What if health were led by all?

Launch of the “Delivered by Women, Led by Men: A Gender and Equity Analysis of the Global Health Workforce”

The reality today is that global health is delivered by women and led by men. Women aret ypically segregated into lower paid and lower status jobs. While women make up 70% of the health workforce globally, they hold only 25% of leadership positions. Much of women’s work in the health sector goes unpaid (about $1.5 trillion worth) and female health workers are burdened by lack of decent work, including sexual harassment and violence; leadership opportunities; gender pay gap; and occupational segregation.

There is a pressing need to rewrite the narrative on gender equality in the health workforce in order to achieve the ambitious goals set out by the Sustainable Development Goals. Goals such as Universal Health Coverage (SDG3) require all aspects of the health workforce to contribute, it is crucial that women are included in this. The Gender Equity Hub, Co-chaired by Women in Global Health (WGH) and the World Health Organization (WHO), in the Global Health Workforce Network (GHWN) recently released a report entitled “Delivered by Women, Led by Men: A Gender and Equity Analysis of the Global Health Workforce.” Simultaneously, WHO released a working paper, “Gender Equity in the health workforce: Analysis of 104 countries”. This work seeks to illuminate the barriers - and some of the solutions - that are preventing us from achieving these global goals. This report was launched at the 63rd Commission on the Status of Women in New York, at an event hosted by the Republic of Niger, France and additional partners International Labour Organization (ILO), WHO, WGH and GHWN, where crucial space was made for intersectional perspectives that highlight the needs of the most vulnerable.

The “Delivered by Women, Led by Men” report was presented by Dr. Roopa Dhatt, a practicing physician and the Executive Director of WGH. Key recommendations include:

  • It is time to change the narrative: women form the base of the pyramid on which global health rests and should be valued as change agents of health, not victims.

  • It is time to change the narrative: It is critical to record and recognize all the work women do in health and social care—paid and unpaid—and bring unpaid health and care work into the formal labour market.

  • Gender Transformative Policies should be adopted that challenge the underlying causes of gender inequities. Instead of policies that fix women to fit into inequitable systems, we need to fix the systems to create decent work for women and close gender gaps in leadership and pay.

  • The focus of research in the global health and social workforce should be shifted to prioritize low- and middle-income countries, apply a gender and intersectionality lens, and include sex-and gender disaggregated data.

  • A Mid-Term Review of the Working for Health Action Plan: assess progress on deliverables on gender equality and recommend steps to ensure delivery of action plan commitments by 2021.

The Working Paper: “Gender equity in the health workforce: Analysis of 104 countries" which using labour force survey data to estimate occupation segregation and gender pay gap in the health sector by WHO was presented by Dr. Werner Obermeyer, Deputy Executive Director of the ​World Health Organization,​ Office at the United Nations. Policy considerations include:

  • Gender Pay Gap remains 11% even when considering “equal pay for equal work,” while total gap is 28% in the health sector.

  • Labour rights against sexual discrimination should be enforced to ensure equal remuneration for men and women for work of equal value.

  • Working conditions should address barriers to access to full time employment and decent work.

  • Occupational segregation is a driver of the gender pay gap among health workers, need to support access to professional development and leadership roles.

  • Gender transformative policy needs to go beyond gender aware and create an enabling environment.

130 attendees joined to hear from community voices, including health and social workers, and a broad range of speakers that provide multilateral, technical, governmental and NGO perspectives. A discussion moderated by Ann Keeling, Senior Fellow at WGH, highlighted necessary changes to be made in both high, low, and middle income countries –calling for gender equality to be everyone’s business. Here are my key takeaways from the report, working paper and its launch event:

Partners in Health (Haiti)

In Haiti we have learned a crucial lesson that gender equality has to be sewn in at the very inception of a revitalized health system, otherwise inequities that persist elsewhere will perpetuate. Ermaze Louis Pierre, OVC/GBV program manager, Zanmi Lasante/Partners In Health, encouraged us to consider that as low-and middle-income countries develop new health systems, there is a great opportunity to rewrite the narrative on gender roles in the health workforce, since many positions are being codified and formalized now. She calls for more parent engagement in modeling gender-equal behavior at home, ensuring that gender roles are not set in stone before children can even speak.

