Gender equality refers to the equitable enjoyment of rights, socially valued goods, opportunities, rewards, resources and life prospects by groups of females and males of all ages regardless of sexual orientation or gender identity. Equality does not mean that women and men are the same but that their enjoyment of rights, opportunities and life chances are not governed or limited by whether they were born female or male.
Gender equality is central to the realization of human rights and key to effective and sustainable development outcomes. Societies will develop effectively and sustainably only when women and men enjoy equitable opportunity to rise to their potential, shape their own lives and contribute to their families and communities. Over the past two decades, investments have been made in reducing gender gaps across every global development goal – from education to economic inclusion. However, substantial inequalities remain across many sectors.
The health sector is one of the biggest and fastest growing employers of women globally, with women constituting approximately 75% of the global health workforce. Yet, they tend to be the majority in the lower cadres and hold the minority in leadership roles. For instance; of all health ministers globally, only 27% are women; in the European region, only 30% are women; out of 54 African ministers for health, only 13 are women.
Additionally, although women’s representation among the higher wage health care occupations (i.e. physicians, dentists and pharmacists) seems to have increased by about 13% in the last two decades, there still exists gender-related gaps in pay, with female health workers earning 26% – 36% less than their male counterparts. This pay differential has been attributed to a wide array of factors, including divergent working hours between men and women, fewer opportunities for career advancement, under-representation in senior positions, gender discrimination, and occupational segregation. A World Health Organization (WHO) analysis of 104 countries on gender equity in the health workforce over the last 18 years showed that: in Europe, male physicians are more than twice as likely as females to be in the highest income category; in Africa, women constitute only 28% of physicians, but 65% of nurses; for most occupations and regions, men have higher average working hours per week than women, with more part-time jobs occupied by women; on the share of health workforce by sector (public or private), men are more likely to be employed for higher wage occupations in the private sector, whereas women are more likely to obtain lower paid private sector jobs, which tend to offer less job security and favour part-time employment.
While gender issues have been at the top of the global agenda, few comprehensive studies exist on gender equality in the health workforce in Nigeria. However, various discourses around gender equality in Nigeria’s health sector reveal the alarming male-female imbalances in the Nigerian health workforce, with under-representation of females in leadership roles identified as the biggest gap.
For instance, the Nigerian government has appointed a female minister for health only once, only 5 out of 36 current state commissioners for health in Nigeria are female, there are more males than females in the appointments of chief medical directors for federal teaching hospitals and federal medical centres, there are more male than female doctors, more female than male nurses, and volunteer (unpaid) community health workers are mostly women.
Why is it imperative now more than ever, to address gender inequality in the Nigerian health workforce?
The WHO Global Strategy on Human Resources for Health predicts a global shortage of almost 18 million health workers needed to reach Universal Health Coverage by 2030, primarily in low- and lower middle-income countries. Unequal opportunities and gender discrimination in the health workforce, if not addressed, will continue to impede efforts to develop, efficiently deploy, and fairly compensate health workers with a consequent health worker maldistribution, workplace absenteeism, poor motivation, and attrition, all of which can negatively impact the provision of quality health care.
In addition, the WHO Sustainable Development Goal (SDG) health price tag study estimates that almost half of the investment required to achieve the health SDGs relates to education, training and employment of health workers. Thus, pursuing more effective, evidence-based investments in gender equality in the health workforce will not only enable better training and deployment of health workers, but will reduce attrition, strengthen health systems, and ultimately improve Nigeria’s prospects of achieving Universal Health Coverage (UHC).
Furthermore, the United Nations Secretary-General’s High-Level Commission on Health Employment and Economic Growth posits that, investments in the health workforce have a powerful multiplier effect on economic growth and can contribute to maximizing women’s economic empowerment and participation.
Therefore, addressing gender inequality in the health workforce will not only contribute to the country’s achievement of universal health coverage and global health security, but will foster the empowerment of women through the institutionalization of their participation in leadership and decision-making, and addressing gender biases in the health labour market.
What will it take to achieve gender equality in the Nigerian health workforce?
