What health systems research in India has taught us about workplace gender issues...the world over

Based on a recent study on gender and health systems strengthening, our experts reflect on gender inequities faced by the female healthcare workforce and how it resonates with challenges faced by women across sectors globally.


Our reimagined feminist leadership principles:

  • Respect
  • Self-awareness
  • Power-sharing
  • Transparency
  • Equity
  • Enablement
  • Mentoring
  • Balance

It is 2023 and we are still talking about equal rights and opportunities for all, and this is especially pervasive in workplaces all over the world. Despite years of progress in the fight for gender equality, women continue to face a range of challenges that limit their professional growth and development. From pay gaps to the lack of representation in leadership positions, these biases can have a significant impact on women's careers and their ability to succeed in their chosen fields.

In our recent study on gender and health systems strengthening (GHSS), the gender inequities faced by the female healthcare workforce were documented in depth. This study shed light on the direct influence of these biases on their performance and the adverse effects it brought to the provision of healthcare services. Interestingly, the learnings from this study resonate with a lot of issues faced by women across workplaces worldwide. Gender deficit in leadership, poor working environment and work policies, gender pay gap, sexual harassment and abuse at workplaces was among the most emergent issues. While much is known about the other issues, the research brought out some interesting perspectives on what gender leadership might mean and how it may need to be redefined.

Replacing male leaders with female counterparts may not work

Women constitute almost half the population of the world and it’s only right that they are equally represented in leadership positions across sectors. According to the Global Gender Gap Report, in 2022, only 36.9% of the leadership positions were held by women worldwide. However, it is not enough to simply have female leaders who are exact replicas of male leaders. The learnings from the GHSS study indicate that the pervasive gender-biased cultures within health systems consider men to be superior to women, irrespective of seniority, and are not receptive to female leadership. Internalised subservient beliefs and behaviours coupled with a lack of leadership and communication skills, render women underprepared for the demands of leadership positions.  According to an expert in the study, female leaders are often mere figureheads, as demonstrated by the example of a nursing advisor to the government who lacks the autonomy and authority to effectively represent the concerns of nursing personnel or push for institutional reforms. This highlights that current leadership positions are typically moulded around male norms, and only accepts female leaders who conform to patriarchal values. Women shouldn’t be elevated to leadership roles as mere proxies to male leaders but need to be empowered and enabled to identify and respond to gendered needs without perpetuating the existing value systems.

Gender-responsive leadership is the need of the hour

As many of the experts from the GHSS study pointed out, gender responsive leadership is not about who occupies the leadership position but what type of leadership is practised. An expert during the study quoted his idea of gender responsive leadership - ‘…A leadership where a lot of thought is put into decision making in a much more transparent and non-hierarchical way even if you are leading. Giving space to people in your teams to weigh in, to mentoring where a person kind of proactively supports mentoring the junior and the early career folk in your team and the organisation. Really creating institutions that support the idea of flexible work hours, allowing both men and women to take time off for childcare or family leaves care…’. This goes to say that to enable more gender responsive leadership – the idea of leadership may need to be redefined to effectively reflect the feminist principle of leadership – reflecting the spirit of transparency, equity, enablement, mentoring and allowing for both men and women to balance their dual responsibilities. Women in leadership roles need to imbibe these ideas and build their leadership capacities at early stages of their careers.

Creating an enabling environment

Female leadership may not emerge intuitively given the deeply entrenched biases in the system, so it is important that workplaces create enabling environment for fostering gender responsive women leaders. This can be done by providing incremental leadership roles to women and building their capacities over time. Allowing entry into leadership roles during the early stages of their career instils confidence and removes any internalised barriers and hesitations that women might have. Workplace systems should further support women leaders with policy provisions which include childcare support, opportunities to build technical capacities on the job, work-life balance, etc. As illustrated by an expert in the study, in India's health sector, a nursing officer can only become a senior nursing officer after 15 years of service, which is close to retirement while doctors have timely career advancement opportunities every two to five years. Thus, experts suggest that creating leadership positions for women is not enough without conducive career pathways.

Diversity among leaders and distributive leadership style becomes crucial

The health systems in India often have centralised leadership, where one person holds decision-making authority. Experts from the field suggest that this model of leadership needs to be rethought, and a more distributed, teamwork-based leadership be advocated. They argue that effective leadership of a service delivery system involves recognising the importance of teamwork, and that doctors must realise that they cannot function without nurses. Distributed leadership will help women manage their dual responsibilities more effectively, as it develops a shared sense of accountability.

Adopting a more collaborative style of leadership with different cadres in the workspace will eventually help break the hierarchical dynamics. As seen in the case of nurse-led AMRIT clinics, where promoting staff engagement, effective communication, and sharing of clearly defined responsibilities between healthcare providers helped build collaboration and mutual respect, strengthening the capacity of nurses in delivering services. This study also found that service providers whose managers promote teamwork are statistically more likely to have higher motivation, as well as to report that their work climate is optimal.


In short, it is in everyone’s interest to change the status quo as gender-based disadvantages affect not only the female workforce, but also have direct implications on the functioning and quality of work. While the disentanglement of gender power relations and professional hierarchy is not easy, systems in workplaces can begin with implementing strategies to tackle gender biases at different levels, beyond mere tokenism, to institutionalise practices and provisions that are systemic and substantive. And yes, gender-related changes, whether focused on making the work culture within facilities more respectful or on building the leadership capacities of women, are gradual and effected over a long timeframe, but it is critical that it begins.


Riya Rajesh is a Research Assistant.

Priya Das is a Principal Consultant.

Dipti Bapat is a Consultant.

Shruti Negi is a Research Assistant.

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