Inspiring change: women’s leadership in health care is vital during the COVID-19 pandemic and beyond

COVID-19 continues to exacerbate existing inequalities and place a disproportionate burden on women, including in health-care settings. Women health workers are faced with increased workloads, a gender pay gap, shortages of personal protective equipment that fits them, and harassment and violence as they respond to the pandemic on the frontlines.

Although women make up 70% of the health workforce, they hold only 25% of senior roles.

“The pandemic has been a setback to the advancement and progress of women. Many women find themselves in an impossible situation of having to assume multiple care responsibilities at home and outside the household. We are extremely concerned about the impact that the pandemic has had on the mental health and well-being of women in the health workforce and beyond,” says Dr Natasha Azzopardi-Muscat, Director of the Division of Country Health Policies and Systems at WHO/Europe.

Here, 4 women holding influential leadership positions across the WHO European Region share their experiences and call for change.

“Life had to be changed in a day”

Dr Marija Zdravkovic is Chief Executive Officer (CEO) of the University Hospital Medical Center Bezanijska Kosa in Belgrade, Serbia, where she has worked for over 22 years. In her role, she has not only witnessed but also managed first-hand the challenges posed by the pandemic in a health-care setting.

“In June 2020, our hospital started working as a COVID-only centre, and this period has been very challenging for all staff at the hospital and, of course, for me as the CEO. Once we moved to full COVID mode, we had less than 24 hours to move 248 non-COVID patients to other hospitals and make all epidemiological preparations to operate as the main COVID centre for the entire Belgrade region. But we did it successfully,” says Dr Zdravkovic.

Health workers have experienced high levels of depression, anxiety, insomnia and distress as a result of responding to the pandemic. Women health workers have been disproportionately affected.

“The main goal was to organize work. In order to make an optimal organization, we set working hours of 6 hours in standard care and 4 hours in the intensive care unit. This was important because we wanted to have doctors and nurses completely concentrate on the patients and avoid exhaustion, because we didn’t know how long it would all last. Life had to be changed in a day,” explains Dr Zdravkovic.

Dr Zhamilya Abeuova, Director of the Enbekshikazakh Multidisciplinary Interdistrict Hospital in the Almaty Region of Kazakhstan, echoes Dr Zdravkovic’s experiences. “The pandemic has created an unprecedented health system environment. In a short time, we retrained the entire medical staff of the polyclinic, hospitals, primary health-care centres and the infectious diseases department,” she says.

“Our work has become more intense because we are now mainly prioritizing emergency surgeries and more complex operations. The pace of change was fast and we are constantly learning and adapting,” says Dr Deborah McNamara, Consultant General and Colorectal Surgeon at the Beaumont Hospital in Dublin, Ireland.

“I have also been involved in designing national policies to help surgeons through this period, to ensure they and their teams are safe, and keep our patients safe. I am still motivated by every patient that I see, and being able to do something to radically change and improve their life,” Dr McNamara adds.

Breaking stereotypes

Gender inequality and patriarchal attitudes and stereotypes in medical training, at work and across society mean that women in health care earn less and are less likely to advance in their careers, often due to having multiple care responsibilities.

As Chair of Ireland’s Royal College of Surgeons working group on improving gender equality in surgery, Dr McNamara and her team found multiple barriers to women’s career progression in surgery, which remains a male-dominated field. Currently, women make up only 7% of surgical consultants in Ireland.

“We found that even students in school have a clear perception about who is a surgeon and what a surgeon looks like. And often they are not thinking of women when they think of a surgeon. Many women medical students didn’t even consider a career in surgery,” she says.

Yet Dr McNamara points out, “In the last couple of years, I’ve had the pleasure of seeing women consultant surgeons appointed around the country, including in my own hospital. It has been superb to see that women have progressed, supported by the work that we’ve done investing in measuring the gender gaps as well as training and mentoring.”

While there has been progress, the pace of change for gender equality continues to stagnate.

“The media plays a major role and needs to do more to promote women’s leadership and to avoid inappropriate and misogynistic comments. We need to start promoting gender equality at an early age, starting from kindergartens, schools and universities, including in health management education,” notes Dr Zdravkovic from Serbia.

Strengthening women’s voices in leadership

Women deliver global health while men design and lead it. Women remain largely absent from national or global decision-making on the COVID-19 response.

“Here, women are represented at all levels, from practical to mid-level executives. However, this is not the case in all areas – in the management system of the civil service in Kazakhstan, women traditionally occupy grassroots positions, while men are widely represented in managerial positions,” Dr Abeuova says.

“And if our society values typical male leadership, it is very hard for women’s leadership to be heard because of the norms in our societies,” adds Dr McNamara, who has been a mentor and an inspiring figure for fellow women surgeons throughout her career. “The visibility of women in leadership positions and being prepared to stand up for younger colleagues who may be facing difficult times in their career are important.”

“We need women and men in leadership together because we bring different experiences and perspectives around the table. We need women in leadership at all levels of management, from local to regional, national and global – in all sectors. This is especially important in public health, where we make decisions affecting the lives of millions on a daily basis,” Dr Natasha Azzopardi-Muscat concludes.