Leadership experiences and practices of South African health managers: what is the influence of gender? -a qualitative, exploratory study

Consensus-based recommendations for strengthening emergency care at primary health care level: a Delphi study

BACKGROUND

Emergency care at a primary health care (PHC) level must be strengthened to reduce overall mortality and morbidity in any country. Developing recommendations for improvement in this area should take into consideration the context and nuances of the current emergency care system and primary health care context. Contribution to policy from the experts in the cross-cutting fields of PHC and emergency care is lacking.

OBJECTIVES

This study aims to evaluate the strengths and weaknesses of emergency care in primary health settings and develop consensus-based recommendations for the strengthening of emergency care at this level.

METHODS

Using a modified Delphi technique, data were collected from various data sources to evaluate the strengths and weaknesses of emergency care at PHC level, from which recommendation statements were developed. These recommendations were proposed to a panel of experts using a Delphi survey to build consensus on 14 recommendations to strengthen emergency care at PHC level.

RESULTS

Ten experts were recruited to participate (n = 10) with a response rate of 90% in round II and 80% in round III of Delphi. Recommendations broadly addressed the areas of education and training in emergency care, the role and placement of various actors, leadership in emergency care and the development of a national plan for emergency care. Consensus was reached in round II for 97.61% of the statements and after modification based on open-ended comments, 98.21% consensus was reached in round III.

CONCLUSION

Strengthening emergency care at primary and subsequent levels of health care requires a coordinated effort and mandate from authority in order to effect real change.

Bargaining with patriarchy through the life course: obstacles faced (and overcome) by women leaders in Kerala's health sector

BACKGROUND

The COVID-19 pandemic has helped shine the spotlight on the role of women's leadership in tackling the world's health and health system challenges. The proportion of women occupying senior leadership positions in the health sector is less compared to males, even as they constitute a vast majority of the work force. The South Indian state of Kerala is an exception to this trend, a phenomenon that we sought to understand and contextualise. We undertook a study to understand the personal and professional journeys of some women leaders in the Kerala health sector to determine the antecedents of their leadership positions, the challenges that came their way in leadership, and strategies adopted to overcome these challenges. We also investigated into how these experiences shaped their styles and approaches to leadership.

METHODS

We conducted a qualitative study involving semi-structured in-depth interviews with women leaders. Sixteen women leaders were identified from public records and through peer nomination and interviewed in their language of preference following written informed consent procedures. Interviews focused on participants' professional and personal trajectories, work-life balance, style of leadership, challenges, enablers, lessons learned in their path, and their vision for the health system. The interviews conducted in Malayalam were transliterated into English and thematically analysed using Atlas.Ti8 software by three researchers.

RESULTS

Our study participants were aged 40 to around 80 years, from 8 out of 14 districts of the state. Women leaders in Kerala's health sector faced challenges through the life-course: during their early school education, in professional service as well as in their roles as leaders. There were myriad experiences - including gender stereotyping and discrimination at the intersection of gender and other social identities. Women developed manifold ways of overcoming them and evolve unique - and again myriad-leadership styles.

CONCLUSIONS

Women leaders in Kerala have faced shared challenges through their life-course to climb up the ranks of leadership; each leader has adopted unique ways of overcoming them and developed similarly unique leadership styles. At each life stage there were bargains with patriarchy - involving family members (often as allies), against formal and informal institutional rules, managers, peers and subordinates., which in turn suggests a feminist consciousness on the part of Kerala women leaders as well as the society in which they are seeking to lead.

Exploring the opportunities and challenges of female health leaders in three regional states of Ethiopia: a phenomenological study

Background

Gender equity involves fairness in all aspects of life for women and men and is usually determined by social, political, economic, and cultural contexts. The proportion of female leaders in healthcare within the health sector is low. The aim of this study was to explore and describe the experiences, opportunities, and challenges faced by women in their path towards becoming leaders within the health sector.

Methods

This study was conducted using the phenomenological method of qualitative inquiry. The approach was chosen for its merits to narratively explore and describe the lived stories and shared experiences of women leaders in the healthcare system. A purposive sampling technique was used to identify six women leaders. Semi-structured interviews were conducted through telephone by the investigators. The qualitative data analysis was conducted parallel with data collection, using steps of thematic analysis.

Results

This study identified individual, societal, and organizational level opportunities and challenges that had an influence on the career paths of female health leaders in Ethiopia. The leadership positions were an opportunity in the career development of women who had long-term goals, were known for their empathy, and exercised wise use of resources. In addition, women who had the support of close family members and their peers are more likely to compete and rise to leadership positions. Furthermore, women who received organizational support in the form of affirmative action, training, development, and recognition also tended to rise to leadership positions. However, women who assumed leadership positions but whose day-to-day decision-making was influenced by their supervisors, those who had experienced sexual harassment, and those under the influence of societal norms were less likely to attain leadership positions.

