“Gender equality and female empowerment are core development objectives, fundamental for the realization of human rights and key to effective and sustainable development outcomes. No society can develop successfully without providing equitable opportunities, resources, and life prospects for males and females so that they can shape their own lives and contribute to their families and communities.”
The production and development of health workers to overcome these health workforce challenges has been a major focus of many governments’ human resources for health (HRH) strategies. Health professional education systems play a pivotal role to developing competent, motivated health workers who are vital to the delivery of high-quality family planning, maternal and child health, HIV/AIDS prevention and treatment, and other essential health services.
“Gender inequalities are systems inefficiencies that contribute to clogged health worker educational pipelines” (Newman 2014, 1). In various contexts around the world, gender discrimination has shown to negatively affect both students and faculty at health professional education institutions, which in turn disrupts the production of health workers. Consider how discrimination due to student pregnancies contributes to higher dropout rates, or how sexual harassment could deter a faculty member from continuing teaching. With fewer health workers at facilities, access to basic services—such as maternal and child health, HIV prevention, treatment and care, and family planning—can be negatively impacted. Having fewer health workers to meet all the health care needs of the surrounding communities also means that the quality of services could be diminished as health workers overextend themselves to meet demand.
Stakeholders from governments and health professional education systems must promote gender equality, equal opportunity, and nondiscrimination to produce robust health workforces able to respond to the needs of the populations they serve.
In education and employment systems, gender discrimination has been directly or indirectly linked to gender stereotyping and discrimination based on caregiver responsibilities, and is manifested in occupational segregation, wage discrimination, and sexual harassment (Newman 2011). Focused on the forms of gender discrimination that affect health professional students and faculty, this tool aims to build capacity and leadership among stakeholders to:
- Better understand how gender discrimination can negatively impact students and faculty
- Consider actions that health professional education institutions and governments can implement to promote gender equality
- Advocate effectively for actions to promote gender equality and nondiscrimination.
Intended users: Ministries of education, deans, administrators and managers from governments and public or private educational institutions, program planners from nongovernmental organizations (NGOs), and other national stakeholders
This tool is part of a series of gender in health and HRH systems:
To learn about gender in the workforce and in health systems in greater depth, consider taking a related eLearning course.
To learn about promoting gender equality in the health workforce, consider reviewing this companion health workforce gender advocacy tool.
To imagine if you were a health professional student, play Vital Pursuit.
This tool is drawn from the CapacityPlus 2012 systematic review, Transforming the Health Worker Pipeline: Interventions to Eliminate Gender Discrimination in Preservice Education (Ng, Newman, and Pacqué-Margolis 2012). The authors compiled over 300 peer-reviewed articles, reports, program documents, and websites from around the world that documented interventions or strategies to counter gender discrimination in higher education. From these resources, 51 specific interventions were identified for review and ranking by an expert panel. The interventions included in this tool are those recommended by expert reviewers, who considered the extent to which the interventions were “gender-transformative.” Gender-transformative approaches are any activities that “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” (USAID Interagency Gender Working Group).
This accompanying technical brief summarizes the systematic review’s approach.
This tool can be used to guide ministries of education, deans, administrators, managers, and other users to implement policy, program, and advocacy interventions to counter gender discrimination at health professional education institutions for improved health workforce development. It is recommended that users navigate the site by following the topics on the top menu bar:
UNDERSTAND the effects of gender discrimination
First, understand how gender discrimination is defined and what forms it may take. Read about health professional students’ and faculty members’ experiences with gender discrimination and gender inequalities in health professional education systems. Find out how different forms of discrimination have negatively affected health professional students and faculty through specific country examples and sex-disaggregated data analyses.
Consider interventions for ACTion
On the Act pages, learn about specific interventions and “basic bundles” (combinations) of interventions that are recommended to promote gender equality and equal opportunity and/or to counter specific forms of gender discrimination.
Develop strategies to ADVOCATE for gender equality and equal opportunity
On the Advocate page, find out the steps to take and tips to remember to launch or strengthen advocacy efforts and promote equal opportunity, nondiscrimination, and gender equality in health professional education systems.
Access RESOURCES to learn more about gender discrimination and the health workforce
The Resources page lists key research, organizations and initiatives, eLearning courses, and resource libraries on gender, health professional education, health workforce, and health systems.
