By Maya Misikir
Dr. Faraja Lyamuya’s interest in public health first came from watching her mother, a medical doctor in Tanzania. Growing up, she saw that her mother’s work wasn’t limited to the hospitals where she spent most of her time, but extended to villages, where she worked with primary school children on treating intestinal worms.
During her community work while receiving her own medical degree years later, she noticed people were being left out because they didn’t have the knowledge or the access to health services.
The hospitals would be too far away for them, or they would stay home very sick, because of traditional beliefs on how they got the illness and its treatment. Dr. Faraja and her colleagues would present their findings at churches and would learn from one another through the discussions that followed; it was these incidents that would leave a mark on her.
Dr. Faraja spent more than a decade pursuing this dream – getting her degree, acquiring her specialization in epidemiology, and later serving as a regional focal person the elimination of lymphatic filariasis within Tanzania’s Ministry of Health. Lymphatic filariasis is spread by a parasite and causes uncontrollable swelling in the limbs or scrotum if left untreated. People suffering from the effects of lymphatic filariasis deal with immense pain, social stigma and reports show they suffer from high rates of depression.
She planned interventions and campaigns with thousands of health workers and visited affected communities at schools and homes. Now, Tanzania is tantalizingly close to eliminating this disease for good.
And yet, she never thought of herself in a leadership position — it was her colleagues who first pointed this out to her.
“I had not considered myself a leader,” said Dr. Faraja. “But as a person who could help others – doing the work, or hitting the targets, but not leading others.”
When she first joined the Mwele Malecela Mentorship Programme for Women in neglected tropical diseases, designed for women like her – she was hoping that it might help build her confidence and get to know herself better.
“There was something that people were seeing in me, but I didn’t realize maybe I have those qualities,” she said.
Dr. Faraja position in the Tanzanian Ministry of Health was once held by Dr. Mwele, an influential public health leader after which the program is named. Dr. Mwele was an unparalleled force in public health. She helped answer important questions about the best treatment regimens for lymphatic filariasis. In recent years, she led the WHO’s Neglected Tropical Disease program.
A lifelong advocate for women, Dr. Mwele died in 2022 and shortly after the WHO created the mentorship program to support African women public health practitioners working on neglected tropical diseases to overcome gender barriers and into becoming leaders in their field.
Gender barriers in the health sector are acute; women, while dominating the workforce – occupying 70 percent of roles in the sector – conspicuously fall out of the picture when it comes to leadership positions. A report published by Women in Global Health last year shows that women only hold 25 percent of leadership roles. The global gender pay gap, which stands at about 16 percent, is several points higher in healthcare at 24 percent.
While there were efforts to change this over the years, including global commitments made by governments, the policy report done by Women in Global Health shows there hasn’t been much progress. In the case of women in government positions, data shows that the share of women health ministers has decreased from 32 to 25 percent globally.
Such a decrease spurred the creation of the second part policy report five years later, said Dr. Shabnum Sarfraz, the Global Director for Gender and Health at Women in Global Health.
“The administrators, the project managers, the policy makers are men and the ones on the front lines were women,” she said.
Dr. Sarfraz has worked extensively on gender mainstreaming, at one point leading the creation of a national gender policy in Pakistan, her home country. She believes that in order to close the divide, finding the link between what policymakers need and the role that women’s participation in the sector have is important.
Women may not be in the leadership seats, but their impact – through delivering health services and unpaid work, is undeniable; contributing about US$ 3 trillion to global health every year.
The gender gap ripples beyond the workforce, impacting access to health care. In a report published by McKinsey earlier this year, data shows that women spend 25 percent more time in poor health than men – making this right means improving the health and lives of millions of women. This can help to alleviate poverty and add a trillion dollars to the economy, according to the report.
The representation of women in the policy rooms is important to close this gap, said Dr. Sarfraz.
“It’s very important for policymakers to ensure equal access to education,” she said. “Where you would see health outcomes of women that are not good, you also see low scores of literacies, and low labor force participation.”
A report by the UN says that at the current pace, it will take 140 years before there’s gender parity in health care. Finding and presenting the compelling economic incentives can speed up this process, according to her.
A significant gender bias identified by the policy report is the motherhood penalty: discrimination women face by being a mother seeking employment or by being a working mother.
Mentorship is especially important, according to Dr. Lyamuya, who says support on time management is vital to upcoming women practitioners in the public health sector who often also carry heavy responsibilities in their homes.
“As women we have a lot to do, at work and then at home. We need to learn from others how they managed to do that and know that it’s possible,” offered Dr. Lyamuya.
Getting communities to get behind women can be done by showing the good they can do to the larger community beyond their households, she said.
“As women, there are roles that the family and community expect from you and I think showing the impact of what you are able to do for the community with your knowledge and skills can be one way to overcome this.”
These gender stereotypes portray women as aggressive for the same characteristics that would make their male counterparts be seen as ‘natural leaders’. The same reasoning that a man may be picked for a promotion may be why a woman will be passed over.
This pervasive cultural belief plays out globally, within different contexts.
Despite having the highest academic credentials, the experience and knowledge, people will feel like women are still not fit to be leaders – this is what I have seen here says Dr. Arwa Elaagip, who lectures at the University of Khartoum, in Sudan.
The disparity is cleary seen at the University of Khartoum, Dr. Elaagip’s employer. Established in 1902, her university only just hired a woman vice-chancellor for the school for the first time in 2021.
“We have plenty of women professors – but why didn’t they take the lead?” says Dr. Elaagip.
A molecular biologist, Dr. Elaagip is also a mentee in a program for entomologists, and says she has never had a women mentor.
“You will see many women in the public health sector specializing in many medical fields. This is also true for the students in my class too. Dedicated, smart, clever, and with high ranks and they go on to post-graduate studies – but when it comes to the responsibility, and the leadership it’s all men,” she said.
“You won’t find women there.”
The support Dr. Elaagip has found in fellowships has pushed her to excel, she said – allowing her to continue her research work, and keeping her encouraged.
Dr. Elaagip’s participation in the mentorship program was stalled weeks after the program started, when war broke out in Khartoum. She feels like she has missed a lot, but despite intermittent internet and electricity service, she recently was able to join her first workshop.
Women role models and mentors can help break the stereotype of men as ‘natural leaders’ said the WGH policy report.
“What women need to do is different from what men need to do to get to the top,” says Dr. Sarfraz. “We’re playing much smarter to get to those positions.”
“Allies and sponsors open doors for you,” she added.
“They talk about you when you’re not in the room and bring visibility to the credentials you hold.”