Conclusion

The opinions and experiences of female health leaders revealed that individual behaiour whileassumming a leadership positon, empathy, and wise resource management positivey influence their career development. In addition, female health workers who had support form close family members and peers strived for growth to leadership positions. Furthermore, the presence of organizational support, in the form of affirmative actions, and succession planning were another opportunity for females in their career paths. Conversely, some social norms were found to deter female health workers from advanicing to leadership positions. Therefore, enhancing the leadership capacity of women and improving social and organizational support is recommended. In addition, addressing the low level of self-image among women and patriarchal societal norms at the community level is recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13871-w.

The Use of Intersectional Analysis in Assessing Women's Leadership Progress in the Health Workforce in LMICs: A Review

BACKGROUND

Human resources are at the heart of health systems, playing a central role in their functionality globally. It is estimated that up to 70% of the health workforce are women, however, this pattern is not reflected in the leadership of health systems where women are under-represented.

METHODS

This systematized review explored the existing literature around women's progress towards leadership in the health sector in low- and middle-income countries (LMICs) which has used intersectional analysis.

RESULTS

While there are studies that have looked at the inequities and barriers women face in progressing towards leadership positions in health systems within LMICs, none explicitly used an intersectionality framework in their approach. These studies did nevertheless show recurring barriers to health systems leadership created at the intersection of gender and social identities such as professional cadre, race/ethnicity, financial status, and culture. These barriers limit women's access to resources that improve career development, including mentorship and sponsorship opportunities, reduce value, recognition and respect at work for women, and increase the likelihood of women to take on dual burdens of professional work and childcare and domestic work, and, create biased views about effectiveness of men and women's leadership styles. An intersectional lens helps to better understand how gender intersects with other social identities which results in upholding these persisting barriers to career progression and leadership.

CONCLUSION

As efforts to reduce gender inequity in health systems are gaining momentum, it is important to look beyond gender and take into account other intersecting social identities that create unique positionalities of privilege and/or disadvantage. This approach should be adopted across a diverse range of health systems programs and policies in an effort to strengthen gender equity in health and specifically human resources for health (HRH), and improve health system governance, functioning and outcomes.

Digitalisation as the Indicator of the Evidence of Sustainability in the European Union

Digitalisation provides access to an integrated network of information that can benefit society and businesses. However, the evidence of sustainability in business is less researched. In our paper, by building up the research approach, we address the relevant gap by investigating how sustainable development goals represent the interrelationship between digitalisation and sustainability. Such research is particularly important because understandings of digitalisation and sustainability determine how different actors, including business managers and policymakers, act in response to those imperatives to develop future employees skills starting from school age. Following a multi-method approach, we have combined our analysis into two steps examining the relationship between digitalisation and sustainability. Building digital networks, business managers and policy makers using digital means can create some unique opportunities to strategically address sustainable development challenges for the United Nations Targets (SDG) to ensure higher productivity, education, and an equality-oriented society. This point of view describes the potential of digitalisation for society and businesses of the future. The authors revise the links between digitalisation and sustainability in the European Union countries by using data available in Eurostat and UNECE public databases. The two-stage methodology for the identification of the relationship between ICT and sustainability is used in the paper and a linear regression model is applied. The results showed tiers with five SDGs, focusing on business, and all these tiers are fixed in the constructed equations for each SDG. The recommended solution is statistically valid and proves the novelty of this research. Among digitalisation indicators, only mobile-cellular subscriptions and fixed-broadband sub-basket prices in part do not affect researched sustainable development indicators.

Intersectionality and nursing leadership: An integrative review

AIMS AND OBJECTIVES

This review aimed to synthesise international research about how intersectionality has been used to explore issues within the nursing profession. The objectives were to determine which intersecting variables have been explored, how intersectionality has been operationalised, and the implications for nursing leadership.

BACKGROUND

Barriers to health system leadership created at the intersection of gender, race, ethnicity, professional cadre and other socially constructed categories exist in the health workforce. Consequently, an intersectionality paradigm has been recommended to explore power, privilege and oppression issues in the nursing profession.

DESIGN

An integrative systematic review method was selected for its ability to include diverse methodologies. The review complies with the PRISMA guidelines for reporting systematic reviews.

METHOD

The search terms nurs* nurses nursing AND Intersectionality intersectional intersectionalism, intersect were used in December 2021 to search the Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus) PsycINFO, PubMed, Ovid, ProQuest and the first ten pages of Google Scholar from 2011 to 2021. Directed content analysis was applied to the data.

RESULTS

Access to education, absence of expectations as a career and patriarchal structures support male nurses into positions of leadership in healthcare systems. Intra-group differences highlight the paradox of homogenous categories for ethnicity and gender. Being a member of an ethnic minority group hinders career progression regardless of gender. The aftereffects of colonisation exist within the nursing space.

