Opinion: We must get women into the ‘control room’ in global health

In a speech at the World Health Organization’s executive board meeting last week, Director-General Tedros Adhanom Ghebreyesus said he was “proud of the gender and geographic balance of my leadership team at headquarters.”

Yet this balance is absent from WHO’s executive board, with women accounting for under 10% of the 34 members. We are shocked, outraged, and driven to demand a radical shift toward gender equality in global health governance.

What’s the problem?

WHO’s executive board holds important biannual meetings where leaders make crucial global health decisions that govern the following months and years, with the agency’s financing and a so-called pandemic treaty at the top of last week’s agenda.

Member states alone are responsible for choosing their representatives to the executive board. Up until the COVID-19 pandemic hit, women had made gains in representation, accounting for 32% of board members in early 2020.

Women holding one-third of the seats — still a minority voice in global health governance — is far from satisfactory, but at least the trend was heading toward gender parity. But as the coronavirus spread and deaths rose at an alarming rate, women’s representation began a downward spiral, dropping to 18% at the executive board in 2021 and reaching even lower levels last week.

These numbers are shocking and represent a larger worldwide trend that is reversing advances in gender equality. According to research on global health leadership across 87 countries during the pandemic, 85% of national COVID-19 task forces consisted mostly of men and a mere 3.5% reached gender parity. This is replicated at the political level, with women accounting for fewer than one-third of health ministers in 2020.

Gender stereotypes and discrimination, portraying women as incapable of leading, act as barriers for those wanting to enter into leadership roles. Women health and care workers are typically clustered into lower-status and lower-paid jobs, as nurses, midwives, and community health workers, while men are making decisions as doctors, surgeons, and public health professionals. A lack of access to capacity-building and training opportunities hinders women from obtaining the skills and certification needed to enter into leadership.

On the political front, women are often in lower, less eligible positions on party lists for parliamentary elections, which affect their representation in Parliament and decision-making political roles. These factors are compounded by the intersection with race, class, migratory status, sexual orientation, gender identity, religion, and disability, creating increased barriers for women from marginalized groups and the global south.

Why does it matter?

Women make up 70% of the health and care workforce and 90% of patient-facing roles, and they have been applauded for their contributions to front-line health delivery during the pandemic. Women health and care workers are experts in the communities they serve, with nurses, midwives, and community health workers often the first or only point of contact for patients.

Their firsthand experience means women in leadership are likely to expand public health agendas, prioritizing issues such as sexual and reproductive health services and personal protective equipment designed for female bodies. With more women entering into the leadership space, girls and young women — as well as boys and young men — will have women role models to look up to, breaking the stereotype of men as “natural leaders.”

Sidelining women leads to a loss of expertise that hurts the decision-making process and negatively impacts the health of populations, as women leaders have reportedly implemented particularly effective COVID-19 responses that are both timely and evidence-based. Also, when women are involved, health discussions are more comprehensive. Due to their extensive experience working in health systems, women are more than qualified to make public health decisions.

What can be done?

National policies that mandate quotas to advance gender parity in global health decision-making bodies are effective. Countries must step up and nominate women for WHO’s executive board and other international bodies, such as the forthcoming intergovernmental negotiating body for the pandemic treaty, and nomination processes need to be transparent.

Official development assistance should be tied to performance on gender parity in global forums. Governments must work to provide child care and other gender-responsive mechanisms that enable women to balance their lives and lead. Deliberate action must be taken toward closing the gender pay gap that sees women earning 23% less than their male counterparts.

Two women on WHO's executive board are currently representing the health interests of nearly 4 billion women and girls, and this is unacceptable. Power and privilege must be recognized and disrupted. The systemic bias and discrimination keeping women in subordinate roles within the health and care sector must be ended to ensure that gender is mainstreamed and that global health benefits fully from the talent and expertise of women.