Adusah-Karikari, Augustina. 2008. Experiences of women in higher education: A study of women faculty and administrators in selected public universities in Ghana. PhD diss., Ohio University. https://etd.ohiolink.edu/!etd.send_file?accession=ohiou1210704502&disposition=inline (accessed June 30, 2015).
Association of American Medical Colleges (AAMC) 2015. Report of Residents. https://www.aamc.org/data/421300/residentsreport.html (accessed June 30, 2015).
Arhin, A.O., and E. Cormier. 2008. “Factors influencing decision-making regarding contraception and pregnancy among nursing students.” Nurse Education Today 28, no. 2: 210-217.
Bailey, Rebecca, Desire Kamanzi, and Rachel Deussom. 2012. “Assessment of Nursing and Midwifery Education and the Training Capacity at Seven Training Institutes in the Democratic Republic of Congo: Synthesis Report.” Nursing Education Partnership Initiative: USAID/CapacityPlus.
Bakari, Salihu, and Fiona Leach. 2007. “Hijacking equal opportunity policies in a Nigerian College of Education: The micropolitics of gender.” Women’s Studies International Forum 30: 85-96.
Bardoel, E. Anne, Robert Drago, Brian Cooper, and Carol Colbeck. 2011. “Bias avoidance: Cross-cultural differences in the US and Australian academies.” Gender, Work & Organization 18, Suppl s1: e157-e179.
Best, C.L., D.W. Smith, J.R. Raymond Sr., R.S. Greenberg, and R.K. Crouch. 2010. “Preventing and responding to complaints of sexual harassment in an academic health center: A 10-year review from the Medical University of South Carolina.” Academic Medicine 85, no. 4: 721-727.
Charles, Maria and David B. Grusky. 2004. Occupational Ghettos: The Worldwide Segregation of Women and Men. Stanford: Stanford University Press.
Council on Europe. 2011. Steering committee for equality between women and men (CDEG): Study on combating gender stereotypes in education. Prepared by Maureen Bohan. http://www.coe.int/t/dghl/standardsetting/equality/03themes/gender-mains... (accessed August 25, 2015).
Finch, S.J. 2003. “Pregnancy during residency: A literature review.” Academic Medicine 78, no. 4: 418-428.
George, Asha. 2007. Human resources for health: A gender analysis. Background paper prepared for the Women and Gender Equity Knowledge Network and the Health Systems Knowledge Network of the WHO Commission on the Social Determinants of Health. http://www.who.int/social_determinants/resources/human_resources_for_health_wgkn_2007.pdf (accessed June 30, 2015).
Gerberich, Susan Goodwin, Timothy R. Church, Patricia M. McGovern, Helen Hansen, Nancy M. Nachreiner, Mindy S. Geisser, Andrew D. Ryan, Steven J. Mongin, Gavin D. Watt, and Anne Jurek. 2005. “Risk Factors for Work-Related Assaults on Nurses” Epidemiology, 16:5. September 2005. http://ldihealtheconomist.com/media/nv08.pdf (accessed June 30, 2015).
Gillespie, Gordon Lee, Donna M. Gates, and Peggy Berry. 2013. “Stressful Incidents of Physical Violence Against Emergency Nurses.” OJIN: The Online Journal of Issues in Nursing 18, no. 1: Manuscript 2. http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No1-Jan-2013/Stressful-Incidents-of-Physical-Violence-against-Emergency-Nurses.html (accessed July 15, 2015).
Griffin, Anne-Marea, ed. 2007. Educational pathways in East Africa: Scaling a difficult terrain. Kampala, Uganda: Association for the Advancement of Higher Education and Development (AHEAD). http://library.unesco-iicba.org/English/Girls%20Education/All%20Articles/Higher%20Education/Educational%20pathways%20in%20East%20Africa.pdf (accessed June 30, 2015).
Hubbard, Dianne. 2008. School policy on learner pregnancy in Namibia: Background to reform. Prepared for the Ministry of Education by Gender Research & Advocacy Project Legal Assistance Centre. http://www.lac.org.na/projects/grap/Pdf/learnerpregnancyfull.pdf (accessed June 30, 2015).
