Why it matters 

Women make up more than 70% of the global health workforce; however, in many countries they are over-represented in informal, low-status and low-paid ‘care’ roles and are under-represented in professional categories and in leadership positions.  

Gender disparity in health care leadership negatively impacts gender equity in the health workforce. If decision-making spaces are dominated by men, the policies and practices that support health and wellbeing of women may be less prioritized. Similarly, the persistent wage gap will continue and the levels of confidence and career progression among women will be affected.  

It is important to understand why women are so poorly represented in higher, decision-making categories of the health system and investigate the role of gender norms, roles and relations in career progression and leadership.  

What we did 

This research aimed to explore and understand the role of gender in career progression and the leadership experiences of male and female senor healthcare managers at the sub-national level in Kenya, Nigeria and South Africa. 

The studies used a qualitative case study approach, focusing on senior health managers. Data was generated through semi-structured interviews and observations to support understanding of the context within which leaders operate. 

Supported by RinGs, researchers have re-analysed data using an intersectionality lens to understand how identity, and specifically the intersection of multiple identities (i.e. gender, race, ethnicity etc.), mediates the career trajectories, leadership approaches and capacities of senior healthcare managers.

What we found 

• Influence of gender on perceptions of leadership 
  Gender biases prevail with regards to perceptions of leadership: stereotypical female attributes, such as emotiveness, are seen to be incongruent with strong leadership, and female managers are less accepted as leaders than men – including by women.  
   
• Importance of professional hierarchies in determining management and leadership roles 
  Gender is not the only factor that affects perceptions and experiences of leadership. In Nigeria, it intersects with other factors including age, marital status, and perhaps most importantly professional hierarchies, where there is an assumption that medical doctors are better suited to management roles. These findings are similar to those in other contexts: in Kenya, gendered professional hierarchies are also found to play a role in the appointment of health managers.