Globally, significant political discussions have taken place on the need to increase political commitments to gender equity and implement gender transformative policies within the health sector. The 2019 Political Declaration for the UN High-Level Meeting on Universal Health Coverage recognizing gender equality as both a prerequisite for and consequence of effective and equitable universal health systems, calls for gender mainstreaming when designing, implementing and monitoring all health policies, the provision of better opportunities and working environments for women, the elimination of gender discrimination, segregation and unequal remuneration, and improving female participation in leadership and decision-making roles.
So far, Nigeria has made some progress towards the institution of some of these strategies, like its extension of paid maternity leave from 3 months to 4 months in the public sector, with Ekiti, Enugu and Lagos states even going a step further to increase it to 6 months.
However, there is still much to be done to increase political commitments to gender equity and implement gender transformative policies within the health sector. Nigeria will benefit from a whole system change to address gender bias, discrimination, occupational segregation, pay gaps, unequal opportunities, sexual harassment and assault, from recruitment to retention. Some of the strategic measures health workforce leaders can take to inform gender-transformative policies, positions, or programs in the country include:
- Developing and implementing inclusive and diverse gender-sensitive policies which include direct and purposeful steps to address gender inequities and imbalances across training, recruitment, male-female wage structuring, harassment and assault, occupational segregation, leadership and decision-making
- Restructuring education systems to culturally transform society by training more women in health care occupations that are traditionally dominated by men
- Creating work settings and enabling environments for women to thrive and advance professionally. This would translate to increased paid maternity and paternity leave (to allow for the burden of childcare to be shared between both men and women, thus affording the woman more bandwidth for her career), flexible work options, designing workspaces to cater to women’s needs (e.g. breastfeeding)
- Instituting workplace leadership or mentorship programs for early career women to intentionally educate, train, and prepare the next generation of healthcare women leaders
- Instituting mechanisms that strongly discourage sexual harassment of female health workers by cultivating an enabling environment for victims to speak up and taking stronger disciplinary actions against culprits
- Promoting partnerships with more male advocates who would intentionally drive the development and institution of gender equality policies both at the highest levels and in their healthcare organizations
- Establishing public-private partnerships that will guarantee gender parity
- Increasing evidence generation to fully understand the gender imbalances and address the paucity of data
- Investing in evaluation and intervention-based research to assess the effectiveness of policies in reducing gender gaps
Fundamental to all these strategies, is the need to increase the presence and participation of women in health care leadership roles who can facilitate the institution of gender equal policies, programs and practices because as Iyadunni Olubode, the Nigeria Country Director, MSD for Mothers, said, “if women are not at the table, their interests cannot be adequately understood and addressed”.
Reviewed by: Folake Oni
 WHO, OHCHR, SIDA. Human Rights and Gender Equality in Health Sector Strategies, 2011. https://www.ohchr.org/Documents/Publications/HRandGenderEqualityinHealthSectorStrategies.pdf
 Capital Business. Meet the thirteen female health ministers leading the fight against COVID 19, 2020. https://www.capitalfm.co.ke/business/2020/04/meet-the-13-female-health-ministers-in-africa-leading-the-fight-against-covid-19-pandemic/
 Matthew, B., Michelle M., Lihui X., et al. Gender equity in the health workforce: Analysis of 104 countries, 2019. https://apps.who.int/iris/bitstream/handle/10665/311314/WHO-HIS-HWF-Gender-WP1-2019.1-eng.pdf
 Nigeria Health Watch. Elevate women’s voices: Nigeria’s health sector must become equal for all, 2020. https://nigeriahealthwatch.com/elevate-womens-voices-nigerias-health-sector-must-become-eachforequal-iwd2020/#.XqedfmhKg2w
 WHS 2019: Gender Equality within the Global Health Workforce. Women in Global Health, November 6, 2019. https://www.womeningh.org/single-post/2019/11/06/WHS-2019-Gender-Equality-within-the-Global-Health-Workforce
Alive and Thrive. Maternity projections in Nigeria: An investment in a healthier, productive workforce and a stronger economy, 2018. https://www.aliveandthrive.org/wp-content/uploads/2018/07/NigeriaPolicyBriefs_Maternity.pdf