Abstract
Women comprise a significant proportion of the health workforce globally but remain under-represented in the higher professional categories. Concern about the under-representation of women in health leadership positions has resulted in increased research on the topic, although this research has focused primarily on high-income countries. An improved understanding of the career trajectories and experiences of healthcare leaders in low- and middle-income countries (LMICs), and the role of gender, is therefore needed. This qualitative case study was undertaken in two counties in coastal Kenya. Drawing on the life-history approach, 12 male and 13 female healthcare leaders were interviewed between August 2015 and July 2016 on their career progression and related experiences. Although gender was not spontaneously identified as a significant influence, closer exploration of responses revealed that gendered factors played an important role. Most fundamentally, women’s role as child bearers and gendered societal expectations including child nurturing and other domestic responsibilities can influence their ability to take up leadership opportunities, and their selection and appointment as leaders. Women’s selection and appointment as leaders may also be influenced by positive discrimination policies (in favour of women), and by perceptions of women and men as having different leadership styles (against women, who some described as more emotive and reactive). These gendered influences intersect in relatively invisible ways with other factors more readily identified by respondents to influence their progression and experience. These factors included: professional cadre, with doctors more likely to be selected into leadership roles; and personal and professional support systems ranging from family support and role models, through to professional mentorship and continuing education. We discuss the implications of these findings for policy, practice and research, including highlighting the need for more in-depth intersectionality analyses of leadership experience in LMICs.
Highlights
Strong leadership and management are crucial for building robust health systems that are responsive to population needs [Hogan et al, 1994; Conger and Kanungo, 1998; Lord and Maher, 2002; International Labour Organization (ILO), 2012; Daire et al, 2014]
Effective leadership and management are especially critical in lowand middle-income country (LMIC) settings where health systems face complex challenges including fragility, resource scarcity and high disease burdens
We identified only one study focusing on the role of gender in health leadership in a middleincome country (Tlaiss, 2013); a study undertaken in Lebanon to explore impediments and enablers of Middle Eastern women’s career advancement in the health sector
Summary
Strong leadership and management are crucial for building robust health systems that are responsive to population needs [Hogan et al, 1994; Conger and Kanungo, 1998; Lord and Maher, 2002; International Labour Organization (ILO), 2012; Daire et al, 2014]. Effective leadership and management are especially critical in lowand middle-income country (LMIC) settings where health systems face complex challenges including fragility, resource scarcity and high disease burdens. Despite increased efforts at global, regional and country level to promote gender equality and women’s empowerment, women continue to be under-represented in leadership positions across a range of sectors and geographic regions (ILO, 2012). Concern about this under-representation of women in leadership and managerial positions has resulted in increased research interest around gender and leadership (ILO, 2012). Much of this research has been conducted in corporate and high-income settings (Eagly and Karau, 2002; Hatcher, 2003; Foundation of the American College of Healthcare Executives, 2006; Sanchez-Hucles and Davis, 2010; Koenig et al, 2011; Minelgaite Snaebjornsson and Edvardsson, 2012; Katila and Eriksson, 2013; Askehave and Zethsen, 2014; Sabharwal, 2015)
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