Women's Leadership in the Health Workforce: Takeaways from an UNGA Roundtable Discussion

Investing in employment for women in the health sector has a massive potential impact on women’s overall economic empowerment - this is a no brainer. However, despite the fact that the world realizes this and the fact that there are persistent efforts being held to raise attention to the barriers that inhibit the maximization of this impact for women (as reported in several recent reports and forums), the international development community still lacks clear, evidence-based solutions to gaining a more equitable leadership landscape.

Last week, in the background of UNGA, Frontline Health Workers Coalition (℅ IntraHealth International) and Women Deliver, in collaboration with Johnson & Johnson, and NursingNow, convened a leading group of advocates to identify concrete actions to be taken to make measurable progress on the core barriers to advancing women’s leadership. WGH sincerely thanks the sponsors for the opportunity to contribute our voice at the table!

Below are the leading questions addressed during the discussion facilitated by Vince Blaser, FHWC Director and Susan Papp, Managing Director of Policy and Advocacy at Women Deliver, along with major thoughts and takeaways from our ED Roopa Dhatt who attended the consultation.

Question: What steps can we take to address unpaid care delivered by health workers? What other changes are needed and feasible to address gender pay gap issues (e.g. creation of #MyWagesToo campaign)? What are the barriers to salary transparency and how can we break down those barriers to salary transparency?

Addressing the gender pay gap is a serious issue and it is has an immense economic cost. The World Bank’s 2018 estimates predict that globally countries are losing $160 Trillion in wealth due to earning gaps between men and women. We know there is more political leadership to address the gender pay gap. The gender investment case has picked up traction, especially in G7 and G20, and we need to keep up the pressure to make sure this is on the radar of countries around the world.

Specifically, we want countries to support the conversion of informal work into formal work, such that Decent Work: rights, roles and responsibilities are the norm in the health sector. The gender dimensions are quite pervasive in this sector, as we know 50% of the work women do in this sector is unpaid (Source: Lancet Women and Health) and the health sector has a wage gap of nearly ~28% per ILO, almost 10% higher than the aggregate of other sectors.

Women in Global Health’s stance:

Change in this area rests on employment law and collective-bargaining rights.

1. Legislation that leads to accountability: We need both anti-discriminatory laws, but also mandatory reporting and transparency on wages.

2. Data: We need better data on the gender pay gap, informal work and unpaid care (but not to wait for the perfect data set before taking action).

3. Collection Action: We need unions, associations and other bodies to address the gender pay gap through pushing the agenda above and holding organizations to account, using tools just as accountability scorecards, requesting their employer releases gender pay gap statistics.

E.g.

Addressing the gender pay gap rests on quantifying it which needs legislation to force employers to comply. The UK for example passed an equal pay act in 1970 based on US legislation making it illegal to pay men and women differently for work of equal value but it took until 2018 for the UK to enforce gender pay gap reporting. Nearly 50 years. With greater awareness and more precedents to follow it is now possible to speed up that Transparency and accountability process.

Question: What policies have demonstrated success in achieving gender parity at leadership levels? Are there programs that have achieved parity, or close to it, that have not used quotas or other mandates that could be replicated?

Quotas work, why not use them?

The fear is that merit gets lost with quotas, but over and over, the most proven way to address the gender gap in leadership and broader diversity are quotas. Keeping equal merit with quotas or less effective targets with incentives to reach them, seems to be the consensus. However, there is still a need to invest into the talent pipeline of women, especially their professional development and access to the training needed for senior, managerial roles. We must also tap into women in their entire life course-- “seasoned” or senior women can contribute as well.

Women in Global Health’s stance:

Women and men have equal merit and quotas or targets are aimed at drawing from hundred percent of the talent pool. Quotas, especially when there is a timetable for compliance eg to reach a % women on boards by a certain date, focus companies to act. Political quotas for example in local bodies elections in India have enabled women’s voices and perspectives to be heard on issues like health and education for the first time. Targets are a softer option and often more politically acceptable. But we must remember we are working to overturn a male majority quota that was based on both informal and formal historical barriers. Many countries for example had formal barriers to women entering medicine and many countries still retain formal barriers to women entering certain professions. There are historic structural reasons why men dominate leadership. Appointment on merit has not been the rule. It seems the question of merit only arises when a sudden increase takes place in the percentage of women leaders.

E.g.

Groups like Nursing Now are advocating for the empowerment of nurses into leadership roles (women make up the majority of nurses), making a case for it through the Triple Impact in 2017 (better health, greater gender equality and stronger economies when nurses are in leadership) and this is having real impact.

Question: What policy changes are needed to create a workplace free from harassment - at national/regional/local levels? Is the creation of reporting mechanisms effective? Are the policies or programs that have demonstrated success in prevention?

In order to create safe workplaces for women, we need policies that go downstream and are centered around zero tolerance! Reporting is key to addressing global sexual harassment and should be made a requirement. Data is absolutely crucial in this area and we need external reviewers for an unbiased assessment of harassment policies and cases to assess what is really happening. We also need a common language across borders to talk about harassment, because, right now, this is something the world lacks significantly. We also need to a surge in safe spaces for women to have these sensitive conversations.

Women in Global Health’s stance:

1. Zero Tolerance Policy.

2. Gender parity in leadership (it is a fact that women are far less likely to be perpetrators of sexual harassment and in gender balanced teams, sexual harassment decreases).

3. Briefing, training and induction that spells out very clearly what is acceptable and unacceptable behaviour and is placed by organisations on the same level of seriousness as financial misconduct

4. Effective whistleblowing and accountability mechanisms that act as a deterrent because perpetrators know they will be reported and penalised. Currently too many men in powerful positions know that women who report sexual harassment against them will not be believed and that even if found guilty it is more often the victim who will be punished and lose her job.

5. Safe spaces for addressing all forms of harassment for women, men and all genders. Organisational cultures that make harassment of colleagues and service users as unacceptable. We must get to the point where all of us feel that such behaviour is morally abhorrent.

6. Men stepping forward to act as effective allies of women, not turning a blind eye, putting their own careers first. Women also being allies for other women.

8. Clear quantification for organisations of the costs of sexual harassment for individuals, attrition, morale, in legal fees, reputational damage and income. After #metoo this cannot longer be a Hidden business cost. Women will not stay silent.

9. Gender transformative leaders, both men and women, who set and enforce organisational culture that is different.

Question: What actions could we take to ensure enough investment in health workforce and health employment in the right places to maximize the health & economic impact for women?

We all agreed that legislation is crucial for significant advancements and that regional alliances and associations have major roles to play. It’s just high time we started to acknowledge women’s leadership in the health workforce through a multisectorial perspective - this is really important! We need think about this from a framework of people’s rights, roles and responsibilities, and really unlock the potential that’s right there for us to see.

Women in Global Health’s stance:

We need to change the narrative and work together collectively to persuade all political leaders that investment in health and the female health workforce who will deliver it, are essentials for the short and long-term survival of society. Please join women in global health in spreading this message.

At the end of the meeting, Frontline Health Workers Coalition (FHWCs), Samantha Rick and Vince Blaser, IntraHealth International, Nursing Now and Johnson & Johnson provided an overview for a new report on barriers and actionable recommendations to women’s leadership. Keep an eye out.