The role of women's leadership and gender equity in leadership and health system strengthening

Abstract

Gender equity is imperative to the attainment of healthy lives and wellbeing of all, and promoting gender equity in leadership in the health sector is an important part of this endeavour. This empirical research examines gender and leadership in the health sector, pooling learning from three complementary data sources: literature review, quantitative analysis of gender and leadership positions in global health organisations and qualitative life histories with health workers in Cambodia, Kenya and Zimbabwe. The findings highlight gender biases in leadership in global health, with women underrepresented. Gender roles, relations, norms and expectations shape progression and leadership at multiple levels. Increasing women's leadership within global health is an opportunity to further health system resilience and system responsiveness. We conclude with an agenda and tangible next steps of action for promoting women's leadership in health as a means to promote the global goals of achieving gender equity.

Promoting equity in maternal, newborn and child health – how does gender factor in? Perceptions of public servants in the Ethiopian health sector

“…Gender responsive budgeting in health [32] Allocation of resources to address gender inequality in health Developing gender responsive budget guidelines to meet the particular health needs of men and women [15] Health workforce initiatives [9,10] Provide gender training and more female employment opportunities within the health sector at all levels The Health Extension Program established an all-female cadre of community-based health workers (Health Extension Workers) to provide basic service delivery and health education [16] Rights based [17] Enshrine gender equality as part of human rights guaranteed by the state Improve the visibility, access and quality of women-specific health services…”

“…The pathways towards such a transition vary considerably (Table 1). While some approaches prioritize alleviating men-women differences in health outcomes or service use [7], others promote women's health agendas [8], address health workforce disparities [9,10], or redefine gender norms through women's empowerment [11]. Gender-based assessments and evaluations of programs and policies, and gender mainstreaming efforts [12] interventions in their own rightremain integral to the advancement of gender equality.…”

Key Considerations for Accountability and Gender in Health Systems in Low- and Middle-Income Countries

“…In contrast to work on accountability, literature on gender and health systems critically analyses how gender roles and relations shape the experiences and room for manoeuvre of women as users, as community members, as low-level employees of the health system and, occasionally, as senior leaders (Percival et al 2014;Dhatt et al 2017;Morgan et al 2016;Theobald et al 2017), although this is not always linked to discussions on accountability. This research and literature calls attention to three characteristics of health systems: firstly, that the health system is itself a 'gendered structure', in which important policy actors are mainly male; secondly, that men do not tend to prioritise women's health issues; and thirdly, that women actors, in the levels of interaction identified by Brinkerhoff and Bossert above, experience issues and challenges -often ignored by the health system -which their male counterparts do not (Hulton et al 2014;Pendleton et al 2015), and largely feminised cadres often have less power and influence.…”

“…This research and literature calls attention to three characteristics of health systems: firstly, that the health system is itself a 'gendered structure', in which important policy actors are mainly male; secondly, that men do not tend to prioritise women's health issues; and thirdly, that women actors, in the levels of interaction identified by Brinkerhoff and Bossert above, experience issues and challenges -often ignored by the health system -which their male counterparts do not (Hulton et al 2014;Pendleton et al 2015), and largely feminised cadres often have less power and influence. Even when women policy actors do achieve levels of seniority, they still tend to have less power than their male colleagues and to be allocated less prestigious, 'softer', feminine ministries (environment, women, family, education, and even health) as opposed to the masculine, prestigious areas of finance and defencewhere decisions about funding are ultimately made (Paxton and Hughes 2017;Dhatt et al 2017).…”

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“…In contrast to work on accountability, literature on gender and health systems critically analyses how gender roles and relations shape the experiences and room for manoeuvre of women as users, as community members, as low-level employees of the health system and, occasionally, as senior leaders (Percival et al 2014;Dhatt et al 2017;Morgan et al 2016;Theobald et al 2017), although this is not always linked to discussions on accountability. This research and literature calls attention to three characteristics of health systems: firstly, that the health system is itself a 'gendered structure', in which important policy actors are mainly male; secondly, that men do not tend to prioritise women's health issues; and thirdly, that women actors, in the levels of interaction identified by Brinkerhoff and Bossert above, experience issues and challenges -often ignored by the health system -which their male counterparts do not (Hulton et al 2014;Pendleton et al 2015), and largely feminised cadres often have less power and influence.…”