Healthcare workers led by nurses taking part in a demonstration over poor salaries in Harare, Zimbabwe, in June 2022. Female healthcare workers are resigning in large numbers due to inequalities in the healthcare system. — AP Filepic
A recent report by Women in Global Health, an organization that challenges power and privilege in global health, shows clear evidence that the Covid-19 pandemic multiplied gender inequities within the health workforce, leading to a wave of resignations by women in the health professions across countries all over the world.
The Great Resignation: Why Women Health Workers Are Leaving highlights an alarming new trend in health that puts lives at risk all over the world.
Women, who make up the majority of health workers, are leaving the profession in significant numbers.
Holding 70% of health worker jobs and over 80% of nursing and midwifery roles, women led the response to the Covid-19 pandemic in the health sector.
From community health workers to midwives, they were at disproportionately high risk of infection because of their frontline roles, which required close contact with patients.
For many women across the world, medical personal protective equipment (PPE) was often insufficient, inadequate, and sometimes unavailable.
Most PPE is designed for the male body, leaving many women health workers with little guarantee of safety or dignity.
To make matters worse, pandemic response measures, such as school and childcare closures, added hours of unpaid care work that falls primarily to women.
This left women health workers juggling crisis-level patient workloads, while also being the primary carers for their families, elderly relatives and households.
Since women earn on average 24% less than men in the sector and millions of women work unpaid or for low ad-hoc stipends (e.g. community health workers who provide vital, first point-of-contact care in many rural and remote parts of the world), the economic shocks of the pandemic hit women harder than men.
Women health workers remain clustered into roles within the health workforce that are generally accorded lower status and lower pay.
Although they are the majority of workers in the sector, women hold only one-quarter of senior leadership roles in health.
This has held true over the last five years and there is evidence that they were further sidelined in leadership after the pandemic started, with 85% of 115 national Covid-19 task forces in 2020 having a majority male membership.
Lack of diversity in leadership contributed to less robust decision-making and poor outcomes.
In one Canadian study of the pandemic response, nurses described never being asked for their input by management, and those who were asked for their input often did not feel their insights were listened to or influenced policy.
"We’re looking at a crisis of global proportions in the health workforce: global shortages of 15 million during the Covid-19 pandemic, mass resignations, widespread recruitment by rich countries from LMICs [lower and middle income countries].
"The women who carry health systems on their shoulders are saying 'ENOUGH'.
"They need more than applause. They need realistic workloads, fair pay, protection from violence and sexual harassment, PPE that protects them from infection. They need a fair share of leadership roles.
"What we’re asking for here is nothing less than a new social contract for women in health.” says report author and Women in Global Health senior fellow Ann Keeling.
In addition, high-income countries with high levels of vacancies are currently actively advertising for health workers in LMICs and removing barriers to inward migration.
For example, the province of Ontario in Canada has directed its licensing bodies to streamline integration processes for immigrants in the province with a nursing or medical credential.
The Canadian province of Québec launched an international recruitment drive to hire over 1,000 French-speaking nurses in February 2022.
In the United Kingdom, new rules make it easier for medical regulators to register those who have qualified abroad (including from Malaysia).
Regrettably, there is a growing trend for high-income countries to actively recruit health workers from the 55 countries on the 2023 WHO Support and Safeguard List from the WHO Global Code of Practice on the International Recruitment of Health Personnel.
This has dire impacts on healthcare provision, with devastating consequences for doctor-to-patient ratios and health system delivery.
In Nigeria, for instance, up to 50 doctors leave the nation for foreign countries every week, leaving only 24,000 doctors to practice in the country.
This puts the doctor-to-patient ratio in Nigeria to approximately one doctor to more than 9,000 patients.
Women in Global Health executive director Dr Roopa Dhatt says: "There are no magic bullet solutions to the Great Resignation and Great Migration of women in the health profession.
"These are complex problems connected to systemic gender injustice, women’s exclusion from leadership, and gender inequity perpetuated via gender norms in society as a whole.
"Progress is possible though.
"We need health systems to look seriously at the burden carried by women on the frontline of healthcare delivery.
"We need gender equity in health leadership.
"We need fair pay and safety from harm, be it infectious disease or violence and sexual harassment.
"Lastly, we need state actors to act responsibly when it comes to recruitment, particularly in high-income countries.
"While there is nothing wrong with trained health professionals migrating in search of a better life, active recruitment in countries with under-resourced health systems leaves them poorly equipped to provide basic care, let alone cope with health emergencies.
"We know this is unethical and that it runs counter to the 2010 WHO Code.
"We must work together to end it, and to make the changes needed to retain women health workers if we are serious about achieving UHC [universal health coverage]."