CONCLUSIONS

This review is the first to synthesise research using intersectionality to explore the impact of socially constructed identities on nursing leadership. There is a dearth of evidence specific to this topic, ignoring the diversity within this professional group. Future research should include intersectionality to discover how social categories empower or impede a nurse's career progression to leadership roles.

RELEVANCE TO CLINICAL PRACTICE

An intersectionality paradigm can encourage nurses to attend to issues of power, privilege and oppression in the profession and their practice.

Gender diversity in chiropractic leadership: a cross-sectional study

BACKGROUND

The purpose of this cross-sectional study was to compare the number of males and females in leadership positions, and whether there is a relationship between gender and degrees held in those positions, within chiropractic academic institutions, national regulatory bodies and the most widely representative national professional associations in the United States and Canada.

METHODS

Publicly accessible websites from chiropractic institutions and organizations were used to collect data. Pearson χ² tests of independence were conducted to determine the relationship between gender (male vs. female) and other variables, including position (principal vs secondary), and chiropractic and other advanced professional degrees.

RESULTS

A total of 107 leaders were identified across institutions and organizations. Under one-third of leaders (30.8%) were identified as female. Males were more likely to be in principal leadership roles (86.2%) and more likely to be in a secondary leadership position (62.8%).

CONCLUSION

Male leaders significantly outnumber female leaders in both principal and secondary leadership positions within American and Canadian chiropractic institutions. Strategies should be developed to include gender diversity within all chiropractic organizations.

Street-level diplomacy and local enforcement for meat safety in northern Tanzania: knowledge, pragmatism and trust

BACKGROUND

With increasing demand for red meat in Tanzania comes heightened potential for zoonotic infections in animals and humans that disproportionately affect poor communities. A range of frontline government employees work to protect public health, providing services for people engaged in animal-based livelihoods (livestock owners and butchers), and enforcing meat safety and food premises standards. In contrast to literature which emphasises the inadequacy of extension support and food safety policy implementation in low- and middle-income countries, this paper foregrounds the 'street-level diplomacy' deployed by frontline actors operating in challenging contexts.

METHODS

This research is based on semi-structured interviews with 61 government employees, including livestock extension officers/meat inspectors and health officers, across 10 randomly-selected rural and urban wards.

RESULTS

Frontline actors combined formal and informal strategies including the leveraging of formal policy texts and relationships with other state employees, remaining flexible and recognising that poverty constrained people's ability to comply with health regulations. They emphasised the need to work with livestock keepers and butchers to build their knowledge to self-regulate and to work collaboratively to ensure meat safety. Remaining adaptive and being hesitant to act punitively unless absolutely necessary cultivated trust and positive relations, making those engaged in animal-based livelihoods more open to learning from and cooperating with extension officers and inspectors. This may result in higher levels of meat safety than might be the case if frontline actors stringently enforced regulations.

CONCLUSION

The current tendency to view frontline actors' partial enforcement of meat safety regulations as a failure obscures the creative and proactive ways in which they seek to ensure meat safety in a context of limited resources. Their application of 'street-level diplomacy' enables them to be sensitive to local socio-economic realities, to respect local social norms and expectations and to build support for health safety interventions when necessary. More explicitly acknowledging the role of trust and positive state-society relations and the diplomatic skills deployed by frontline actors as a formal part of their inspection duties offers new perspectives and enhanced understandings on the complicated nature of their work and what might be done to support them.

Intersectionality and global health leadership: parity is not enough

There has been a welcome emphasis on gender issues in global health in recent years in the discourse around human resources for health. Although it is estimated that up to 75% of health workers are female (World Health Organization, Global strategy on human resources for health: Workforce 2030, 2016), this gender ratio is not reflected in the top levels of leadership in international or national health systems and global health organizations (Global Health 50/50, The Global Health 50/50 report: how gender responsive are the world's leading global health organizations, 2018; Clark, Lancet, 391:918-20, 2018). This imbalance has led to a deeper exploration of the role of women in leadership and the barriers they face through initiatives such as the WHO Global Strategy on Human Resources for Health: Workforce 2030, the UN High Level Commission on Health Employment and Economic Growth, the Global Health 50/50 Reports, Women in Global Health, and #LancetWomen. These movements focus on advocating for increasing women's participation in leadership. While efforts to reduce gender imbalance in global health leadership are critical and gaining momentum, it is imperative that we look beyond parity and recognize that women are a heterogeneous group and that the privileges and disadvantages that hinder and enable women's career progression cannot be reduced to a shared universal experience, explained only by gender. Hence, we must take into account the ways in which gender intersects with other social identities and stratifiers to create unique experiences of marginalization and disadvantage.