Advancing health labour market data, analysis and tracking: The Importance of Gender-Disaggregated D

The 3rd annual World Health Worker Week was held April 2-8, 2017. In celebration of this event, Women in Global Health reflected on the High-Level Ministerial Meeting we attended in December 2016. This meeting was hosted jointly by the International Labour Organization (ILO), Organisation for Economic Co-operation and Development (OECD), and the World Health Organization (WHO), and responded to the request of the High-Level Commission on Health Employment and Economic Growth to convene stakeholders before the end of 2016 to agree on a five-year action plan to implement the Commission’s recommendations.

Gender disaggregated data in the health workforce is essential. Such data can contribute to more effective health workforce investments and better understanding and policy action to address gender inequities in education, employment, unpaid care work, informal work and pay gaps. We know that 67%, and in some settings nearly 90% of the health workforce is comprised of women, but at the leadership levels the numbers are grim and this clearly reveals that a gender lens is needed to understand the forces at work.

Question: How could the timely availability, completeness and quality of health workforce data be improved?

Data on the health workforce is not only important for monitoring progress, but it is crucial to the design, analysis and evaluation process of any health vision- from the sustainable development goals, health systems strengthening and resilience to universal health coverage.

QUALITY data which is timely, accessible, usable, context specific, complete and includes intersectionality, such as gender, and other background related information, such as background, ethnicity, class, sector, religion, and other differences, including power and privilege components on the health workforce is both TANGIBLE and a CROSSCUTTING measure of the world’s ability to address health challenges and reach all people that we must realize. Investing in the data is not an add on to one’s commitment to the health workforce, but essential.

When talking about the health workforce, we cannot neglect the gendered components which are some of the drivers to the challenges facing health worldwide.

So we pose two questions:

1. Who is involved in data gathering and how does that impact the health workforce?

A few groups (The US government and DHS) are responsible for the production of a major proportion of data worldwide. Many governments and their civil servants do not have the resources: skills/time/money. There needs to be greater innovation and scale up in national/community/local ownership of data generation.

This includes WOMEN being part of driving the data revolution--from measurement to implementation of solutions. The World Economic Forum report -the Future of Jobs, emphasized the impact of the fourth industrial revolution and have emphasized there is a gender gap dimension, as the growth of new and emerging roles in computer, technology and engineering-related fields is outpacing the rate at which women are currently entering those types of jobs—putting them at risk of missing out on tomorrow’s best job opportunities and aggravating hiring processes due to a more restricted talent pool” [1].

What is concerning, in this survey, the perception of the health sector to target women’s talent as key in future workforce strategy to be only 17% (Chief Human Resources and Strategy Officers from 371 employers) [2]. Granted this survey has limitations, it still reveals a neglected area. Given the gender dimensions of the health workforce, hopefully this number is not reflective of the reality as we invest in health workers and when we invest in the health workforce, we must invest in all genders, as we have heard from many today and the High-Level commission's action plan.

2. Second, what data is gathered?

Data collection for the SDGs is allowing us to design new processes, we can measure from ground up and make sure the collection is equal and diverse as possible. There is also opportunity to ensure that the data that is being collected is gender sensitive and responsive. Looking at Gender disaggregated data in health workforce highlights discrepancies and opportunities. Gender data is needed to make women more visible and to make good policy [3].

Women play a vital role in the advancement of health. Their contribution to health systems is monumental-in some countries women comprise at least 67%* OECD (75%) of the health workforce, yet on the average they occupy less of the leadership roles [4]. Majority of their work is either underpaid or unpaid, leaving women with few opportunities for advancement or to care for their own health. This creates an inequitable health system that impacts the the health of all. Moreover, recent studies from McKinsey estimate that achieving gender parity would be worth around $28 trillion to the global economy, an increase of 26% [5]. The Lancet Women and Health commission revealed, that in health, women are contributing around $3 trillion to global health care, but nearly half of this (2.35% of global GDP) is unpaid and unrecognized [6]. This untapped potential in the health workforce is massive from a rights and economic perspective, yet when we want to analyze what is happening in a context specific manner, the data is practically non-existent.

We need data which can give us insight in how do the gender norms of a particular setting impact the health workforce? the responsiveness and resilience of a health system?

We should be also considering the disaggregated nature of the data--going further to understand the complexities facing the health workforce in a context specific manner. Gender is one of the blind spots, however, we should include inter-sectional dimensions in the data collected (background, ethnicity, class, sector, religion, and other differences) which means not only focusing on some- but it is about everyone, about understanding privileges and disadvantages to understand and address inequalities that drive poverty. We are glad to see the High Level Commission factor these aspects in their strategies and action plan.

Finally, numbers only tell part of the story, qualitative data is essential, not optional. In the action plan, in the key strategic phases there is explicit mention of “Analysis to identify strengths, weaknesses, failures and underlying causes to inform context-specific national health workforce strategies and investments.” - this is a great example of where more qualitative data on gender and its impact on the health workforce can be gathered.

