Women persevere. Women are resourceful. Women LEAD.

This post originally appeared on LMGforHealth.org.

Belkis Giorgis speaks at the LMG panel. [Photo credit: S. Lindsay/MSH]

Belkis Giorgis speaks at the LMG panel. [Photo credit: S. Lindsay/MSH]

Fifteen years ago, Dr. Belkis Giorgis was in North Nigeria at a health clinic. At this clinic, Giorgis asked the midwives why women continue to prefer to deliver their babies at home. The midwives told her that the clinic throws away the placenta after delivery, while giving birth at home allowed the women to bury their placenta as is traditionally done. Giorgis then inquired why the midwives did not fix this seemingly easy obstacle. “I don’t have a voice,” the midwife said. “The men [at the clinic] say the women should get over it.”

It was this visit that led Giorgis to wonder: What if women were the health leaders? Would services be more women friendly?

Giorgis’ story set the foundation for LMG’s panel, “Women Deliver as those who Manage, Lead, and Govern for Health,” on Wednesday, May 29, at the Women Deliver 2013 Conference. Joining Giorgis on the panel moderated by LMG director Dr. Jim Rice was Honorable Ruth Nvumetta Kavuma, former parliamentarian in Uganda, Constance Newman, senior team leader of gender equality and health at IntraHealth, and Dr. Narjis Rizvi, an assistant professor at Aga Khan University.

The diverse panel clearly illustrated that women are not well represented in leadership positions in health systems. In Kenya, Newman said, 43% of the health workforce is male, but 77% of these men are in senior leadership positions. Conversely, women are 57% of the health workforce, but make up only 23% of senior leaders in Kenya’s health sector.

Explaining this pattern, Newman said, “Women and girls face a force field of accumulating inequalities and disadvantage starting at their primary school years and continuing to their retirement years.”

Rizvi reported a similar pattern in Pakistan, “Despite Pakistan’s laws and constitution and the work of the Aga Khan Development Network, women are still underrepresented in senior leadership positions.”

The panelists, however, were adamant that this pattern can change.

“We need to put women in leadership positions. Let them make the mistakes. The men make mistakes, but when women make the mistakes, people act like it’s the worst thing in the world. We need to support them through these mistakes,” Kavuma told the crowd. Supporting women’s confidence in the public eye is key to building strong women leaders, she stated.

And it’s not just up to women to make the change. Giorgis said:

“There are many opportunities [to advance women’s leadership], start by making sure we put forward the justification that women can lead. Women are resourceful. Women persevere. Women are capable of leading. It requires advocacy not only from women, but from men as well.”

“Change the behavior, ideas, and lenses that men see women leaders through,” Rice said, and we will see progress.

Rice and Newman ended the panel with a request for evidence. “We want to move from anecdotes to rigorous impact studies,” Rice said.  Newman continued with a request for the audience: “Invest in participatory action research, where women look at the data of their own lives. Understand it, frame it, and build upon it.”

Sarah Lindsay is a communications specialist with LMG at MSH.

WOMEN LEAD: Strong Women Save Lives

Join us at Women Deliver’s 3rd Global Conference for more discussions on how Women Lead on Tuesday, May 28, and at the MSH booth: #277/283/284.

Belkis Giorgis

Belkis Giorgis

Strong Women Save Lives

At Management Sciences for Health (MSH), we say that leaders aren’t born: Leadership is learned.

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.

Head of household

As health caretaker for her family, a woman requires all the characteristics of a good leader. She has to multi-task, prioritize, negotiate, manage, inspire, and persuade. The stakes are high: 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 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.

A woman talks with Belkis (right). (Photo credit: Dominic Chavez)

A woman talks with Belkis (right). (Photo credit: Dominic Chavez)

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.

And the global 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.

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.

My colleague, Celia Tusiime Kakande, blogged about this on International Women’s Day:

“For most of my life, women in Uganda—as in most countries—were treated as inferior to men. Girls were less likely to be educated than their brothers, and had little control over the direction of their lives Many girls grew up being told how to act, eat, and talk; many women were regarded as little more than domestic caregivers.

Women in Uganda now hold more leadership positions than ever before—35 percent of the seats in Parliament are now occupied by women, and our Speaker of Parliament and Minister of Health are women. Quality family planning, safe motherhood, and HIV & AIDS services have helped lower the maternal mortality rate from 435 deaths per 100,000 live births in 2006 to 310 deaths per 100,000 live births in 2010.

This translates to 1,700 women’s lives saved each year.” 

Celia Tusiime Kakande

Celia Tusiime Kakande

Empowering leaders

At MSH, our work to advance the well-being of women and girl 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.

As Celia said:

“Ugandan women have gained ground at the highest levels of leadership. They are taking control of their lives and their families’ health.”

It is this spirit that inspires MSH to continue our work in Uganda, Ethiopia, Afghanistan, and in over 60 countries worldwide.

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

Follow this blog and hashtags #WOMENLEAD and #WD2013 on Twitter @MSHHealthImpact for live updates from Kuala Lampur. We are a proud gold sponsor.

Belkis Giorgis, PhD, is senior technical advisor for the Leadership, Management and Governance Project, led by MSH. Celia Tusiime Kakande, MA, is Chief of Party of STRIDES for Family Health, a project led by MSH.

(Portions of this post were published on the MSH Global Health Impact blog.)