Health workers are the beating heart of every health system and the majority - seventy percent - are women. Global demand for health workers is rising. Changing demographics and expanding health systems are driving the creation of 40 million new health and social sector jobs by 2030. In parallel, low- and middle- income countries will be short of 18 million health workers to achieve universal health coverage (UHC).
At the heart of WHO’s new five-year strategic plan are the “triple billion” targets: one billion more people benefiting from universal health coverage; one billion more people better protected from health emergencies; and one billion more people enjoying better health and well-being. To achieve those targets we need a fit for purpose, robust health workforce. The global mismatch between the supply and demand of health workers is both a cause for concern and a potential opportunity. The opportunity for transformative change to challenge the gender inequities that constrain the health workforce is voiced in both a report and a working paper being launched by WHO this week at the 63rd Commission on the Status of Women.
The report “Delivered by women, led by men: A gender and equity analysis of the global health and social workforce”, co-produced by WHO and Women in Global Health, confirms that women health workers are concentrated into lower status, lower paid and often, unpaid roles, facing harsh realities of gender bias and harassment. The working paper “Gender equity in the health workforce: An analysis of 104 countries” uses recent health workforce data to provide robust estimates of female participation in the health workforce, occupational segregation by gender and the gender pay gap.
The barriers faced by female health workers undermine their well-being and livelihoods, hold back broader gender equality and negatively impact health systems. We need a stronger and more equal foundation for the health systems that serve us all. This is within our grasp. By taking advantage of the rapid growth in health employment, especially for young women, there is potential for large-scale economic and equity impacts through the implementation of gender-transformative strategies for the health and social workforce. Investments in the health workforce results in women’s economic empowerment and an estimated 9:1 return on investment.
The report highlights occupational segregation by gender in the health sector that is both deep and universal. The clearest example is that 24 million of the 28.5 million nurses and midwives globally are women. Men, on the other hand, are more likely to be physicians and specialists than women. In addition, more men reach leadership positions, leaving women underrepresented in senior, higher-paid roles. The working paper shows increasing participation of women in highly paid occupations in health, a trend likely to continue over the next 20 years. That, however, cannot be taken for granted and much remains to be done. The result of this occupational segregation by gender is that health systems miss out on female talent and perspectives in particular specialisms and in leadership. Health systems are stronger when the women who deliver them have an equal say in the design and delivery of the systems they know best.
Occupational segregation does more than rob sectors and systems of talent, it drives a gender pay gap that is larger than in many other economic sectors. Women in the health care sector earn on average 28% less than men with occupational segregation alone appearing to drive a 10% pay gap. This gap in earnings, multiplied over a lifetime, translates into poverty in older age for many women.
And outside the formal labour market are the women whose work in health and social care is not even recognised, let alone paid. It is estimated that women in health contribute 5% to global gross domestic product (GDP) (US$ 3 trillion) annually, out of which almost 50% is unrecognised and unpaid. It is an uncomfortable fact that health systems are currently subsidised by the unpaid work done by women and girls delivering care to family and others in their communities. If women were able to participate in the economy equally, it would result in nearly an estimated $160 trillion increase in global GDP or a 21.7% increase in human capital wealth.
The report also points to workplace gender biases, discrimination and inequities that are systemic in the health workforce. Many organizations expect female health workers, for example, to fit into systems designed for male life patterns and gender roles (with no paid maternity leave), and many countries still lack laws on sex discrimination, sexual harassment, equal pay and social protection that underpin gender equality at work. Workplace violence and sexual harassment of female health workers - from male colleagues, male patients and members of the community - is common but often not recorded or reported due to stigma and fear of retaliation. Violence and harassment harms women, limits their ability to do their job caring for others, and causes attrition, low morale and ill-health, and impacts the quality of care.
Given these gaps, gender transformative action is needed to address occupational segregation, leadership, harassment and gender pay gap in the health and social workforce. With a critical push in filling the 18 million jobs that will make or break UHC, the time to commit to investing in Decent Work for women in the health and social care workforce in now.