Abstract
BackgroundThe feminisation of the global health workforce presents a unique challenge for human resource policy and health sector reform which requires an explicit gender focus. Relatively little is known about changes in the gender composition of the health workforce and its impact on drivers of global health workforce dynamics such as wage conditions. In this article, we use a gender analysis to explore if the feminisation of the global health workforce leads to a deterioration of wage conditions in health.MethodsWe performed an exploratory, time series analysis of gender disaggregated WageIndicator data. We explored global gender trends, wage gaps and wage conditions over time in selected health occupations. We analysed a sample of 25 countries over 9 years between 2006 and 2014, containing data from 970,894 individuals, with 79,633 participants working in health occupations (48,282 of which reported wage data). We reported by year, country income level and health occupation grouping.ResultsThe health workforce is feminising, particularly in lower- and upper-middle-income countries. This was associated with a wage gap for women of 26 to 36% less than men, which increased over time. In lower- and upper-middle-income countries, an increasing proportion of women in the health workforce was associated with an increasing gender wage gap and decreasing wage conditions. The gender wage gap was pronounced in both clinical and allied health professions and over lower-middle-, upper-middle- and high-income countries, although the largest gender wage gaps were seen in allied healthcare occupations in lower-middle-income countries.ConclusionThese results, if a true reflection of the global health workforce, have significant implications for health policy and planning and highlight tensions between current, purely economic, framing of health workforce dynamics and the need for more extensive gender analysis. They also highlight the value of a more nuanced approach to health workforce planning that is gender sensitive, specific to countries’ levels of development, and considers specific health occupations.
Highlights
The feminisation of the health workforce—the movement of women into occupations where they were formally under-represented [1]– is a phenomenon that has been extensively documented in global health research [1,2,3,4,5,6,7,8,9,10,11,12,13]
We present the trends of the global health workforce with an explicit focus on gender and examine if and how these trends are associated with changing wage conditions over time
A significant increase in the health workforce gender ratio occurred in upper-middle-income countries, which may reflect the growth of the health sector as well greater opportunities for women to enter the health workforce
Summary
The feminisation of the health workforce—the movement of women into occupations where they were formally under-represented [1]– is a phenomenon that has been extensively documented in global health research [1,2,3,4,5,6,7,8,9,10,11,12,13]. Women have moved from exclusion from the profession to the majority of medical graduates in many countries around the world [2, 3]. Women comprise approximately 75% of the global health workforce [11], and over 90% of nursing and midwifery professions [12]. Little is known about changes in the gender composition of the health workforce and its impact on drivers of global health workforce dynamics such as wage conditions. We use a gender analysis to explore if the feminisation of the global health workforce leads to a deterioration of wage conditions in health
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