By Rosemary Morgan, Asha George and Ravi Ram
We were pleased to have the opportunity to feed into the World Health Organization consultation on the health workforce. The process of developing the final policy is still ongoing and we commend Global Health Workforce Alliance (GHWA) for their leadership in facilitating such a vital strategy for health systems worldwide. Reading through the draft provides an opening to discuss how gender relates to this area and how it can be better represented in the strategy.
Gender is an important component of the health workforce, relevant to each of the strategy’s four objectives and we would like to see it mainstreamed throughout the strategy document. We were happy to see that guaranteeing “the right of health workers to be free from gender discrimination and violence in the work place, and ensure ‘decent work for all’” was one of the key strategy principles. Gender discrimination and violence is pervasive within human resources for health, and not often recognized. We strongly feel, however, that ‘sexual harassment’ should be also listed within this principle, as this is a unique form of discrimination/violence that predominately affects women.
Despite their importance, gender issues were largely missing from strategy document, and we would recommend that they be reflected in other areas, such as within the indicators for the objectives.
Funding and supporting system-wide reforms
We agree with the authors of the draft strategy with the priority accorded to investing in human resources. Concurrently, it is vital to emphasize reforms of the current systems that are in place. Business as usual is no longer tenable and this applies to gender as well. It is not that we lack resources to ensure that women have qualified employment opportunities, but that institutionalized discrimination keeps them on the lower levels of the workforce or doesn’t recognize or support their contributions, as is the case of most informal caregivers. We need to not just expand what we are currently doing in human resources for health with more resources, but also change what we are currently doing.
Other areas where the World Health Organization and governments could invest their efforts include:
- Acting on the gendered distribution of the health workforce, including that women make up the majority of professions on the lower tiers of the workforce, however, proportionately there are few women in leadership and management positions, particularly within low and middle income countries.
- Recognizing that female health workers face distinct challenges, including violence and sexual harassment and the competing demands of work and family responsibilities, which lead to increased levels of stress and mental health issues affecting their ability to pursue and/or be awarded training and career advancement opportunities.
- Policy responsiveness towards life course events for health workers with family responsibilities (such as maternity and paternity coverage policies) to prevent gender discrimination within the workplace, such as pregnancy-based and caregiver discrimination and vertical segregation (the concentration of men in management positions).
- Supporting and encouraging men’s participation in occupations conventionally held by women, such as nursing, midwifery, and community health work.
Gender mainstreaming should be recognized as an important Human Resources for Health policy, and as such should be included as a core principle of the strategy. In addition, further evidence is needed to support policy development and implementation. If we as a health systems research community don’t provide contextual information on the prevalence and nature of gender disparities and discrimination within the health workforce then efforts to promote gender mainstreaming will be ineffective.