WHS 2019: Gender Equality within the Global Health Workforce
The health sector is a major employer of women globally. But although women comprise around 70% of the global health workforce they are largely clustered into lower status, lower paid sectors and jobs, with men holding the majority of senior roles. A large percentage of female health workers in low and middle-income countries particularly, work on insecure terms and conditions, without a supportive legal and social protection framework. Against the background of a predicted shortage of 18 million health workers needed to reach Universal Health Coverage, addressing gender inequality in the health workforce will enable better use of talent and deployment of health workers, reduce attrition and generally strengthen health systems. Investing in the health and social workforce is investing in women’s economic participation and empowerment.
Significant political discussions are taking place in 2019 on the global health workforce at the September UN High Level Meeting on Universal Health Coverage (UHC), June G20 Meeting and August G7 Meeting with opportunities to address the weaknesses in health systems identified in WHO report, 'Global Health: Delivered by Women, Led by Men.' The World Health Summit, held in October, also touched on this global inequality.
Why is there a need to address gender equality within the global health workforce?
Gender is a central and cross-cutting issue for the global health workforce. The WHO report 'Global Health: Delivered by Women, Led by Men.' has shown that women build up the majority of the health and social care workforce but only hold the minority of leadership positions in this sector. In addition, nearly half of their work is unpaid or unrecognized, contributing to a gender pay gap in health care, which is largely unexplained.
But the problem exceeds the monetary aspects; workplace bias, discrimination and harassment form further barriers for women in the global health workforce, which keep them away from leadership positions. Occupational segregation might narrow job options for women compared to men and exclude them from reaching their full potential. This exclusion or underrepresentation of women distorts and creates bias between men and women which is already present.
As gender inequality is rooted in traditional cultural roles and already starts at a young age it needs to be tackled in all parts of society, including education. While the report has brought some light on this issue, there is much to be done to increase political commitments to gender equity and implement gender transformative policies within the health sector.
Political commitments to address gender and equity in the health workforce
WHO and Women in Global Health have been thought leaders in the field of gender inequities in the health workforce. The ‘Delivered by Women, Led by Men’ report, co-authored by the two organisations, laid out the available evidence on four gender dimensions of the health workforce (occupational segregation, leadership, gender pay gap, bias, discrimination and harassment), taking an intersectional lens to their analysis.
The 2016 High-Level Commission on Health Employment and Economic Growth was a milestone for health workforce development, having been established by the United Nations Secretary-General and co-chaired by the Presidents of France and South Africa (Francoise Hollande and Jacob Zuma at the time). The Commission emphasized the need to maximize women’s economic participation and foster their empowerment through institutionalizing their leadership and addressing gender biases and inequities in the health labour market.
The Political Declaration for the UN High-Level Meeting on Universal Health Coverage was approved on 23 September 2019. The document is gender-mainstreamed, as a result of concerted efforts by dedicated Member States and non-governmental advocates. The Political Declaration recognises that gender equality is both a prerequisite for and consequence of effective and equitable universal health systems. Specifically, the Political Declaration calls for gender mainstreaming when designing, implementing and monitoring all health policies. On the health workforce, the Political Declaration calls for “Provide better opportunities and working environments for women [...] addressing inequalities and eliminating biases against women, including unequal remuneration, while noting that women, who currently form 70 per cent of the health and social workforce, still often face significant barriers in taking leadership and decision-making roles”.
There are also a number of ILO conventions that cover fair treatment at work, including the Equal Remuneration Convention (No. 100), the Discrimination Convention (No. 111) and the Violence and Harassment Convention (No. 190).
What will it take to get gender transformative policy change in the health workforce?
Encouraging a whole-system change to tackle stigma, bias, discrimination, harassment and violence. Those affect all stages of labour from entry into the workforce to retainment in work, as well as horizontal occupational segregation.
Developing an inclusive form of communication and promoting gender equity within the healthcare workforce as a political buy-in from all stakeholders.
Developing Gender-sensitive policies on a national and global level which include direct and purposeful steps to address gender inequities and imbalances.
Implementing policies that are intersectional and consider all facets of identity, including race and social class, to deliver true inclusivity and diversity.
Investing in women’s economic participation and empowerment to both empower female community health workers, who perform majority of health work that will drive UHC but are often un/underpaid, and also to address vertical occupational segregation and provide access to women to whole spectrum of careers in health.
Encouraging the education system to culturally transform society via processes that have a goal to include more women in occupations that are traditionally dominated by men.
Building accountability mechanisms.
Establishing public private partnerships that will guarantee gender parity, as a large percentage of the health workforce lies in the private sector
Increasing evaluation and intervention based research to assess the effectiveness of policies in reducing gender gaps.
Addressing gender equality within the health workforce is recognizing the crucial role it plays in women's ́ economic participation and empowerment. The adoption of gender transformative approaches to addressing health workforce challenges and achieving gender equality will enable a better use of talent in healthcare workers and strengthen health systems in general. An intersectional and gender sensitive system change is needed to overcome barriers for women with regard to leadership, payment, discrimination and occupational segregation within the health workforce .
Women in Global Health
Prof. Dr. Hélène Boisjoly
Université de Montréal | Dean of Medicine | Canada
Dr. Roopa Dhatt
Women in Global Health | Executive Director | United States of America
H.E. Epsy Campbell Barr
Costa Rica | Vice President | Republic of Costa Rica
Dr. Mwenya Kasonde
Women in Global Health | Co-chair, Gender Equity Hub | Zambia
Dr. Caline Mattar
Global Health Workforce Network | Youth Hub Chair | United States of America
Dr. Charlotte Refsum
KPMG International | Global Healthcare Executive | United Kingdom
SEEK Development | Managing Director | Germany
International Labour Organization (ILO) | Senior Health Services Specialist | Switzerland