What we're reading… Global Health Leadership: The Urgent Need

"...those with excellent leadership skills are invaluable in these settings —ensuring long-term sustainable change to the health of numerous populations. They are able to work cohesively and respectfully with the communities they serve, to influence and empower others in their health vision and to be able to confidently navigate fluid political and organizational contexts."

, writes Claire Bayntun for Global Health Now  Claire is Director of the Executive Programmes in Global Health Leadership at LSHTM.

Read the article.

Naomi Stewart
Media scholarship launched for WLGH18

The Women Leaders in Global Health (WLGH) Project Team invite applications from journalists who are citizens of low or middle income countries to apply for funding support to attend the WLGH 2018 conference. There is one Media Scholarship available which will fund travel, accommodation and conference registration. Online applications are now open, and the deadline to apply is 15 August 2018.

Mathias Oleron
How has the role of women in the NHS changed since its inception?

By: Dina Balabanova, Associate Professor in Health Systems and Policy

Caption Elizabeth_Garrett_Anderson Credit Wikimedia .jpg

Nearly seventy years after the creation of the NHS, women are finally occupying more leadership roles - but this was not always the case.

Elizabeth Garrett Anderson, Credit: Wikimedia

Sophia Jex Blake, an early British physician who became an active campaigner for the education of women, had to study in Berne, Switzerland, as she was unable to study for degrees in the UK.  Another early female medic, Elizabeth Garrett Anderson - the first woman to openly qualify in Britain as a physician and surgeon, was awarded a degree in 1865, but soon after the Society of Apothecaries changed the rules preventing any more women registering to study.

In 1875, legislation was enacted allowing women to study medicine, however only some institutions actually allowed women to enrol, such as the Royal Free in London. It was only in 1944, four years before the creation of the NHS, that the government decided it would only provide funding for medical schools that admitted what it termed a ‘reasonable’ proportion of women - about one fifth.

We don’t actually know how many female doctors worked in the NHS when it was created. Data on gender in the workplace was not being collected and wouldn’t be deemed important for another 20 years. However, we do know two things. Women were a minority, and they often occupied lower levels in the professional hierarchy.

Some hospitals run for women by women existed in the NHS’ infancy but the vast majority of consultants in teaching hospitals were male.

Despite women working as doctors and nurses, there is some evidence that their professional status actually declined in the first few years of the NHS. During the war they had occupied the posts of men who were serving in the armed forces; when these men returned (along with others who had not previously worked in the NHS) they benefitted from programmes providing work and compensating for missing out on university education. These programmes often gave these men priority over women in employment.

Then came the post-war baby boom, with many women marrying returning servicemen and starting a family soon after. Unlike in some other countries, there were no legal restrictions on employment of married women at the creation of the NHS, however, for many years there was still a widespread belief that ‘a woman’s place was in the home’. Until 1970, women had to have a male guarantor to obtain a mortgage, and only in the 1960’s was safe contraception, controlled by women, widely available, along with access to legal abortion.

By 1965, women made up nearly 21% of all doctors on the medical register. Among those aged under 30 the percentage was slightly higher- almost 25%. By 1974, these figures had increased slightly but they were still a minority.

Today the situation is very different. In 2018, almost 46% of all doctors on the General Medical Council registerare female, and those aged under 30 actually form a majority, at almost 57%.

The roles that women occupy have also changed. In the early days of the NHS, women were often found in posts offering part-time work, particularly community child health, pathology, and anaesthetics. Many also worked in general practice - sometimes in partnership with their husbands. Although women continue to be under-represented in some specialities, including surgery, the proportion of female trainees has increased greatly.

Women can now be found in senior roles across all medical specialities, with current examples including Professor Dame Sally Davies, Chief Medical Officer for England, Dame Jane Dacre, President of the Royal College of Physicians and Fiona Godlee, Editor in Chief of the British Medical Journal.    

