The World Health Organization’s (WHO) Director-General Dr Tedros Adhanom Ghebreyesus recently announced he would not run to be the next United Nations (UN) Secretary General, adding that a woman should take that role. But what is the state of women’s representation in global health governance, and what does gender parity entail?

Last week, Tedros told the news agency Bloomberg that he would campaign for a woman to seek the top role at the UN. He added that since becoming minister of health in Ethiopia in 2005, he had barely taken time off and wanted to spend time with his family.

WHO spokesperson Christian Lindmeier denied that there were other motivations for Tedros’s decision, including criticism of his handling of sexual abuse and exploitation by staff during emergency response to the Ebola outbreak in the Democratic Republic of Congo. 

“WHO is exemplary in organising the response to sexual abuse,” he told Health Policy Watch last Friday. “The steps WHO has taken in the recent months, encouraging staff and potential victims and survivors of sexual abuse or harassment are exemplary throughout the UN.”

The comments on the need for female leadership at the UN by WHO’s chief were echoed by Helen Clark, a former New Zealand prime minister and advocate for gender equality. In a tweet, she commended Tedros for his leadership, adding “it’s time” for a woman to head the UN.

#Leadership! @drtedros is clear that a woman must be the next United Nations 🇺🇳 Secretary-General. Next SG election will be for UN’s 10th SG. It’s time! ⁦@GWLvoices⁩ ⁦@CWWLeaders⁩ https://t.co/bOQfU6OmWS

— Helen Clark (@HelenClarkNZ) August 9, 2023

The senior management team of the current UN Secretary-General, António Guterres, who took office in 2017, is 60% female, though entry-level jobs in recent years have been filled predominantly by men.  Guterres was re-appointed in 2021 without any opposition, and Tedros was also reappointed last year without anyone challenging him.

Roopa Dhatt, a co-founder of Women in Global Health, a group seeking to reduce gender disparities in global health governance, recalled that when Tedros had first announced his goal of achieving gender parity within WHO, “it caused a lot of rumbles.”

“After the first announcement, some people were saying: ‘Look, incompetent women are being appointed with some of them being potentially unqualified’ and ‘what will happen to the men in the organisation?’,” she said. 

“No one asks when there are men being appointed, are they qualified, what will happen to the women?  The default male bias in global health makes it such that women deliver health and men lead it.”

“From the first days, Dr Tedros made a commitment publicly… and it was a game-changing commitment because very few global health organisations had gender parity.”

Addressing the roots of gender inequity

But Dhatt emphasised that gender parity alone was not enough. “The organisation and its programme (needs to be) driving a gender transformative agenda, which means going to the root drivers of gender inequities.”

A report published in March by her organisation stressed the importance of women’s leadership in global health. Some 70% of healthcare jobs are held by women globally, and women represent 80% of jobs as nurses and midwives, yet only 25% of senior management roles in the sector are held by women.

In the WHO itself, Dhatt said Tedros’ senior management in his first cabinet had been around 67%. In contrast female representation on WHO’s Executive Board, which is made up of member states’ appointees, was only 6% in January 2022 at the peak of the COVID-19 pandemic. 

“That’s astonishing,” she commented. “I repeat 6%!”

Currently, the proportion of women on the 34-member Executive Board – responsible for issues such as endorsing reform and staffing policies –  represents less than a third of members.

Meanwhile, Dhatt said that she was glad to hear Tedros supporting the idea of having a woman as the next UN secretary general, senior male leaders also have to show that they are ready to take on roles in the supporting cast. 

“It’s great when you have men practice leadership by leaning out. But it’s also about supporting women and willing to be the deputy, the behind the scenes person supporting them, either in formal or informal roles.”

Parity in the works

Advocates for women’s rights have said that sexual harassment and exploitation, such as that allegedly committed by WHO staff and contractors in the DRC during the Ebola crisis between 2018-2020, deserved more attention. 

Following the DRC allegations, an independent commission was set up by the WHO that went on to interview over 3000 women and girls and 12 men, ultimately concluding that 83 Ebola emergency responders, including 21 WHO employees of consultants, had been involved in rape, coercion and exploitation.

Tedros said he assumed “ultimate responsibility” for the behaviour of WHO aid workers and apologised to the women who said they were abused. However, some critics said that the WHO had protected some leadership figures and had been slow to respond to the allegations.

Gaya Gamhewage, appointed by Tedros as WHO Director of Prevention and Response to Sexual Misconduct after the Ebola scandal, has instituted reforms in the policy and implemented training of staff.

Hounded by accusations of a lack of transparency in how accusations were being processed, a publicly-accessible website now lists the number of cases of misconduct, but with few other details.

Gamhewage stressed the importance of women occupying key roles in the organisation. “It’s not just about achieving gender parity, but it’s really about changing the culture of the organisation. When women are in decision-making powers, like in my area of work, this addresses a number of institutional issues.”

She told Health Policy Watch that while at the country-office level, gender parity has not yet been achieved, across the board, slightly over 50% of WHO’s employees were women in 2022.

But she said that given the challenges which women often face in accessing healthcare, ensuring gender-responsive management of the sector is essential: “Within the organisation itself, our culture has to evolve so that men and women are equally contributing to the big changes that are really underway.”

Increasing the proportion of women working in emergency response still needed to be addressed across UN agencies, she said, as well as supporting a pipeline of female senior managers.

When asked about whether the person succeeding Tedros should be a woman once again, Gamhewage said she would like the most suitable candidate for public health to be selected. “But what is most important is really to get gender parity across all of the grades and geographical locations of the organisation.”

Image Credits: Mark Henley/ IMF, Israel in Geneva/ Nathan Chicheportiche.