This report examines the unpaid and underpaid work done by women in health systems, asks why women take up this work, and considers the impact of that work for women, health systems, and societies. It draws on interviews with women health workers in Ethiopia, India, Malawi, Mexico, and Zambia and aims to include their diverse perspectives.

 

The COVID-19 pandemic has put health center stage globally and exposed the deep inequalities between and within countries, highlighting gender inequality between women and men. Women have made an exceptional contribution to health systems, economies, and societies from community to global levels since the start of COVID-19. They have shouldered the burden of health systems delivery for more than two years of the pandemic since women are 70% of the global health workforce and 90% of health workers in patient-facing roles. 
 

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

Gender inequity is hard-wired into the global health workforce, with women clustered into lower status sectors and jobs, marginalized in leadership, frequently subject to violence and harassment, and on average, paid less than their male counterparts. In addition, at least 6 million women work unpaid and underpaid in core health systems roles, effectively subsidizing global health with their unpaid labour. Typically, these women are from low-income families, with little education, working in their local communities whose livelihood choices are constrained by power and gender dynamics. Often the first point of contact for community members with the health system, their work has measurable impact for the well-being of their communities and has been critical in the pandemic response. These women are the focus of the report.