ABSTRACT
IntroductionEqual access to water, sanitation and hygiene (WASH) for all requires leadership that prioritises and drives inclusion. Inclusive WASH also presents opportunities to advance equality more widely, with WASH a pathway to meaningful participation and empowerment for diverse groups. The concept of gender-transformative leadership-which connects ideas of leadership to transformative models of gender equality in development theory that challenge prevailing power structures-is a relevant lens for exploring inclusive WASH. This article shares findings and reflections from a positive deviance study that aimed to investigate gender-transformative leadership in the WASH sector to explore (i) the factors shaping gender-transformative leadership and the characteristics of gender-transformative leaders;(ii) actions taken by gender-transformative leaders;(iii) the types of outcomes achieved;and (iv) ways to strengthen gender-transformative leadership. MethodsThe study was undertaken during the COVID-19 pandemic and consisted of interviews with 19 leaders in Bhutan, Lao People's Democratic Republic, and Nepal. We developed a conceptual framework which considers leaders' (i) personal values and traits;(ii) leadership styles;(iii) actions;and (iv) outcomes, influenced by a range of (v) enabling factors and barriers. ResultsLeaders' personal values and traits included a strong learning orientation, social justice values, humility, courage, and altruism. Leadership styles were primarily empathetic, with leaders guided by a mission to lead by example and pursue equality in their professional and personal lives. Exploration of actions and outcomes revealed a range of inclusion-oriented WASH activities responding to pandemic-related challenges, with associated potential outcomes in shifting norms. However, validation of outcomes was not possible due to the study timeframe and complexity of tracing complex social change in a positive deviance study reliant on self-reporting. Analysis of enablers and barriers to gender-transformative leadership respectively emphasized the importance of educational opportunities and the persistence of traditional gender norms. ConclusionFindings contribute to the body of knowledge on gender-transformative leadership, being the first study to connect this concept to WASH. Future research could build further evidence by applying the conceptual framework to analyze additional contexts or sectors, and by more fully articulating and validating outcomes in terms of their potential for gender-transformative leadership to drive equality both in and beyond WASH.
ABSTRACT
PURPOSE: The purpose of this manuscript is to provide an overview of the significant role that women play in providing global health care, barriers encountered to achieving gender equality in global health leadership, and to propose key recommendations for advancing gender equality in global health decision-making through the integration of gender mainstreaming, gender-based analysis, and gender transformative leadership (GTL) approaches. METHOD: Data were evaluated to determine the participation rate of women in global health care and social sector roles in comparison to men. Gender equality data from the United Nations, World Health Organization, Organization for Economic Co-operation and Development, International Labour Organization, and other resources were analyzed to assess the impact of the coronavirus disease 2019 pandemic on gender equality with an emphasis on women in global health leadership positions, the health care and social sector, and gender equality measures for girls and women throughout the world. The literature was examined to identify persistent barriers to gender equality in global health leadership positions. Additionally, a review of the literature was conducted to identify key strategies and recommendations for achieving gender equality in global health decision-making; integrating gender mainstreaming; conducting gender-based analysis; and adopting GTL programs, incentives, and policies to advance gender equality in global health organizations. FINDINGS: Women represent 70% of the health and social care sector global workforce but only 25% of senior global health leadership roles. Since 2018, there has been a lack of meaningful change in the gender equality policy arenas at global health organizations that has led to significant increases in women serving in global leadership decision-making senior positions. During the pandemic in 2020, there were nearly 100 open vacancies-one-quarter of CEO and board chair positions-at global health organizations, but none were filled by women. Women disproportionately provide caregiving and unpaid care work, and the pandemic has increased this burden with women spending 15 hours a week more on domestic labor than men. A lack of uniform, state-sponsored paid parental leave and support for childcare, eldercare, and caregiving, which is overwhelmingly assumed by women, serve as major barriers to gender parity in global health leadership and the career advancement of women. CONCLUSION: The pandemic has adversely impacted women in global health care and social sector roles. During the pandemic, there has been a widening of the gender pay gap, a lack of gains for women in global health leadership positions, an increase in caregiving responsibilities for women, and more women and girls have been pushed back into extreme poverty than men and boys. Globally, there is still resistance to women serving in senior leadership roles, and social and cultural norms, gender stereotypes, and restrictions on women's rights are deeply intertwined with barriers that reinforce gender inequality in global health leadership. To ensure comprehensive human rights and that equitable workforce opportunities are available, the concept of gender equality must be expanded within the global health community to consistently include not only women and girls and men and boys, but also persons who identify as nonbinary and gender nonconforming. Efforts to eliminate remnants of systemic and structural gender discrimination must also incorporate gender mainstreaming, gender-based analysis, and gender transformative approaches to achieve gender equality throughout global health systems and organizations.