In Summary:

  • More attention is being paid to the need for health workforce data to be disaggregated by gender. Data should also include qualitative, life course info to understand the gaps and barriers to achieving leadership positions.

  • This will allow researchers to understand patterns in health workforce practices, and allow for the development of inclusive, gender transformative policies to increase women's role in leadership positions

Question: The success of the Commission’s recommendations and strategic actions will be measurable by the extent to which progress is achieved on SDGs 3, 4, 5 and 8. How can we best align our efforts on health labour market data to strengthen or establish metrics and data systems for SDG indicators?

When we think about our efforts on data in health labour market, we need to approach it through innovation & a partnership model.

There needs to be real time innovations and solutions that are both high tech and low tech that allow for on the ground input and feedback into data which will allow data to be generated by the communities it comes from.

Partnerships includes identifying efforts to create measurement systems for the SDGs, such as those mapped by the UN Data revolution project. A great example is Data2x (Data2X is led by the UN Foundation with support from the William and Flora Hewlett Foundation and the Bill & Melinda Gates Foundation). Through Gender Data Partnerships, technical advisors, and Expert Group, Data2X works with a variety of countries, United Nations agencies, non-governmental organizations, regional bodies, and private sector partners to monitor progress on gender equality. There are several such groups across sectors-- from academia to non-profits to private sector who are measuring aspects of this data that we need to coordinate with.

Women in Global Health is seeking data in global health from a leadership angle, encouraging mapping of leadership at all levels through a life course approach through a gender lens in global health and health workforce. We are also advocating for greater qualitative understanding of how/why women are not advancing to leadership roles, why are they not empowered, etc what are the barriers, what are the solutions that work in a context specific manner.

“Sex-disaggregated supply-side data is also the cornerstone of the business case for banks to serve women — the building of which could prove catalytic in closing the financial inclusion gender gap. The GBA and its members have made great strides in this area, producing data that enables bank managers to understand that if women are served well they are very good customers. If all banks were to report sex disaggregated data on their customers, we would not only have national-level datasets that measure how close we are to women’s full financial inclusion, but the numbers would demonstrate a clear business case for serving women.” While this is about financial inclusion of women -but wondering if a similar argument could be used for improving women’s (and men’s) interactions and outcomes with the health system and using that data to improve the delivery of services with a more responsive health system.

In Summary:

  • International organizations should work collaboratively with partner groups to develop a set of indicators and metrics for evaluation using a gender transformative approach and innovation that are both low and high tech.

  • Data should be both quantitative and qualitative in nature, including life stories of women throughout the life course, and disaggregated by gender.

  • Data should be collected on both the hiring practices of health workforce and on the roles that women are encouraged to pursue within the health workforce

  • Data should also be collected on the pay rates of different health professions to understand bias, and establish patterns. Of particular interest might be how pay rates change as high numbers of women enter certain fields, and if there are biases associated with changing gender roles.

The High-Level Ministerial Meeting in December 2016 was hosted jointly by the International Labour Organization (ILO), Organisation for Economic Co-operation and Development (OECD), and the World Health Organization (WHO), and responded to the request of the High-Level Commission on Health Employment and Economic Growth to convene stakeholders before the end of 2016 to agree on a five-year action plan to implement the Commission’s recommendations.

The ILO, OECD and WHO have developed the present five-year action plan (attached) that sets out how the three agencies in partnership with their constituents and other multilateral organizations can support their member states as they implement the ten recommendations. Member States and relevant stakeholders are invited to review and provide inputs to the finalization of this action plan through a consultative process that will be launched at the High-Level Ministerial Meeting on Health Employment and Economic Growth.

This consultative process sought ideas and inputs for the proposed action plan deliverables and indicators. It also informed further development of targets, timeframes, and partnerships. Following the High-Level Ministerial Meeting, the three agencies organizes individual consultations with member States through the Permanent Missions in Geneva, discussed with constituents in ILO’s and WHO’s governance structures, consulted with respective regional offices, a public consultation online, and bilateral meetings and consultations with all relevant international and regional organizations, development partners as well as concerned global initiatives. The consultative process informed a final version of the action plan, which was be made available in March 2017 and will be discussed at the 70th World Health Assembly.

This meeting brought together governments, including the ministers of education, finance, health, labour and foreign affairs; employers, health worker associations and unions, civil society, global initiatives, agencies and multilateral organizations, regional organizations, financing institutions and the private sector engaged in health, education, youth, gender equality, decent work, and inclusive economic growth. We encourage the use of social media to continue this discussion through the use of #InvestInHealthWorkers and #ComHEEG.

[1] World Economic Forum report -the Future of Jobs.

[2] World Economic Forum report -the Future of Jobs.

[3] http://www.undatarevolution.org/2014/12/15/gender-data-revolution/

[4] OECD Estiamtes in 2016.

[5] McKinsey.

[6] Lancet Women and Health Commissions.

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