Women hold just one leadership post in four in the healthcare field, according to a team of US-based researchers whose paper was published today (5 February) in the open access journal BMJ Global Health.
The paper’s lead author is Anna Kalbarczyk, who works at the Department of International Health at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
After conducting a review of the available evidence, Dr Kalbarczyk and her colleagues argue that women healthcare leaders are good for a nation’s wealth, health, innovation and ethics. Yet, despite their unique and positive impact, they are a major underused resource – particularly in low and middle income countries.
The researchers call for more and sustained investment to maximise women’s potential and reap the benefits of their contribution. While women constitute 70 per cent of the healthcare workforce as a whole, and 90 per cent of the nursing and midwifery workforce, they hold just 25% of leadership roles, they point out.
Good evidence is emerging that women leaders make a positive difference to maternal and healthcare policies, and to the reduction of health inequalities, but it’s not yet clear what their impact might be on global health, they note.
Focus on global health
To find out, Dr Kalbarczyk and her colleagues carried out a scoping review of peer-reviewed research to map evidence on the impact of women’s leadership in organisations in low and middle income countries, focusing in particular on global health.
A total of 137 relevant articles met the eligibility criteria and were included in the review. A study was tagged positive if it reported an improvement, increase, or benefit of the assessed outcome as a result of women’s leadership. It was tagged negative if it reported a decrease, weakening, or worsening of the assessed outcome. Null results didn’t report any change.
‘Increased and sustained investment in women’s leadership within the health sector can lead to improved outcomes for organisations and their clients’ [Anna Kalbarczyk et al]
Areas of ‘positive influence’
Most of the included studies reported a positive impact of women’s leadership: 119 (97 per cent) were positive and statistically significant; 12 (9 per cent) were positive and statistically insignificant.
Some 35 (26 per cent) reported negative and statistically significant results for particular outcomes, 13 (9 per cent) reported negative and statistically insignificant results and 33 (24 per cent) reported null results.
Dr Kalbarczyk and her colleagues highlighted the following six areas in which women leaders had a positive influence
- financial performance, risk, and stability
- innovation
- engagement with ethical and sustainability initiatives
- health outcomes
- organisational culture and climate, including reputation employee retention, and team cohesion and communication
- influence on other women’s careers and aspirations
Even those studies reporting mixed findings still largely pointed to positive results, particularly when modified by other factors, such as better education, greater levels of experience, and opportunities to work with other women across an organisation.
‘What is less clear is why women leaders have this impact, particularly in the face of overt and covert biases, discrimination, harassment, patriarchal norms, etc,’ note the researchers.
The answer, they suggest, may lie in women’s more effective transformational leadership behaviours and their tendency to use more democratic and participative styles.
‘In all sectors, across leadership roles, and across geographies, women’s leadership can produce positive results. Women leaders’ success, however, cannot be separated from the contexts in which they work, and unsupportive environments can affect the extent to which women leaders can have an impact,’ Dr Kalbarczyk and her fellow researchers state.
And they conclude: ‘Increased and sustained investment in women’s leadership within the health sector can lead to improved outcomes for organisations and their clients.
‘Such investments must not only target individual women, but also seek to foster organisational cultures that promote and retain women leaders and support their independent decision making.’
Change is ‘everyone’s responsibility: linked editorial
In a linked editorial, Jocalyn Clark, The BMJ’s international editor, argues that men’s monopoly on global health leadership is at odds with the scientific evidence. And in the current context of the backlash against rights and equity, diversity, and inclusion efforts, it’s even more important to advocate for gender equality, Dr Clark says.
‘Change is the responsibility of everyone – not just women. But clearly more women appointed to leadership positions could drive transformative change in these biased systems,’ she argues.
To access the full version of the research article – titledA scoping review on the impact of women’s global leadership: evidence to inform health leadership Doi:10.1136/bmjgh-2024-015982 – see: https://globalhealth.bmj.com/lookup/doi/10.1136/bmjgh-2024-015982
To access the full version of the editorial – titled The case for women’s leadership in global health – see: https://www.bmj.com/content/388/bmj.r190
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