Recognizing and Empowering Women Leaders at All Levels of the Health System

Recognizing and Empowering Women Leaders at All Levels of the Health System

A midwife in Wau, South Sudan. {Photo credit: MSH.}Photo credit: MSH.

Josephine, a wife and mother of six living in rural Uganda, tried to soothe her 3-year-old daughter. The girl was suffering from diarrhea and a high fever and her crying filled the home. Recognizing that the girl's health was in danger, Josephine summoned the courage to ask her husband for permission to take their second-youngest child to the local health facility unit -- and pleaded for money to cover the travel and treatment expenses.

Requesting permission from her husband to travel to the facility was not her only choice, however: choosing to take her daughter for treatment also meant leaving her other children -- including her youngest -- unattended at home. Once at the health center, she continued to navigate the challenging road to treatment for her daughter, communicating her situation to the health providers and negotiating the financial and provider aspects of the health center system, without assistance. Relieved and exhausted, Josephine returned home safely with her daughter, oral rehydration salts, and knowledge.

Recognizing women leaders

What makes a person in the health system a good leader? Who determines that he or she is a leader? How do we empower leaders to improve the health of those around them?

Current definitions of leaders are static and can disenfranchise women. If we only look to those in official positions of power, whether in the health system or in political offices, we may be missing the most influential leaders to develop and empower: the women in the households and on the frontlines of the health system.

At MSH, we say that leaders are not born. We also understand that being a leader is not an entitlement and not ensured by a title. A person is a leader when those they lead perceive them as leaders. Sometimes that may be because the person is in an official leadership capacity, or because the beneficiary -- in this case the person receiving health care -- perceives the health provider as a leader. A leader in the health system can be defined as a person whose leadership impacts others, whether as community health worker, midwife, nurse, head of hospital, or head of ministry of health -- or head of the health care of a household, like Josephine.

As health caretaker for her family, Josephine required all the characteristics of a good leader. She had to multi-task, prioritize, negotiate, manage, inspire, and persuade. The stakes are higher for this woman: the strength of her leadership can ensure the survival of her family.

Empowering women on the frontlines

Women are more likely to work on the frontlines of the health system but less likely to hold formal positions of leadership in the health system. While much of the health worker data in developing countries is still not disaggregated by gender, one study in Ethiopia found men accounted for 80 percent of clinicians and specialists -- those at the top of the health worker pyramid.

Women health practitioners are more likely to face discrimination based on marital status, be expected to conform to male work models, be subjected to harassment and violence while working, and be employed in low- and entry-level positions. Furthermore, women often are compensated poorly, resulting in a cadre of quasi-volunteerism: unpaid or underpaid. In all industries combined, women are compensated at a rate of 40 percent less than men for their work.

The personal safety of women health care workers is also a primary concern in many countries. Women are often subjected to harassment or sexual violence as health workers. One Rwandan study found 39 percent of health workers experienced some form of workplace violence. This affects recruitment as well as retention of women in critical health care positions.

Despite these global hardships, women are major contributors to positive health outcomes, from promoting health in the household to reducing maternal and child mortality in communities. Still the need for more skilled health workers is great. Over 70 percent of maternal mortality in developing countries could be prevented if every woman had access to a skilled health worker when giving birth [World Bank 2004].

While there is a growing body of evidence that women leaders impact health outcomes, we must do more to document this link between gender equity and health outcomes. In Rwanda, a critical mass of women in parliament led to more accountability, transparency, inclusiveness and equity. In India, girls and parents perceived more options for the girl children -- a so-called "role model effect" -- in states that required more female representation.

Irene Jao of the International Centre for Reproductive Health explains the empowering effect like this:

"To me, the greatest leader is one who will walk a step ahead of you, look back always to know you are right behind and extend a helping hand when bigger steps need to be taken. A leader should be able to pick you up when you fall and explain to you why you fell so that you continue with the walk more carefully. I believe if this is done, within no time, you will be able to walk beside the leader and finally ahead of them. My goal would be to finally walk without this leader. This way I will be in a position to lead others, giving them a chance like the one I got."

Recognizing and legitimizing women leaders, while also applying strategic approaches to good governance, is necessary to achieving better health outcomes.

According to UNIFEM (which is now part of UNWOMEN): "Governance must lead to a more equitable world, where women also have choices and their rights are realized ... It cannot be effective or 'good' unless it is gender sensitive." Good governance must include: accountability, transparency, inclusiveness and equity, gender responsiveness and upholding rights.

At MSH our work to advance the well-being of women and girls extends to leadership development, clinical training, technical assistance to programs that use community health workers (most of whom are women), and literacy programs. Through one five-year project, MSH trained or provided technical assistance to more than 4,000 senior female leaders and engaged 27,000 women in learning programs.

It's not only about getting women to leadership and management positions -- but also making sure that women see themselves as leaders wherever they are in the health system. If a woman is impacting the life and wellbeing of others, then she is a leader.

We are encouraged by the announcement this week of the new USAID Policy on Gender Equality and Female Empowerment. The goal of this policy is to pursue more effective, evidence-based investments in gender equality and female empowerment and incorporating these efforts into core development programming.

By creating, legitimizing and empowering women leaders, we will empower beneficiaries of the health system and improve health outcomes for all.

Belkis Giorgis, PhD, is senior technical advisor for the Leadership, Management and Governance Project (LMG) at MSH. She served as capacity building and gender advisor for the HIV/AIDS Care and Support Program (HCSP) in Ethiopia, the largest national expansion of HIV & AIDS services at the community and health center levels in Africa.

Jonathan D. Quick, MD, MPH, is president and chief executive officer of Management Sciences for Health. Dr. Quick has worked in international health since 1978. He is a family physician and public health management specialist.

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