To enhance the performance of health sectors in low- and middle-income countries, public and private health systems need to engage more women in management, leadership and governance roles. Recent studies are presenting data that indicate that the style of leadership needed in modern health systems is more like that exemplified by women rather than men (See CEDPA's From The Ground Up, 2010, and consider a 2013 global study recently published as The Athena Doctrine: Rise of Feminine Values, in which the authors conclude that the world would be a better place if men thought more like women.)

In "A Study of Leadership: Women do it Better than Men," (Zenger and Folkman, 2011), of the 7,280 leaders who had their leadership effectiveness evaluated in 2011, 64% of the data set was male (4651), and 36% was female (2629). The data represents managers and executives who completed an “Extraordinary Leader 360 Assessment” in 2011 (See chart below).

The study finds that men and women indicate that women out perform men in various attributes of leadership such as:

• Initiative
• Drive for results
• Displays high integrity and honesty
• Develops others
• Building team work

Women are shown to have higher scores in emotional intelligence and empathy (e.g., Brackett et al., 2006; Hall, 2006; VanRoowy et al., 2005). Additional reports show that:[1] -

• Women tend to be better than men at empowering staff.
• Women encourage openness and are more accessible.
• Women leaders respond more quickly to calls for assistance.
• Women are more tolerant of differences, so they're more skilled at managing diversity.
• Women identify problems more quickly and more accurately.
• Women are better at defining job expectations and providing feedback.

Health systems need these type leadership traits if we want to achieve significant and sustained performance gains.

So why do we have more women in health sector leadership roles?

What is holding women back?

Many classic challenges remain, including such factors as:

1. Lingering Gender discrimination about roles in the workplace: Promotion bias 2:1 in favor of men at all levels (Smith, 2002); Token women generally suffer slow promotion in male-dominated careers but token men advance quickly in female dominated careers => glass escalator effect (Williams, 1992). Gender pay gap: 21% in the US, 17% in the EU[2]
2. Lack of training opportunities for women in management, leadership and governance
3. Lack of mentoring and persistent ”good-old-boy networks”
4. Sexual harassment that discourages risk taking
5. Family responsibilities: Women’s domestic responsibilities exceed men’s by 2:1 (Bianci et al., 2000). Childcare. An interesting research finding is that employed mothers in 2000 spent as much time interacting with their children as mothers without a job in 1975! But they still think they spend too little time (Bianci et al., 2000). Taking breaks from employment. 37% of professional women voluntarily dropped out of employment at some point in their lives vs. 24% of men (Hewlett & Luce, 2005). Women take time out for “family time,” whereas men take time out to change careers. This has serious implications for women: lost income, impeded career growth, depreciation of skills, and difficulty in reestablishing one’s career.[3]

Health system strengthening strategies must:

• Break down the myths and discriminations
• Invest in more women training, more mentoring opportunities
• Enact rules and regulations for employers about safe work places and acting upon harassment and discrimination
• Change policies in public and private workplaces that demand equal pay and promotion opportunities
• Give more recognition and create award programs for successful women
• Engage men to be visible and continuous champions for women’s equity

What strategies are you finding to be essential to attract, enable and facilitate more women into management, leadership and governance roles within health systems?