Women Make Up 75 Percent Health Workforce But Not Enough Senior Leaders

ASHA workers have been working amongst us for more than a decade. But no one has really acknowledged their worth while these selfless employees still go underpaid in India. Currently ASHA workers are paid a fixed monthly salary of Rs 4,000 by the state government and Rs 2,000 by the Union government and other incentives. Given the increasing cost for even basic needs and amenities, Rs 6,000 doesn’t aid the ASHA workers and reward the services they provide to the community.

However, this is not just India’s problem. Women hold around 70 percent of health worker jobs globally. They occupy over 80 percent of nursing and over 90 percent of midwifery roles. Females deliver the majority of unpaid care and domestic work in families and communities. Yet women hold only 25 percent of leadership roles in health.

Dubbed ‘The XX Paradox’, the Women in Global Health Report released in March 2023, exposed the shocking disparity between the two genders in the healthcare sector. Globally, men are less than 30 percent of the health workforce but hold 75 percent of leadership roles. The report questioned that if the default health worker is a woman, why is the default health leader not female.

“We don’t have a talent pipeline issue in the health sector, women are entering in high numbers, even at the highest levels of the health sector as physicians, and graduating high numbers from PhDs for several decades. So XX Paradox is exactly about the fact that women exist in high numbers but are underrepresented” said Dr. Roopa Dhatt, Executive Director & Co-Founder of Women in Health during a video call.

As the numbers reflect there is no shortage of women in the health leadership sector. Women make up the majority of junior doctors, nurses, pharmacists and dentists. But men are promoted as women are subjected to ‘glass ceilings’.

“Since childhood, I have only heard this as gospel truth: ‘Women’s primary job is to take care of the household.’ It is difficult to keep challenging this notion, even internally, when everyone around you keeps saying this. When I got married, my mother-in-law very explicitly told me that my job is to do ‘Seva’ (serve) for my husband and my future son”, a doctor in India was quoted in the same report that talked about the inequalities pertaining to the leadership positions in the healthcare sector. 

Whether it was the initial stages of the pandemic when women community health workers went door to door urging people to mask up or at the height of the second wave, when nurses worked double shifts in suffocating personal protection equipments (PPE), the frontline of the COVID response especially in India was female.

Even India’s enormously successful vaccination drive aimed at covering the last mile saw many women volunteers trek up mountains, walk through dense forests and jump over rivers to power the government’s mass immunisation drive.

However the report revealed that while women are the troopers who make up the health-force, the generals continue to be mostly men. Not just that, women are not paid as much as their male counterparts.

When the World Health Organization’s Executive Board met in January 2022, only 6 percent of its members were women. This is despite the fact that its Chief Scientist at the time was female and India born Soumya Swaminathan.

Recalling a past incident Dr. Roopa spoke about the stark difference in genders which she witnessed.  “Whether I was in the hallways of the UN, the World Health Organization, or the hallways where I was getting clinically trained, I would see a stark reminder, the walls were decorated by photos of prominent men and yet women made up the majority of the health workforce.”

Worldwide, women hold just one fourth or 25 percent of leadership positions in the sector. When it comes to India, official data showed that this number is only slightly higher than the global average in India.

The report shows that women average around 28 percent in leadership roles across national health organizations. The only exception is in the Nursing Council which is led by females. On the other hand organisations such as the Pharmacy Council of India have almost no women in leadership positions.

Why Is This Gap So Enormous?

Experts argue that the reasons are mostly cultural and entrenched in societal prejudice.

There is a concept of what the report calls the ‘motherhood penalty’. Mothers and would-be moms “suffer a penalty in the form of lower perceived competence and commitment, higher professional expectations, lower likelihood of hiring, being re-hired and promotion, and lower recommended salaries”, says the 26 page research paper that profiled three countries – India, Kenya and Nigeria.

The other side of the coin is the ‘male bonus’. The report talks about how the human resources policies in health and other sectors have been designed to fit the ‘default man’ and treat women issues and conditions of menstruation, pregnancy, miscarriage, breastfeeding and menopause as ‘the exception’ despite women being the majority in the health workforce.

“Even women without children can be disadvantaged in career progression by the assumption that they will have children in the future and are therefore ‘less suitable’ for promotion than their male peers,” the report noted.

When the MOJO STORY spoke to Kimi Chhabra, Pathologist at Government Medical College in Patiala shared that these biases blatantly exist in the society. She cited an example about what happens when a doctor wants to become a professor at a medical college. They need to pursue a three year senior residency course and have to appear for interviews.

“When females appear for such interviews, if she has a bump they will be rejected. They automatically assume that she won’t be able to do a 24 hour or a 36 hour job on a routine basis. She will need extra care and in a few months she’s going to deliver which will enable her for maternity leave. This could happen despite the female doing better in tests and interviews compared to other males” she added.

While talking about India, Dr. Roopa pointed out that there are policies on paper but they also need to be implemented. “Implementation is one of the hardest things to achieve. In India, there are policies to provide women with safer workplaces and just create safer societies. India has made progress in this area after a long journey but the social norms have not yet been transformed.”

She further explained that when women try to report incidents of harassment or sexual harassment, it is often perceived that it is the ‘woman being difficult’ and are ‘discouraged from filing a formal complaint’, this is also one of the reasons why women are leaving workplaces.

Long Journey To Achieve Leadership

According to a recent UN report, it will take 140 years for women to achieve equal representation in leadership positions.

Talking about solutions, Dr. Roopa suggested that all forms of unpaid work that is taking place in the health sector needs to end. “ We need to stop under-paying women for the work that they do. We need to give them living wages and we must begin with community health workers like the ASHA workers in India”.

Other measures mentioned in the report to end the bias in healthcare sector were to enable diverse women to lead, mobilize men to lean out and step up as allies, deepen understanding and the evidence base for policy with more research and data, and support women’s movements to accelerate collective action. 

The Healthcare sector employees 234 million people globally and it is one of the most important employment sectors for women. Women need support to climb up the ladder and take up positions that will help build a more equitable health sector.