Global health has a gender equality problem. Across geographies and cultures, women are the drivers of health delivery, accounting for 70% of the overall global health and social care workforce. And yet despite this broad pool of expertise in global health delivery, only 25% of global health senior leadership roles are held by women.  

This underrepresentation of women in senior leadership positions has real consequences for the sector. Evidence suggests that when women are in positions with influence and decision-making power, the resulting decisions produce outcomes that are more favorable to girls and women, and advance gender equality over the medium-term. And, under the right circumstances, gender-diverse governance bodies make decisions that are better for organizational health, effectiveness, and profitability. 

Significant research has been done about the barriers and bottlenecks that lead to women being excluded from leadership opportunities. We wanted to switch the conversation to what influential organizations can do to accelerate women’s leadership. We asked 38 women and other leaders in global health and development, with an emphasis on those from countries in the Global South, to share their experiences and insights. Here’s what they told us:  

1. Design efforts to accelerate women in leadership with an intentional focus on intersectionality (or risk re-entrenching existing discriminatory power dynamics) 

“It’s clear, no matter how competent you are, if you are local you are not competent enough.” 

There is broad acknowledgement that power and privilege play a role in determining which women have access to leadership. For example, when global health organizations do hire and promote women into senior leadership role, they tend to select women who are from or studied in the Global North. At the same time, leadership programs have largely served “elite” women who are already in senior roles – there is limited access for women who are from marginalized communities or who work in low prestige cadres. Access is even worse for nonbinary and nonconforming genders. There is a justifiable argument to be made for speed: helping women already in the pipeline over the last hurdle to reach senior leadership, the argument goes, will accelerate efforts for all marginalized genders. However, if an equity lens is not applied, there is a risk that a focus on women’s leadership will fail to address, or even propagate, longstanding structures of oppression​. 

2. Support not only individual training programs, but also organizational change efforts 

“If I had all the money in the world, I would put 90 percent of it into the organization level. We’ve done a lot of defining the problem and a lot of trying to ‘fix’ the women.”  

The majority of efforts to support women’s leadership have focused on individual training and mentorship programs, which help but are insufficient. Even after women participate in programs, they often return to organizations with discriminatory norms and practices (e.g., traditional division of roles by gender, patriarchal definitions of leadership, unpaid or underpaid labor, sexual harassment). Leadership training does serve a useful role, and notably needs to be expanded to include women who have traditionally been excluded from these efforts such as women from the Global South and non-English speaking populations. However, significant efforts are needed to ensure the organizations they return to are gender equitable. This is a broad undertaking touching on every aspect of an organization’s structures, culture, and processes. Some (out of many) example elements might include:   

Enabling environment and change management: 

• Ensuring men and members of the dominant group take an active role and responsibility in the change process 
• Enlisting third party orgs for guidance, audits, and certifications

Recruitment and retention:  

• Considering quotas to counteract hiring bias 
• Recruiting from a diverse set of backgrounds and educational programs 

Professional development: 

• Creating both mentorship and sponsorship programs connecting low to mid-career and senior-level advisors 
• Revisiting performance criteria to ensure gender equity in metrics 

Work arrangements: 

• Equalizing compensation across levels 
• Instituting parental leave policies with equal time off for all genders (and incentives for men to use it) 

Culture: 

• Conducting trainings on gender equity and implicit bias to ensure buy-in across the organization, especially among men 
• Enforcing a zero-tolerance policy for sexual harassment and abuse of power 

3. Provide gender equity resources directly to national and regional health organizations  

“There are options, such as EDGE certification and a McKinsey program, but they have cost and limits to working with smaller organizations. Is there something similar for smaller organizations?” 

While support for moving toward gender equity is needed at all levels, larger organizations at the global level tend to have relatively greater access to resources for gender equity such as organizational change consultancies, certifications, and accountability tracking. On the flip side, organizations most proximal to health policy delivery, i.e., national or smaller regional organizations, paradoxically have the least access to these resources. These organizations employ large numbers of female workers and serve large portions of female populations. Provision of gender equity resources, such as funding, training, expertise, and accountability frameworks (including quantitative and process metrics), directly to local health organizations would enable them to advance gender equality more effectively. 

4. Challenge internalized patriarchal norms for “leadership” – for women and men 

“At its foundation, feminist leadership is inclusive and non-hierarchical. The critical question: How do we adjust the structure to accommodate all the kinds of leadership in our organization?” 

Traditional leadership development programs deliver critical skills to help women advance in existing hierarchical structures, but also risk losing the benefits of diffuse and transformative leadership styles. We heard in our interviews multiple views of women’s leadership. One view is indeed where women demand equal opportunity to fill leadership roles and exert the same leadership styles of male leaders – traditionally seen as authoritarian and decisive. Another speaks to women in these roles that emphasize collaboration, cooperation, and empathy in decision-making. A third is a feminist definition of leadership that interrogates the hierarchical distribution of power and deliberately moves to shared power across the organization toward shared goals of social transformation and equality for all. It is important to note that each of these leadership styles can be exercised by women and men. To achieve gender equitable organizations and unlock gains in social impact, men, as well as women, need to be engaged in redefining norms for leadership. 

5. Invest in national-level civil society and advocacy capacity 

“Global uptake has started to take place, especially with the Sustainable Development Goals, but how much is it translating at country level? It’s not there yet. We need to use influence at the country level.”  

Achieving gender equality in leadership – and moving beyond that to translating women’s influence and decision-making into positive outcomes for women and girls – is a challenge for global health organizations at all levels. However, the root causes and solutions are context specific. The challenges faced by a woman working in a multilateral organization in the Global North are different from those faced by a woman working in a government agency in Ethiopia or in health delivery in rural India. Addressing these root causes and identifying solutions requires the knowledge, relationships, and deep experience in local culture, history, narratives, and political systems that can only be carried by advocates from the communities seeking change. Local advocacy and civil society organizations need flexible funding support to be able to tackle the social narratives, norms, policies, and power structures distinct to their communities that hold women back. 

We are excited by the efforts of incredible women-led organizations such as Women in Global Health, WomenLift, Global Health 50/50, and FAIR SHARE of Women Leaders to begin to address some of these opportunities, and the highlighting of feminist movements and leaderships as a core component of the Generation Equality Forum’s Global Acceleration Plan for Gender Equality. With more inclusive programs, expanded resources, accountability tools, and coordinated advocacy efforts, we are optimistic about the potential of achieving gender equal leadership in global health.  

Sources 

[i] Batliwala, Srilatha (2010). Feminist Leadership for Social Transformation: Clearing the Conceptual Cloud 

[ii] The Lancet (2019). Gender Equality, Norms and Health,    

[iii] Global Health 50/50 (2019). Equality Works: The Global Health 50/50 2019 Report 

[iv] Global Health 50/50 (2020). Power, privilege, & priorities: 2020 Global Health 50/50 Report 

[vi] World Economic Forum (2020). Global Gender Gap Report 2020 

[vii] World Health Organization (2020). Consultation on Policy Brief on Gender, Equity and Leadership in the Global Health and Social Workforce 

[viii] World Health Organization (2019). “Delivered by Women, Led by Men: A Gender and Equity Analysis of the Global Health Social Workforce” 

[ix] World Health Organization (2019). Female workers driver global health 

[x] Respondents included 38 leaders from 26 organizations in sectors influential to global health and development