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Introduction to ‘Exploring Gender Equality in the Health Workforce: A study in Uganda and Somaliland’

7 August 2019

Whilst women comprise 70% of the global health workforce, delivering care to more than five billion people and contributing $3 trillion to global healthcare annually, they remain critically underrepresented in health leadership and face monumental barriers to promotional and professional advancement opportunities, with only 25% holding leadership positions. On a global scale, systemic gender biases and inequities are undermining our progress towards achieving Universal Health Coverage (UHC), particularly in LMICs.

In 2019, THET conducted a qualitative participatory study in Uganda and Somaliland in an effort to deepen its organisational understanding of the main enabling factors and barriers posed to gender equality and women’s empowerment for health professionals in low- and middle-income countries (LMICs). In Exploring Gender Equality in the Health Workforce we examine the main findings of this study, with a particular focus on the barriers posed to women in accessing health leadership opportunities, and how this intersects with gender discrimination derived from socially engrained perceptions of male and female roles, obligations and qualities.

key findings

In this report we examine a range of structural and agency-related factors that affect gender equality at various levels of the health system in Uganda and Somaliland, from governmental departments, to health facilities and academic institutions. Drawing on personal accounts and analytical explorations at the institutional and system levels, a number of key insights were drawn:

Firstly, the research suggests that unconscious gender biases play a role in hiring and recruitment practices, with favouritism and nepotism along gender lines affording greater opportunities for training, scholarships and promotions to males, particularly in Somaliland.
Secondly, there is evidence to suggest that gendered specialisations within the medical profession often reproduce traditional gender roles, and that the implicit hierarchy of these ascribed gender roles is reflected in patient biases towards male and female medical staff.
Finally, the researchers found that women suffer disproportionately from the dual burden of domestic unpaid care obligations and professional responsibilities – a reality emanating from gendered cultural norms in both Uganda and Somaliland.

While the researchers identified some positive examples of women disrupting stereotypes these cases are still in the minority, and the day-to-day reality of discrimination and imbalance is unfortunately still the norm in Uganda and Somaliland. To overcome gender inequality in the health workforce we need targeted and tailored interventions. In some instances a top-down approach in which management take the lead in implementing facility-wide policies may be appropriate, while in other cases community-wide participatory and consultative awareness raising is necessary. The range of overlapping research findings which came to light in Uganda and Somaliland, and the global relevance of some of these issues – such as the burden of unpaid care responsibilities for women – necessitates a systemic yet context-specific response.

Read the full report here.

“Until we get to a point where it is normal to see 50% or more of women on the board or at senior management, women are still not going to aspire for these positions and men will not accept that women can take these roles…You know how they say equality is giving everyone the same size of ladder to climb, sometimes you need to give the shorter person the taller ladder to climb to be able to see overboard.”

Female doctor - Uganda