Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
Int J Equity Health. 2018 Sep 18;17(1):148. doi: 10.1186/s12939-018-0859-0.
The importance of strong and transformative leadership is recognised as essential to the building of resilient and responsive health systems. In this regard, Sustainable Development Goals (SDG) 5 prioritises a current gap, by calling for women's full and effective participation and equal opportunities for leadership, including in the health system. In South Africa, pre-democracy repressive race-based policies, coupled with strong patriarchy, led to women and especially black women, being 'left behind' in terms of career development and progression into senior health leadership positions.
Given limited prior inquiry into this subject, we conducted a qualitative exploratory study employing case study design, with the individual managers as the cases, to examine the influence of gender on career progression and leadership perceptions and experiences of senior managers in South Africa in five geographical districts, located in two provinces. We explored this through in-depth interviews, including life histories, career pathway mapping and critical incident analysis. The study sample selection was purposive and included 14 female and 5 male senior-managers in district and provincial health departments.
Our findings suggest that women considerably lag behind their male counterparts in advancing into management- and senior positions. We also found that race strongly intersected with gender in the lived experiences and career pathways of black female managers and in part for some black male managers. Professional hierarchy further compounded the influence of gender and race for black women managers, as doctors, who were frequently male, advanced more rapidly into management and senior management positions, than their female counterparts. Although not widespread, other minority groups, such as male managers in predominantly female departments, also experienced prejudice and marginalisation. Affirmative employment policies, introduced in the new democratic dispensation, addressed this discriminatory legacy and contributed to a number of women being the 'first' to occupy senior management positions. In one of the provinces, these pioneering female managers assumed role-modelling and mentoring roles and built strong networks of support for emerging managers. This was aided by an enabling, value-based, organisational culture.
This study has implications for institutionalising personal and organisational development that recognise and appropriately advances women managers, paying attention to the intersections of gender, race and professional hierarchy. It is important in the context of national and global goals, in particular SDG 5, that women and in particular black women, are prioritised for training and capacity development and ensuring that transformative health system policies and practices recognise and adapt, supporting the multiple social and work roles that managers, in particular women, play.
强有力的变革型领导力至关重要，这一点已得到广泛认可，是建立有弹性和反应灵敏的卫生系统的关键。在这方面，可持续发展目标 5 优先考虑了一个当前的差距，呼吁妇女充分有效地参与并获得领导机会，包括在卫生系统中。在南非，民主前的压迫性种族主义政策加上强烈的父权制，导致妇女，尤其是黑人妇女，在职业发展和晋升为高级卫生领导职位方面“落后”。
鉴于对此主题的前期研究有限，我们采用案例研究设计进行了一项定性探索性研究，以个体管理者为案例，研究了性别对职业发展和领导的影响，以及南非五个地理区域的高级管理者的看法和经验，这些区域位于两个省份。我们通过深入访谈、职业道路图和关键事件分析来探讨这一问题。研究样本选择是有目的的，包括来自地区和省级卫生部门的 14 名女性和 5 名男性高级管理者。
我们的研究结果表明，女性在晋升为管理层和高级职位方面明显落后于男性。我们还发现，种族在黑人女性管理者的生活经历和职业道路中与性别强烈交织在一起，在部分黑人男性管理者中也是如此。职业层次结构进一步加剧了性别和种族对黑人女性管理者的影响，因为经常是男性的医生更迅速地晋升为管理层和高级管理层职位，而不是女性。虽然并不普遍，但其他少数群体，如主要由女性组成的部门中的男性管理者，也经历了偏见和边缘化。新的民主统治引入的平权就业政策解决了这一歧视性遗留问题，并促成了一些女性成为高级管理职位的“第一人”。在其中一个省份，这些开创性的女性管理者担任了榜样和指导角色，并为新兴管理者建立了强大的支持网络。这得益于一个有利的、基于价值观的组织文化。
这项研究对机构化个人和组织发展具有重要意义，承认并适当推进女性管理者，关注性别、种族和职业层次结构的交叉点。在国家和全球目标的背景下，特别是可持续发展目标 5，优先培训和能力发展女性，特别是黑人妇女，并确保变革性卫生系统政策和实践认识到并适应管理者，特别是女性，所扮演的多种社会和工作角色，这一点非常重要。