Huggins, Allison, and Shirley K. Randell. 2007. Gender equality in education in Rwanda: What is happening to our girls? Paper presented at the South African Association of Women Graduates Conference, Cape Town, South Africa. http://www.academia.edu/6619016/Gender_Equality_in_Education_in_Rwanda_What_is_happening_to_our_Girls_1 (accessed June 30, 2015).
Humphrey, Albert. n.d. Strengths, Weaknesses, Opportunities, and Threats (SWOT) Analysis. http://www.toolshero.com/albert-humphrey/ (accessed June 30, 2015).
Institute of Education, University of London. 2005. Gender Equity in Commonwealth Higher Education, Working Paper 3, 2005, p. 5.
International Labour Office. 2010. Women in labour markets: Measuring progress and identifying challenges. Geneva, Switzerland. http://www.ilo.org/wcmsp5/groups/public/---ed_emp/---emp_elm/---trends/d... (accessed August 25, 2015).
Jagsi, Reeshma, Kent A. Griffith, Rochelle A. DeCastro, and Peter Ubel. 2013. “Sex, Role Models, and Specialty Choices Among Graduates of US Medical Schools in 2006-2008." Journal of the American College of Surgeons. Volume 218, Issue 3:345-352. http://www.journalacs.org/article/S1072-7515(13)01215-5/abstract (accessed June 30, 2015).
Karega, Regina G. Mwatha. 2001. Statistical overview on girls’ education at the university level. Nairobi, Kenya: Forum for African Women Educationists (FAWE).
Larsson, C., G. Hensing, and P. Allebeck. 2003. “Sexual and gender-related harassment in medical education and research training: Results from a Swedish survey.” Medical Education 37, no. 1: 39-50.
Makerere University, Gender Mainstreaming Division. 2011. Mainstreaming gender in university policies – Sex for marks: Derailed academic progress.
Mason, M.A., A. Stacy, M. Goulden, C. Hoffman, and K. Frasch. 2005. University of California faculty family friendly edge: An initiative for tenure-track faculty at the University of California. Report. http://ucfamilyedge.berkeley.edu/ucfamilyedge.pdf (accessed June 30, 2015).
Mirsky, J. 2003. Beyond victims and villains: Addressing sexual violence in the education sector. London, UK: The Panos Institute. http://panos.org.uk/resources/beyond-victims-and-villains/ (accessed June 30, 2015).
Morley, Louise, and Kattie Lussier. 2009. Sex, grades and power: Gender violence in African higher education. Paper presented at Society for Research into Higher Education Annual Conference, South Wales, UK. http://www.srhe.ac.uk/conference2009/abstracts/0068.pdf (accessed June 30, 2015).
Nagata-Kobayashi, S., M. Sekimoto, H. Koyama, W. Yamamoto, E. Goto, O. Fukushima, et al. 2006. “Medical student abuse during clinical clerkships in Japan.” Journal of General Internal Medicine 21, no. 3: 212-218.
Newman, C., A. Kimeu, L. Shamblin, C. Penders, P.A. McQuide and J. Bwonya. 2011. “Making non-discrimination and equal opportunity a reality in Kenya’s health provider education system: Results of a gender analysis.” World Health and Population 13, no. 2: 23-33. http://www.ncbi.nlm.nih.gov/pubmed/22543441 (accessed June 30, 2015).
Newman, Constance, Catherine Murphy, Rebecca Rhodes, and Beth Massie. 2012. Foundations of gender equality in the health workforce. Washington, DC: CapacityPlus. http://www.capacityplus.org/foundations-gender-equality-health-workforce (accessed June 30, 2015). [French version available at http://www.capacityplus.org/fondations-egalite-genres-personnel-de-sante]
Newman, Constance, Crystal Ng, and Sara Pacqué-Margolis. 2012. Strengthening the health worker pipeline through gender-transformative strategies. CapacityPlus Technical brief no. 7. Washington, DC: CapacityPlus/IntraHealth International. http://www.capacityplus.org/strengthening-health-worker-pipeline-through-gender-transformative-strategies (accessed June 30, 2015).
Newman, Constance. 2014. “Time to address gender discrimination and inequality in the health workforce.” Human Resources for Health 12: 25. http://www.human-resources-health.com/content/12/1/25 (accessed June 30, 2015).
