opportunities.
In 2019, the organisation introduced a gender and diversity policy to further ensure gender parity, with targets established at every step of the recruitment process. To support equal opportunities for all employees, the policy includes a commitment to eliminating obstacles based on gender, particularly in relation to family and caring.
“MPP has a rotating gender focus group with different staff every year reviewing progress and suggesting improvements,” Caldwell says. “The annual staff survey asks whether staff agree that MPP’s commitment to gender equality is reflected in the decision-making processes, which further ensures that the improvement that MPP has made over the past few years is not lost to complacency.”
Looking more broadly across the global healthcare sector, donors who support gender equality are also exerting pressure by asking organisations to share their diversity-, equality-, and inclusion-related practices and achievements in the workplace.
Other forces of change include global advocacy groups, including Global Health 50/50 and Women in Global Health, which now has chapters in more than 40 countries. WomenLift Health, a non-profit organisation, works to accelerate the advancement of talented women into senior leadership positions by investing in mid-career professionals.
Sue Holland, MSI Reproductive Choices’ global director of people and culture, sums up the current zeitgeist when she says that as an organisation that supports the reproductive health and choices of millions of women around the world, MSI wants its leadership teams to represent the clients and communities it serves. “We’d like women to be making decisions that affect women.”
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