Informed consent was sought from all participants, and researchers were particularly careful to develop a good rapport with participants to facilitate a reflective and open discussion. Given small numbers of health workers in some contexts, particular care was taken to ensure confidentiality in the write up and dissemination of findings. Ethical clearance was gained from the respective national ethical boards.
As the concepts detailed in this paper use terminology that may be interpreted differently based on one's background or discipline, we make explicit our definitions as follows in Box 1, ‘Selected Terminology’.
Box 1. Selected terminology.
The concepts detailed in this paper use terminology that may be interpreted differently based on one's background or discipline. Hence, we make explicit our definitions as follows:
Global Health is the multi-disciplinary field of service, research, and training that seeks to improve the health of both individuals and populations and to achieve health equity for all people worldwide, especially for the resource-poor [Reference Koplan16]. It ‘stands for a new context, a new awareness, a new strategic approach to matters of international health’ [Reference Kickbusch17].
Gender v. sex
Gender – the socially constructed roles, behaviours, activities and attributes that a given society considers appropriate for males, females and other genders – affects how people live, work and relate to each other at all levels, including in relation to the health system [Reference Morgan18] whereas sex encompasses the biological differences between male and female, such as chromosomes and reproductive systems. Gender roles vary over time and between cultures, but sex varies little [Reference Morgan18].
Being gender-responsive means recognising and understanding the lives, roles and contribution of women and men, ensuring that women benefit equally from interventions [19, Reference Bloom, Owen and Covington20].
Gender mainstreaming aims to promote gender equality. It is a process of analysing the consequences for women and men of any planned action, such as programming or policy, ensuring that the perspectives of both men and women are present in design, implementation, monitoring and evaluation . Gender mainstreaming always includes a systematic gender analysis, analysing the situation of women, men, boys and girls and their relationships to each other. Gender should be integrated in every aspect of programming and policy development, and actions working towards gender equality should be prioritised .
Equity can be distinguished from equality in that while equality carries some notion of ‘sameness’, equity carries some notion of ‘fairness’. Therefore while a focus on equality would argue that men and women should be treated exactly the same (that is, not discriminated against in the provision of healthcare explicitly on the basis of their sex), a focus on gender equity argues that men and women may have different needs and face different barriers to meeting those needs or having them met (Gender and Health Group, 1999) .
Gender equality in global health leadership
Having gender equality in global health leadership refers to women and men having equal access to leadership positions, without norms, prejudices, discrimination, legislature or other standing in the way. Equal leadership means equal representation, power, rights and influence between genders. One way of monitoring this is by comparing the number of men and women in leadership positions, gender equality referring to at least 40% and not more than 60% of one gender. However, equal representation does not necessarily mean equal impact.
In the same way as gender is a social variable, there are other social variables influencing people's position in society; ethnicity, religion, class, age, disability, sexual orientation among others. Intersectionality refers to the fact that these variables interact, ensuring some people privileges and making it easier for them to reach global health leadership positions, resulting in diversity in the leadership not reaching its full potential.
Gender-responsive, transformative leadership
Gender-responsive, transformative leadership is about approaching leadership through a multi-disciplinary value based approach. Gender-responsive leadership strives to gender mainstream ‘the process of assessing the implications for women and men of any planned action, including legislation, policies or programmes, in all areas and at all levels. It is a strategy for making women's as well as men's concerns and experiences an integral dimension of the design, implementation, monitoring and evaluation of policies and programmes in all political, economic and societal spheres, so that women and men benefit equally and inequality is not perpetrated’ . Gender-responsive, transformative leadership is not only about achieving gender equality, but about equipping women and men with the tools to change the mindset of society in manner to achieve gender equity at all levels. In the global health community, using such an approach to leadership can be a tool to achieve greater gender equity for achieving health and wellbeing of all people .
Health system strengthening and resilience
A Health system consists of all people, institutions, resources and activities whose primary purpose is to promote, restore and maintain health . Health system strengthening and resilience involves integrating national policies, strategies and plans with evidence-based research to evaluate and develop a health care system, which meets the needs of the community, while being responsive to disasters or public health crises [24, 25]. It involves shifting the focus from responding to singular diseases, to considering the broader system as a whole, and its ability to provide for the health care needs of everyone in the community . Women play a critical role in strengthening health systems by giving voice to the concerns of half the population whose health care needs may be unmet and they also provide the bulk of health care worldwide in the formal and informal sectors . In their 2016 Strategic Report, The Alliance for Health Policy and Systems Research emphasised the need to empower more women as leaders in conducting health systems research and policy making, and included them as one of their target groups in Objective 2, ‘Support institutional capacity for the conduct and uptake of health policy and systems research .’