Strengthening the Health Worker Pipeline through Gender-Transformative Strategies

A competent health workforce has adequate numbers and types of well-trained and fairly remunerated health workers deployed to where they are most needed. To achieve this, countries have implemented interventions aimed at strengthening preservice education (PSE), including curriculum development, financing, and institutional management reforms. Gender discrimination in PSE settings is a significant issue that affects health professional students and faculty. Forms of gender discrimination include occupational segregation by gender, sexual harassment, and discrimination related to pregnancy and family responsibilities. These forms of discrimination can affect students' opportunities, treatment, and ability to complete their studies, as well as limit faculty members' career satisfaction, advancement, and economic opportunities. Students experience gender discrimination throughout their academic life cycle, including sexual harassment and assault, which are often normalized but not reported. Cultural beliefs and gender norms create environments in which these behaviors are tolerated. Additionally, gender-blind institutional policies and practices prevent or limit female students from participating in classes, practica, and other curricular offerings by failing to consider students' family responsibilities or potential safety issues. Faculty members also experience gender discrimination, including gender segregation within an occupation, which prevents fuller female representation in more senior decision-making positions and professional networks. An academic culture of long working hours and the perception that faculty with family responsibilities are less committed affect decisions about promotions and tenure. Measures to counter gender discrimination include redistributing resources, implementing affirmative action, and allocating resources equally to men and women. Multilevel interventions are needed to target the complex individual, family, organizational, structural, and societal contributors to gender discrimination, inequality, and violence that disrupt the health worker pipeline. Comprehensive family-friendly "bundles" of interventions are key to equalizing opportunities for women and men. These bundles signal that the institution values the ability of both male and female faculty, staff, and students to have a career and a family without professional setbacks. Governments and PSE institutions must take action to produce the robust workforces able to respond to the health needs of the populations they serve. To effectively counter gender discrimination, interventions must be 1) gender-transformative and 2) multilevel and comprehensive. Gender-transformative interventions actively strive to examine, question, and change rigid gender norms and imbalances of power as a means of reaching health as well as gender-equity objectives. These include norms that women can be approached sexually, regardless of the setting, or beliefs related to female employees' commitment or competence. Institutions must end impunity for perpetrators of sexual harassment and strengthen legal protections for women, who also need access to information on their legal rights. Schools and workplaces must be restructured to reflect the value of caregiving for both male and female employees. Establishing a sexual harassment policy and grievance procedure appears to be feasible across resource settings.