Press Release: Report exposes XX Paradox in global health: women shockingly underrepresented in leadership

Just 25% of senior health leadership positions held by women despite being 90% of the frontline health workforce

March 06, 2023  – Despite making up 90% of frontline health workers and 70% of the health workforce, women continue to be overlooked in global health leadership due to longstanding systemic bias and a widespread lack of policy implementation, fueling a crisis in the health workforce, according to a new report [ LINK TO EXEC SUMMARY].

The State of Women and Leadership in Global Health exposes the XX Paradox in global health, whereby women hold only 25% of senior leadership roles in a sector they largely deliver. Women from the Global South are particularly marginalized in health leadership. Men gain from “male bonus syndrome” because their women colleagues are advantaged by policies and organizational cultures modeled on the ‘default’ man. 

“The crisis in the health workforce: global shortages of 10 million, mass resignations, widespread migration from poor to rich countries are wreaking havoc on the majority of women who are shouldering health. What we have is a system where women have proven their expertise, but are being held back in leadership due to an unequal playing field characterized by a lack of respect, recognition and reward,” says Dr Roopa Dhatt, Executive Director of Women in Global Health, an organization that challenges power and privilege in global health. 

The analysis shows that there has been no improvement in the representation of women in global health leadership over the past five years, and experts predict that it could take up to 300 years to reach gender parity given the current lack of progress. 

The continued practice of placing women in jobs accorded lower status and lower pay is not only a violation of women’s basic human rights, but also a clear manifestation of the widespread discrimination in the health sector, the report states.  It found that women from marginalized backgrounds in particular are being left behind, recognizing that health leaders of all genders should be as diverse as the people they represent and have an equal right to leadership. 

“Women will not wait any longer. If we truly want to build health systems that serve everyone, we need to redress the inequality that has sidelined women from all backgrounds. We are calling on health leaders of all genders to take prompt action and intentionally promote gender transformative policies as the basis for strong and effective health systems,” says Dr. Dhatt.

Researchers reviewed evidence at global level drawing lessons from country case studies in Nigeria, India and Kenya. They found that women are sidelined in leadership as a result of cultural gender norms, discrimination and ineffectual policies that are not working fast enough to redress historic inequalities. The lack of a clear path from national to global leadership perpetuates the male-dominated status quo, representing a “broken pipeline” between women working in national health systems and global health leadership 

As long as men are the majority of health leaders at national level and systemic bias against women continues, the global health leadership pipeline will continue to funnel more men into positions with global decision-making power. When more diverse women are recognised and supported in leadership at national level, this will positively disrupt this status quo.  

The report strikes a positive note by acknowledging that progress towards greater equity is possible and that the health sector, employing 234 million health and care workers globally, can serve as an exemplar sector to generate learnings for the rest of the economy. It points out that collective action for gender equity can positively disrupt the systems that perpetuate men’s leadership, using innovative examples from countries such as Argentina, South America, India and the UK where affirmative action measures, such as gender quotas and all women shortlists have challenged the status quo and brought about progressive change in women’s representation in political leadership. 

Many of the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP) agencies have achieved, or are already close to achieving parity in leadership. At the national level too, more women are entering leadership positions. For example, in Kenya, 42% of mid-level leadership roles are held by women, while in Nigeria, 35% of these positions are women-led. 

The report also acknowledges that the COVID-19 pandemic has reversed progress, especially for women health workers who are burnt out and leaving their careers, but the pandemic should be treated as a break in history; a time to build back equal in global health leadership, as long as that responsibility doesn’t rest solely on the shoulders of women leaders. And though the problem may be global, the solution must be local. It is the system that must be fixed, not women, the report states.

“Men have a crucial role to play, but more actions are needed by governments and organizations. Leadership in global health is everyone’s business. Increasing female talent in health leadership will have wide benefits, enabling the expansion of the global health and social care workforce needed to achieve the SDGs and UHC, while also catalyzing the”triple gender dividend in health” to drive better health; gender equality and economic growth,” says Dr Dhatt. 

For interviews and press inquiries, contact:

Joan Bolger – Women in Global Health

e: joan.bolger@womeningh.org t: +353 85-285-6977

Ana Gutierrez – Women in Global Health

e: ana.gutierrez@womeningh.org t: +34 684 147 713

Editors notes

1. While the proportion of Fortune 500 healthcare companies led by women has increased between 2018 and 2022 (from 5% to 12%), the number of female ministers of health has decreased from 31 to 25%.
2. The proportion of World Health Assembly (WHA – the highest decision making body in health) member state delegations led by women has fallen from 27% to 23%. Previous WGH analysis reveals how 83% of delegations to the WHA over the last seven decades were composed of a majority of men, and no WHA had more than 30% of women Chief Delegates.
3. During the COVID-19 pandemic, women were excluded and even lost ground in decision-making: a WGH study in 2020 found 85% of 115 national COVID-19 task forces had majority male membership.
4. The UN reports that at the current lack of progress, it will take 140 years for women to achieve equal representation in leadership positions in the workplace.

About Women in Global Health 

Women in Global Health (WGH) is the fast-growing women-led movement demanding gender equity in global health. While women represent 70% of the workforce and about 90 percent of front-line health workers, they hold just a quarter of leadership positions. Now with supporters in more than 90 countries and 47 official chapters predominantly in low-income countries, Women in Global Health campaigns for equal representation for women in health leadership; equitable pay and ending unpaid work for women health workers; protection and safe and decent work; and the prevention of sexual exploitation, abuse and harassment. These are the essential foundations for strong health systems, Universal Health Coverage and global health security.

The organisation campaigns to address gender inequity as a systemic health care problem with grave impacts on health care delivery around the world. Its canon of evidence, such as today’s report, works to prove that decisive measures to ensure greater representation of women in global health leadership will pay off longer term in better health outcomes.