France

Anne Guéguen, Deputy Permanent Representative of France to the United Nations, spoke about the situation in France, where the entrenchment of men as assumed leaders, like in other countries, is often considered the status quo. Her own mother did not take the high-level medical exam because she was told she would be taking the spot of a man. While matters are improving in France, employers may still view women as less flexible or adaptable to their assumed domestic tasks. She cited a need for a societal shift to a more equal sharing of domestic tasks between women and men to enable equal working opportunities.

Niger

Mrs Mariama Chipkaou, Director of the Promotion of Girls' Schooling at the Ministry of Primary Education, Girls in Niger, for various reasons, sometimes end up leaving school well before they have completed their education. While interventions to keep girls in school are critical, says Mariama, more needs to be done to remove the barriers to re-enrollment. Girls stay out of school when they are not allowed to come back, reducing or changing their career options and keeping rates of girls’ graduation low. She urged attention at the supply side, and called for a renewed effort to support girls’ education to address inequities before the employment level.

Nursing Now (Canada)

Canada has demonstrated evidence of the positive outcomes of gender equal leadership in several sectors. Sarah Walji, a Registered Nurse and Nursing Now Young Board Member, urged us to complement women’s leadership initiatives with the creation of more, and varied, opportunities for young women. The development of the health sector opens up the door to catalyzing change for young women just entering the workforce. Providing young people with decent work, including gender-equal workplaces, could have cascading effects on the social and cultural norms that dictate women’s roles for decades to come.

ILO

Vinicius Pinheiro, Special Representative to the UN and Director of the International Labour Organization Office for the United Nations gave us an inter-sectoral perspective alongside the international views. He reminded us that while many jobs are threatened by the rising rate of automation - like manufacturing and construction - health is not. We will continue to need the “human touch” when people need care and treatment. The global health sector may not need to be concerned that jobs will be displaced, but it does mean that men will soon be looking to health for guaranteed work. Implementing policies to achieve gender equality in the health workforce now is critical, before the opportunity evades us.

WHO

Michelle McIsaac, Labour Economist at the WHO, emphasized the importance of gender transformative action and working with other sectors to root out the gender inequities that are challenging the health workforce. Gender transformative policy action including education, labour, wage and social protection policies and strong labour rights, in particular, can help redress persistent gender inequalities in the health and social sectors.

The diversity of perspectives shared at the report launch illustrates the importance of intersectional representation. We are able to see how issues of male dominance and unequal pay are both global and widespread, and therefore require a global and wide-ranging response that transcends the health sector. Best practice and lessons learned should be shared across sectors- such as the need to foster girls’ reintroduction to school - and see how a return to work after pregnancy or childcare needs to be normalized too. We can hear from young people facing mounting debt, stagnant wages, and declining social welfare on top of the issues covered in the report and realize that we must develop policies specific to the needs of youth. And we can hear from men (a group rarely present at events on gender equality) about the need to find ways to make men feel like stakeholders in this movement.

As Walji said, “If we don’t hear from the invisible, how can we integrate these perspectives?” This report goes a long way toward making what has long been invisible – whispered about in hushed tones – visible. It is a testament to what is possible when everyone is given a seat at the table. Right now, we can only imagine a world where such integration is the norm. We must continue to use our platforms to push so we can realize a world where health is delivered by all and led together.

In closing, Dhatt called for gender transformative action at all levels, including valuing and investing in women in the health and social workforce such that Women Deliver Health and Lead it! We can achieve the Triple Gender Dividend: health, gender equality, and development and economic growth.

Join the Gender Equity Hub, co-hosted by Women in Global Health and the World Health Organization to engage in the next phase of gender transformative policy action. The hub has many organizational and individual members, including Frontline Health Workers Coalition and IntraHealth International.

Additional info:

Watch the launch of the report

Key messages and recommendations can be found here.

Report and Working Paper is available on the Human Resources for Health (HRH) home page: https://www.who.int/hrh/en/

WHO corporate feature story: https://www.who.int/news-room/feature-stories/detail/10-key-issues-in-ensuring-gender-equity-in-the-global-health-workforce

Director General of the WHO commentary piece: https://www.who.int/news-room/commentaries

Gender Equity Calendar of Events can be found here.

Join the hub: https://www.womeningh.org/gender-equity-hub and info@womeningh.org.

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