Despite this progress many barriers remain. Recent analyses demonstrate a significant under-representation of women in positions of leadership, including women holding 37% of senior leadership roles for clinicians on clinical commissioning groups and NHS provider boards, and among non-clinicians, only 12% are in lead roles. This underrepresentation is explained by the demands of childcare, male-dominated networks and outdated attitudes to women leaders.

In April 2018, the NHS reported a median gender gap in hourly pay of 17.4% while other sources cite it closer to 23% - importantly, these figures related to basic pay. In addition, female consultants were said to be 6.5 times less likely to receive the top clinical excellence awards - worth £77,000 a year.  

Women have made an enormous contribution to the NHS throughout history. For most of that time their work was poorly recognised in a profession whose upper echelons was dominated by men. Even now, many women lack self-confidence, and are conditioned in traditional gender norms, thereby hampering their progress. This is changing, but there is no room for complacency.

This expert opinion piece is part of a series that LSHTM are publishing in the lead up to the 70th anniversary of the NHS on 5 July 2018 and was originally published by LSHTM here. You can read more about our NHS 70 series and join the conversation online using #NHS70LSHTM.

What we’re reading… #MeToo meets #HealthForAll

How achieving universal health coverage can (and should) drive gender equity

Jennifer Schechter, co-founder and executive director of Hope Through Health, on how increased attention on gender inequities in global health coincides with a growing recognition of the value of Community Health Workers, and the potential for the Community Health Worker movement to advance gender equality.

Read the article.

Katie Steels
Are you up to the Women Leaders in Global Health Challenge?

Think it's important to support female clinical researchers from low- and middle-income countries (LMICs)? Wish to attend this year's Women Leaders in Global Health (WLGH) conference in London for free? Well enter the new WLGH Challenge and you could do both!

Organised by The World Health Organization's Tropical Disease Research Programme (WHO/TDR), the challenge contest aims to expand women’s participation in the WHO/TDR Clinical Research and Development Fellowship, an initiative that provides support for mid-career individuals from LMICs to spend a year in a high-income country to learn about clinical research.

While women who apply for the Fellowship are just as likely as men to receive it, women have been less likely to apply. 16-24% of Fellowship applicants are women and about one-quarter of all participants are women. Challenge entrants could make a difference by developing creative ideas to make the fellowship more flexible or encouraging more women to apply. This could be a way to raise awareness of the Fellowship call among women, make the Fellowship more accessible to women with caregiving obligations, or a way to increase the number of qualified women applicants. 

Submissions will be judged on a 1-10 scale according to the following three criteria:

(1) capacity to increase the number of women who apply and receive WHO/TDR fellowships
(2) feasibility
(3) innovation, defined as different from the current practice used in the Fellowship

The contest is open to men and women from any location. Ideas from women in LMICs are particularly encouraged, but reviews will be blinded so that judges do not know who submitted each one. 

Individuals who submit exceptional ideas will be supported to join the 2018 Women Leaders in Global Health conference in London at the London School of Hygiene & Tropical Medicine this November. More importantly, selected ideas deemed feasible by WHO/TDR will be implemented to increase women’s participation in the Fellowship.

Ideas must be no more than 500 words and written in English. Submit your idea on the WLGH Challenge Contest website, where you can also find more information and contest guidelines.

Contact the Challenge coordinator, Ewen, at womenglobalhealthchallenge@gmail.com.   Best of luck!

WLGH Challenge Contest website >>

Chris Howard
African women working in global health: closing the gender gap in Africa?
 Credit: MRCG

Credit: MRCG

The lack of female researchers in sub-Saharan Africa reduces the diversity of scientific perspectives on gender dimensions of health, and curtails the ability of the society to advocate for maternal and reproductive health research agendas.

Researchers from the MRC Unit The Gambia Women in Science Working Group write in The Lancet about the challenges faced, and what changes are needed to enable African women to play a more prominent role in science.

Read Article >>

Katie Steels