In most countries across the world, women comprise more than 65% or more of the workforce, but they remain underrepresented in management and leadership roles. Perhaps the fact that the workforce is predominantly women has made it easy to overlook the fact that, in general, women deliver health and men lead it. Even in global health, the sub-sector I am more familiar with, men head 69% of international health organizations, and 80% of board chairs are men.
In Africa, as we watched the horrors of the 2014-2016 Ebola virus outbreak in West Africa unfold and the risks taken by many frontline workers, the majority of whom were women, I wonder what a woman-led response would look like?
When nursing staff work night duty in unsafe areas in countries like South Africa, would different plans be put in place to safeguard their safety if the leadership were predominantly women? I also often reflect on the design of numerous public health facilities which women in Africa largely attend. Still, there are no thoughts about women’s privacy or their dignity, where it is not unusual to find a room full of women half naked waiting for gynecological examinations. From what I have seen, no thought goes into the users’ needs besides separate toilets for men and women.
I would like to believe that systematically increasing the number of women in leadership roles in the health sector would begin to address some of these gaps. However, it shouldn’t just be a question of quotas but intentional and transformative leadership to address the disparities in the workforce and how health systems across the world treat women.
In Africa, we still have appalling maternal mortality rates, particularly in rural areas where there are simply no facilities equipped to provide emergency obstetric care. At best, the only care available in the event of an emergency is alone midwife, usually a young woman with no back-up and no ambulance to enable the transfer of the patient. The midwife invariably earns the ire of the family and the community and sometimes even the public health leadership when the outcomes are adverse for the mother.
It is no surprise that almost half of all global maternal fatalities from pregnancy-related complications are estimated to occur in Sub-Saharan Africa. While studies have shown that higher levels of education among women in a country are associated with lower levels of maternal mortality affecting the demand side, there is little in the way of interventions on the supply side to address how services are delivered.
From my point of view, we can contribute by preparing women in healthcare for leadership roles with some elements offered in the MBA in International Healthcare Management programme that I’m currently pursuing at Frankfurt School.
In resource-constrained environments, there are limited opportunities to attract additional resources to healthcare. Still, strategic reallocation to areas that have the potential to yield good development outcomes for the most vulnerable members of society is something that can be done. But this depends on the leadership and its ability to take the kinds of risks and decisions they can make.