Ng, Crystal, Constance Newman, and Sara Pacqué-Margolis. 2012. Transforming the health worker pipeline: Interventions to eliminate gender discrimination in preservice education. Washington, DC: CapacityPlus/IntraHealth International. http://www.capacityplus.org/files/resources/transforming-health-worker-pipeline.pdf (accessed June 30, 2015).
Reed, V., and B. Buddeberg-Fischer. 2001. “Career obstacles for women in medicine: An overview.” Medical Education 35, no. 2: 139-147.
Reichenbach, L., and H. Brown. 2004. “Gender and academic medicine: Impacts on the health workforce.” British Medical Journal 329, no. 7469: 792-795.
Standing, Hilary. 2000. “Gender – a missing dimension in human resource policy and planning for health reforms.” Human Resources Development Journal 4, no. 1: 27-42. http://www.who.int/hrh/en/HRDJ_4_1_04.pdf (accessed June 30, 2015).
Stratton, T.D., M.A. McLaughlin, F.M. Witte, S.E. Fosson, and L.M. Nora. 2005. “Does students’ exposure to gender discrimination and sexual harassment in medical school affect specialty choice and residency program selection?” Academic Medicine 80, no. 4: 400-408.
Tandi, Tinyami Erick, YongMin Cho, Aba Jean-Claude Akam, Chick Ofilia Afoh, Seung Hun Ryu, Mink Seok Choi, KyungHee Kim, and Jae Wook Choi. 2015. “Cameroon public health sector: shortage and inequalities in geographic distribution of health personnel.” International Journal for Equity in Health. 14:43. http://www.equityhealthj.com/content/14/1/43 (accessed July 15, 2015).
UK Department of Health. 2006. Managing attrition rates for student nurses and midwives: A guide to good practice for strategic health authorities and higher education institutions. London, UK: MPET Funding Team & Special Projects, UK Department of Health. http://webarchive.nationalarchives.gov.uk/20080905235643/http://dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073230?IdcService=GET_FILE&dID=136553&Rendition=Web (accessed June 30, 2015).
Unterhalter, Elaine, Emily Kioko-Echessa, Rob Pattman, Rajee Rajagopalan, and Fatmatta N’Jai. 2004. Scaling up girls’ education: Towards a scorecard on girls’ education in the Commonwealth. Beyond Access Project, Institute of Education, University of London and Oxfam Great Britain. http://www.iiav.nl/epublications/2004/scaling_up.pdf (accessed August 25, 2015).
USAID Interagency Gender Working Group. 2012. Handout: IGWG gender integration continuum categories. http://www.igwg.org/igwg_media/gender101trainingmodule/Handout_GenderContinuumCategories.pdf (accessed June 30, 2015).
Walsh, Allyn, Michelle Gold, Phyllis Jensen, and Michelle Jedrzkiewicz. 2005. “Motherhood during residency training: Challenges and strategies.” Canadian Family Physician 51, no. 7: 990-991. http://126.96.36.199/cgi/reprint/51/7/990 (accessed June 30, 2015).
World Health Organization. 2001. Transforming health systems: Gender and rights in reproductive health: A training manual for health managers. Geneva, Switzerland: World Health Organization. http://www.who.int/reproductivehealth/publications/gender_rights/RHR_01_29/en/ (accessed June 30, 2015).
World Health Organization. 2006. The World Health Report 2006: Working together for health. Geneva, Switzerland: World Health Organization. http://www.who.int/whr/2006/en/ (accessed June 30, 2015).
World Health Organization. 2008. Gender and health workforce statistics. Spotlight on Statistics: A Fact File on Health Workforce Statistics. Issue 2.
Zeleke, Kifle, Rebecca Bailey, Azeb Admasu, and Yemesrach Adamu. 2012. “Summary of Nursing and Midwifery Education Capacity Assessments at Three Colleges of Health Sciences in Ethiopia.” Nursing Education Partnership Initiative. USAID/CapacityPlus.
Zindi, Fred. 1994. “Sexual harassment in Zimbabwe’s institutions of higher education.” Zambezia 21, no. 2: 177-186. http://archive.lib.msu.edu/DMC/African%20Journals/pdfs/Journal%20of%20the%20University%20of%20Zimbabwe/vol21n2/juz021002006.pdf (accessed June 30, 2015).