Author(s): Dr. Norah Obudho, Health Integration and East Africa Director, WomenLift Health; Dr. Florence Temu, Country Director, Amref Health Africa in Tanzania
Over a decade ago, Pan African Parliament Women’s Conference President, Mavis Matladi of South Africa, declared that it was “more dangerous to be a woman than a soldier” in Africa. In that time much has changed, but at the same time, too much has remained the same.
While women and girls now have more access to education and economic opportunities and are better represented in politics and other spheres of leadership, they remain the most vulnerable to impacts of disease outbreaks, fragile health systems, conflict, domestic abuse, economic instability, and climate change.
African women and girls for example still account for about 66 percent of global maternal mortality rates and are twice as likely as boys to miss out on formal education. Additionally, approximately 63 percent of the world’s extremely poor women live in Sub-Saharan Africa, limiting their ability to access essential health services and pushing the continent further away from achieving its health targets.
Much of this has been driven by sociocultural norms skewed towards enforcing patriarchal structures that have traditionally subdued women and denied them access to the same rights as men. The same structures have also perpetuated the gender inequities that keep women from attaining leadership positions, which are often assumed to be reserved for men despite the presence of numerous, qualified women on the continent.
Consequently, decisions in health are frequently made without women’s input, even when the issues at hand directly affect them, as with maternal and reproductive health. While it would be unfair and simplistic to blame one gender for the loss of millions of lives due to infectious and non-communicable diseases, poor quality health services, and lack of access to essential care, there is a direct correlation between Africa’s health outcomes and its health leadership.
Considering majority of positions in health leadership are occupied by men, and that nearly all decisions affecting the resilience and responsiveness of our health systems are made by men, one could then rightly say that Africa’s homogenous health leadership has been – and continues to be – a key determinant in the continent’s (in)ability to achieve health for all.
Now, as we stand at the midway point of the Sustainable Development Goals 2030 target, it would benefit us to have candid conversations about leadership and the role it plays in either bringing us closer to the goals or taking us further away from them.
The simple truth is that leadership that is not representative of the people it serves, be this across racial, gender, or socio-economic lines, will not and cannot address the challenges preventing us from ensuring the highest attainable level of health for all.
We need to reimagine the face of health leadership if we are to rebuild our health systems and equip them to move towards and sustain universal health coverage (UHC).
By placing the needs of women at the centre of health system design and delivery and elevating our voices in health, we can unlock gender equity at leadership level and add impetus to Africa’s journey towards UHC. In doing so, we would also allow women to not only be consumers of health services, but to be the leaders that our health systems need if they are to meet our needs and withstand future health shocks.
This is not to discount the contribution of male leadership. It’s simply to say that there is need for balanced representation in leadership to include women and other minority groups. By excluding key groups in decision-making, we fail to benefit from the knowledge and wisdom provided by their lived experiences. For it is only those who feel the weight of the burdens they bear that can help create solutions to those burdens.
Achieving health for all is within reach, but it requires a seismic shift in leadership to create and implement uniquely African solutions to the challenges we face on this continent. If more governments embrace the role of women and girls as leaders and bring them to decision-making tables, we can come closer to achieving UHC.
Africa is ripe for this change. It is indeed exciting to see this agenda being driven by development leaders such as Amref Health Africa through their upcoming Africa Health Agenda International Conference, which will provide a platform for discussions on gender equity, health leadership, and the role of women in health.
By strengthening male allyship, engaging women at all levels, and working together to promote inclusive leadership that considers the needs of the most vulnerable among us, we can achieve the goals that have for far too long eluded us.
In accomplishing this we can make Africa a continent where women and girls do not simply try to survive, but where they thrive – in every sense of the word – alongside men and boys.