Opinion: Time to let a woman lead the WHO Eastern Mediterranean Regional Office

The WHO’s Eastern Mediterranean Regional Office is gearing up to elect its new regional director in the lead-up to next week’s World Health Assembly in Geneva.

In the WHO’s headquarters, the 2017 election of Dr. Tedros Adhanom Ghebreyesus promised a new approach and renewed focus on gender equality both in WHO’s leadership and programming — an approach based on the understanding that gender equality is smart global health. While gender parity has been achieved in leadership at WHO headquarters, it has not been matched by similar progress in all regional levels.

Four out of six WHO regional directors are women — yet all five of the Eastern Mediterranean Regional Office’s regional directors since its establishment in 1949 have been men.

After nearly 70 years of male leadership in EMRO, it is time to ask: Why elect another man as regional director of EMRO, when appointing a female regional director would show that this region of WHO is shifting its mindset?

Gender equality is critical for health in the EMRO region

WHO EMRO serves 21 United Nations member states and Palestine — a population of nearly 583 million people. These countries are highly diverse, and range from some of the richest countries in the world such as Qatar and Kuwait, to some of the poorest, including Yemen and Sudan. Many countries in the region are currently affected by conflict, including Syria, and others are emerging from conflict, such as Afghanistan.

Despite advances in the region since EMRO was established, many countries score low on indices of gender equality.

In 2015, only four countries in the EMRO region were ranked among the top 50 countries globally on the UNDP Gender Inequality Index, and none made it into the top 25. Seven EMRO countries had female labor force participation rates of 20 percent or less in 2015 (that figure reflects women’s autonomy and access to income, but does not factor in unpaid work). And the maternal mortality rate among EMRO countries ranged from four maternal deaths per 100,000 births in Kuwait, to 396 per 100,000 in Afghanistan in 2015.

All of this points to a critical need for the region to prioritize both women’s health and gender equality as a key determinant of women’s health.

Currently, at the global level, women make up around 70 percent of the global health and social care workforce. In the Eastern Mediterranean Region, regional female doctors, nurses, midwives, and community health workers play a vital role on the frontlines of health, delivering health and social care to millions, often in insecure and high-risk contexts. Yet only six out of 21 — about 28 percent — of EMRO ministers of health in 2018 are women, and eight out of 18 — about 44 percent — of WHO EMRO head of country offices staff are women.

In most regions of the world, female medical students now outnumber their male counterparts. And although this is the case in only some of the EMRO region, it is a growing trend. Female medical postgraduates, for example, have outnumbered their male counterparts in Kuwait since 1993, and a recent study in Oman showed that, in 2015, 61.5 percent of graduate resident doctors were female.

These figures partly reflect a culturally gendered trend in some EMRO countries for women to study at local universities while their brothers travel overseas. The entry of large numbers of women into medicine also reflects a cultural taboo in some socially conservative societies against female patients consulting male health providers. Where this is the case, it is especially critical for women and men to work in equal numbers in health and social care to reach all sections of the population — especially if the region is to achieve universal health coverage.

It is critical that women’s contribution to the health and social care sector in EMRO be recognized, counted, and enabled. Currently, as elsewhere in the world, women working in health are clustered into particular specialisms and sectors (often lower status and lower paid), and women are not equally represented in decision-making positions. Typically, the health sector is staffed by women and led by men, leaving health systems undermined by a loss of talent diverse perspectives.

The race for the next EMRO regional director

The race for the next regional director of EMRO is reaching its final stages, and women are already handicapped, with female candidates outnumbered four to one by male candidates.  Eight candidates for the RD post have been proposed by member states from EMRO, two women and six men.

This is also the first time in history women are running for the EMRO RD position. This does not reflect the role played by women in the largely feminized health and social care profession. The process has also not followed the more transparent precedent set by the race for the position of WHO director-general in 2017 where candidates set out their manifestos, were interrogated by civil society and member states and where the candidate selected could later be held to account for the commitments they made.

In the race for the WHO director-general, those commitments included promises on gender equality and women’s health since both are critical to delivery of global health goals.

Our asks

In deciding which candidate to vote for as EMRO regional director at the World Health Assembly, Women in Global Health ask the following:

1. Member states must recognize the role of women as drivers of change in health in EMRO. 

2. Member states must recognize that gender equality is smart for global health everywhere, but particularly in EMRO given the needs and cultural norms of many countries in the region.

3. Member states must recognize the importance of women leaders as role models for both men and women in health. The fundamental change needed to deliver quality health and social care to diverse EMRO countries and to reach universal health coverage will not be achieved by business as usual. Diverse ideas and new models of leadership are needed.

4. Member states should interrogate candidates specifically on their records promoting gender equality, ask how they propose to achieve gender equality in health in EMRO, and ask for specific commitments — and later hold the selected candidate to account.

5. Candidates for EMRO regional director must declare their commitments to gender equality and state what they will do to lead change to achieve gender equality within WHO EMRO and to support the countries of the EMRO region in this area. 

6. Civil society organizations in EMRO must work in countries and at the regional level to stress to governments the importance of electing a gender transformative leader as the next EMRO regional director.

7. Member states must make decisions based on technical, professional merit and integrity, not politics.

In previous competitions for leadership posts in global health, the question asked has often been: Why give the job to a woman? But after nearly 70 years of male regional directors in WHO’s EMRO, the question should be: Why another man?