Understanding women’s leadership in health sector; findings of a qualitative study in Kerala, India

Abstract

Abstract Background The lack of women's representation in health and medicine, especially in leadership positions, is a major global challenge. An exception to this is the state of Kerala in India, where female representation is high, defying national trends. We undertook a study to understand the contexts undergirding women's rise to leadership in Kerala and their experiences in leadership. Methods We employed a qualitative research methodology like in-depth interviews. We identified 16 women by peer nomination (respondent-driven sampling) or from public records as leaders in health, working in Kerala's health system, in civil society or political leaders dealing with health issues. Following informed consent procedures, interviews were carried out seeking to understand the work-life balance, challenges, gender norms, motivation and leadership styles of participants. Transliterated English transcripts were analyzed by three researchers using a thematic analysis approach and Atlas.Ti8 software. Results Participants were aged 42 years and older, with between 19 and 60 years of occupying senior managerial positions in different levels. Most emphasized family members' influence and support for their leadership roles. Their work in communities and in primary care was described as formative. Women leaders reported a combination of leadership styles to accommodate and adapt to varying circumstances, emphasizing motivation and coalition building. Challenges like false allegations, non-recognition of competence and discrimination were overcome through self-determination and perseverance. Conclusions Kerala women leaders have faced hardships and challenges and rely on reflexive and variable strategies. They have climbed up the ranks and developed their leadership styles mindful of and benefitting from the maintenance of community and family relationships, suggesting a different kind of leadership model altogether. Key messages Women leaders from Kerala’s health sector have faced unique challenges. Women leaders from the health sector have addressed different challenges by developing a hybrid, distinct leadership style.