Dr Diti Pundrik Vyas highlights how structural inequities and cultural norms continue to shape women’s leadership journeys in healthcare, and explores strategies to navigate and overcome these barriers through evidence-based case insights
Dr Diti Pundrik Vyas, Associate Professor, School of Creative Practices and Entrepreneurship, Anant National University
Women and care are more often treated as synonymous. Therefore, it might not be a surprise when we read the World Health Organization’s Gender and Equity Analysis of the Global Health and Social Workforce report, stating that globally, women comprise 7 out of 10 health and social care workers. Particularly in India, in 2023, 29 per cent of doctors, 80 per cent of nursing departments and 100 per cent of Accredited Social Health Activists (ASHAs) were women.
Women are estimated to deliver health care to around 5 billion people globally and contribute US$ 3 trillion annually to global health. However, in this healthcare sector of high visibility, women remain largely segregated vertically and horizontally. With men holding the majority of higher-status roles, women are clustered into lower-status jobs, holding only 5 per cent of leadership roles worldwide and 18 per cent in India. This vertical occupational segregation is worsened by its horizontal counterpart, driven by gender stereotypes, branding nursing or gynaecology as domains for women or surgery/cardiology as domains for men.
Prevalent gender norms, deeply entrenched structural and cultural barriers, limited career advancement options, overt stereotyping, difficulty in achieving work-life balance, limited mentorship and exclusion from key decision-making processes are often cited as reasons for these segregations that stunt women’s rise to leadership positions.
In this context, a state like Kerala outshines others through its women’s empowerment in the health care sector. The higher presence of women in leadership positions of the district administration and health sector of the State has been upheld as a model of how exemplary women’s leadership can harness better healthcare outcomes and enhanced responsiveness in service delivery, especially during trying times such as COVID-19.
While accepting the model of ‘positively deviant’ Kerala, it should be acknowledged that these exemplary women leaders are strewn all across the country. These leaders, sometimes loudly and at other times silently, are loosening the hold of patriarchal norms through their situational leadership styles, adaptive communication, distinctive relationships and commitment building and by sheer self-determination and perseverance. It is crucial to determine the antecedents of their critical leadership, acknowledge their challenges and celebrate and learn from the strategies adopted by them to circumvent these challenges. It is equally important to also bring these evidence-based, context-specific antecedents for discussions to the classrooms of higher education.
The case study ‘Dr Meena and Mission Maternal Health: Building Allies in the Government Hospital (2024) by me in collaboration with Dr Shilpa Jadav, Dr Veena Iyer and Dr Jallavi Panchamia from the Indian Institute of Public Health, Gandhinagar, exactly does this.
Based on the in-depth interviews with a woman leader in a large government hospital in Western India, the case study explores the critical leadership challenges in a healthcare facility/hospital ecosystem, such as infrastructural deficiencies, workforce deficit, healthcare bureaucracy and heavy patient load. It traces the evolution of Dr Meena Sharma (name changed for ethical and privacy reasons) for the effective implementation of the upcoming LaQshya – Labour Room Quality Improvement Initiative by the Ministry of Health & Family Welfare.
Completely dedicated to the cause of LaQshya, Dr Meena strives to put together and motivate her team to work toward improving the quality of care during delivery and the immediate postpartum period at her hospital. As a teaching-learning tool to bring real-life discussions in the management/public health/leadership related course, the case brings to the fore the issues that arise in the organisational leadership for a woman in health, such as adopting an appropriate leadership style and using appropriate motivation and communication strategies for optimal performance. This case study underscores the need to address the challenges of women’s leadership in health and empower women to rise to leadership positions so that they can contribute towards resilient health systems and strengthen health for all.