Gender inequality is playing a significant role across development, leadership, and the overall delivery of global health, according to a report by the World Health Organization (WHO), the Global Health Workforce Network, and Women in Global Health.

The report, published on Wednesday, highlights social and economic factors that impact women’s ability to lead in global health and how that, in turn, negatively impacts the delivery of global health overall.

The global health force is 70% women and yet, only 25% of women have senior roles. The report argues that this disparity in leadership is fueled by stereotypes, discrimination, racism, classism and power imbalances.

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Marnie Davidson, head of global health for CARE Canada, has worked in global health for 15 years. Her work with CARE currently takes her to sub-Saharan Africa.

She was unsurprised by the findings of the report.

“It’s very hard to get women’s voice in the planning of the services that are extensively there to meet their needs,” she told Global Citizen.

She references a maternal health training program that CARE delivered across six districts in Tanzania between 2012 and 2015. During this time, CARE trained 375 primary health care workers on basic emergency neonatal and obstetric care — 138 were men and 237 were women.

She has only ever known there to be one female district medical officer since 2012 and not one single regional medical officer (the highest leadership role in this project).

This lack of women in leadership roles doesn't just impact the roles that women play and further exacerbate an existing pay gap, but it also impacts the delivery of health services.

Women make up 70% of the health workforce but only 25% hold senior roles: New report by WHO, @GHWNetwork, @WomeninGHhttps://t.co/B2okun9CxP#HealthWorkerspic.twitter.com/UdiD7AGLKL

— World Health Organization (WHO) (@WHO) March 20, 2019

“There really is a gendered way in which health services are designed and delivered when you have so many men making the decisions, and all of the women doing the work,” she said.

The report found that men led 69% of global health organizations and that they accounted for 80% of board chairs. Only 20% of global health organizations reported gender parity on their boards and only 25% saw gender parity at senior management level, according to the WHO.

CARE did formative gender research at the start of their project in Tanzania. They compiled diaries, did focus groups and in-depth interviews to show how women were experiencing health services.

“You can present the data about women using health services, but getting the stories and experiences of how women experience the health services, and the discrimination, particularly for younger women, the refusal of services that was happening in some cases — was something that the regional medical officer simply did not have any experience with,” she said.

She added that the regional medical officer they presented their information to was very good at his job and meant no harm in how he delivered his services — but the point remains that men can’t be the only voice in the room when it comes to services for women.

A large percentage of women face bias, discrimination, and sexual harassment in the workforce, the report also noted. Davidson said she had seen that, too — situations in which women health workers were harassed by male workers in leadership roles.

Then there’s the issue of the gender pay gap.

The gender pay gap in the global health sector is 25%, according to the report. Female health workers often occupy lower-paid roles — if not unpaid ones.

Amref Health Africa Global CEO Dr. Githinji Gitahi told Global Citizen by email that he was not surprised by the findings in the report either. Gitahi said that Amref Health Africa sees gender inequality issues firsthand in the community-level health workforce.

"Many African countries use volunteer community health workers to deliver essential health education in remote, rural and marginalized communities,” he said. “These volunteers are vital because they are community members themselves; they have the communities' trust which is so important for health emergencies, as we saw with the Ebola outbreak in West Africa, and with public health initiatives such as immunization.”

Gitahi said that many of these workers are female. He also said that many countries do not integrate community workers into their health system — meaning they are not paid.

“That affects the individual female community health workers as they must find other means of earning a livelihood while carrying out this vital health work. And, it affects the quality of health services at the community level as attrition for volunteer community health workers can be as high as 70%,” he said.

The benefit of this report in the global health world is that it’s evidence that supporting women and achieving gender equality is necessary in order to achieve the goal of good health and well-being for all — it can act as a road map towards achieving Global Goal 5, as well as Global Goal 3.

But Davidson cautions that an actual shift is needed.

“Global leadership matters. So if our entire global health architecture is still very male dominated,” Davidson said. “[If] we don’t bring in a female lense — or for want of a better word a feminist lense — and think about doing things differently, nothing is going to change.”