Abstract:
Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.