Inclusive leadership key to closing gender pay gaps in health

Kenyan women in politics made national history by securing a record number of elective seats in the August 9 General Election. According to the National Gender and Equality Commission, Kenyans elected 30 female Members of Parliament, up from 23 in 2017; seven female governors, up from three; and three female senators, the same number elected in 2017 – pushing women’s representation in the upper and lower houses higher than it’s ever been.

While the numbers are still far below the threshold set by the two-thirds gender rule of the Constitution, they mark a significant step towards achieving parity in representation in a country where politics can be a dangerous calling for women. It also marks a subtle yet considerable shift in the face of leadership, despite the hurdles presented by a male-dominated arm of government that has in the recent past appeared determined not to meet the constitutional threshold for gender representation.

Now as President William Ruto settles into his new role as Head of State, it will be interesting to see whether – and how – he makes good on a raft of campaign promises he made to women, which included actualising the two-thirds gender principle, allocating 50 per cent of all Cabinet positions to women, placing women at the centre of decision-making and implementing legislative, policy and budgetary measures to help eliminate gender discrimination in the labour market, as well as introducing an affordable healthcare plan for women and children, among others.

Also read: Gender inequality in healthcare impeding services

Even for the more optimistic among an electorate accustomed to post-election disappointment, the promises are lofty. However, with strong political will and action that considers the value of (gender) diversity, equity, and inclusion, they are achievable.

Equitable development

Having more women in leadership is critical to the achievement of equitable development, especially in key areas such as education, health and economic empowerment as envisioned by the Sustainable Development Goals. In fact, research has shown that increasing the number of women in positions of power not only promotes gender diversity, equity and inclusion, it also improves the health and wellbeing of populations, as women are more likely to influence higher government spending on education, health and social protection.

Tapping into the unique attributes of female leaders could be key to addressing the challenges in Kenya’s fragile health system, which is buckling under the weight of a high burden of disease, inadequate funding, lack of essential medical equipment, facilities and medicine, and a health workforce that is overstretched and poorly motivated and requires management under a health service commission.

Our leaders have a responsibility to work collaboratively to strengthen health systems and actualise national health goals. Fulfilling pledges made to health workers, from building a fit-for-purpose workforce that is highly skilled and equipped, motivated, equitably distributed and responsive to the health needs of Kenyans – alongside investment in other critical health infrastructure – will go a long way in bolstering primary healthcare, which is the building block of any resilient health system.

Further, ensuring transparency in hiring, placement, and remuneration across all cadres of health workers will help close the gender and pay gaps in health. It is a widely acknowledged truth that global health is led by men, but delivered by women, who despite making up 70 per cent of the global health workforce are concentrated in junior ranks.

Here, they are often paid less than their male counterparts or work in unpaid roles, perpetuating gender biases that keep them from growing into senior leadership positions and meaningfully participating in decision-making at the highest levels.

Healthcare gaps

In Kenya, for example, where there are only 13 doctors, nurses and midwives for every 10,000 people (much lower than the World Health Organization’s recommendation of a minimum of 23 per 10,000 population), women made up 76 per cent of nurses in 2019, but men held 62 per cent of faculty positions in health training institutions.

The same year, data from the Kenya Medical Practitioners and Dentists Board (KMPDB) revealed that about 42 per cent of retained doctors were women, and of the 2,284 registered specialists only 696 (30 per cent) were women.

Also read: Gender pay gap: Women earn less and this is why

When you consider that specialists command higher pay than general practitioners and others in stereotypically “female” roles such as nursing, community health work and nutrition, you begin to see why poor compensation is a key contributor to the rising number of trained health workers – many of them women – abandoning careers as practicing health professionals in search of more lucrative jobs.

This is an issue that the government is aware of. According to a 2019 Ministry of Health policy brief on Human Resources for Health, health workers surveyed in 19 counties cited poor salaries, late payment and discrepancies in salaries as the leading causes of demotivation.

Following closely were the lack of promotions and pay rises, little to no opportunities for training and poor working conditions that expose women, especially at junior levels, to verbal and sexual harassment. Sexual harassment and gender discrimination was also identified in the Women Lift Health Discovery analysis as the second top barrier for women in public health in the workplace

The 13^th Parliament has a chance to address these challenges and firmly set us on the path to achieving Universal Health Coverage. And as we reflect on the significance of International Equal Pay Day this September (marked on September 18 of every year), may we celebrate the progress made towards narrowing existing gender and pay gaps in political leadership and health.

May we also take this opportunity to call on our newly elected female leaders to leverage their positions to advocate equal pay for work of equal value for all cadres of health workers, and to remind President Ruto that if he is to deliver on his promise to strengthen access to quality, affordable, accessible and inclusive care for all, he must place women at the centre of decision-making in health and implement the necessary legislative, policy and budgetary measures to close these gaps once and for all.

Dr Norah Obudho, East Africa and Global Health Integration Director, WomenLift Health