‘True male allyship is about using power and privilege to create opportunities for women’: Dr. Roopa Dhatt

Dr. Roopa Dhatt has noticed that there are a lot of promises made to women’s groups at large international gatherings like the UN General Assembly. She’s also noted that women’s rights organizations currently receive less than a percentage point of total overseas development assistance funding. “It just shows you how severely underfunded it is,” she says.

What’s needed, according to Dr. Dhatt, the co-founder of Women in Global Health, is a movement to transform global health so it’s gender equal. Donors, governments, and private philanthropy should also all assess how much money is truly going to women's rights work, she says.

What’s also needed, she says, is for men in global health to realize they benefit from a ‘male bonus’ and take active steps to champion women, including using their influence to ensure women take positions they vacate.

In this second part of an interview with Dr. Dhatt, Exemplars News asked her about some of the immediate actions that could be taken to redress gender inequality in global health leadership and what real male allyship looks like.

Why does the global health governance system privilege men when it comes to leadership roles?

Dr. Dhatt: At Women in Global Health we say health systems were designed by men for men and continue to serve men. Over time women did enter medicine, but they often entered in volunteer-type roles such as nursing. Even as the medical profession evolved, women formally joined much later into the majority of the health systems – the first women doctors were graduating in the 1940s and 1950s. It was much later for ethnic minority women. So there are root historical drivers that perpetuate inequalities.

The second reason men more often hold leadership positions is occupational segregation. We know that almost 70% of the health workforce are women, but they're often in lower-paying or lower-status roles and have less opportunities. For example, 90% of nurses are women. And many of them are in frontline, patient-facing roles that are stipend-based or nearly volunteer-based, if not fully volunteer. Community health workers or community volunteer workers are easily 90% or more women, as well.

We also see occupational segregation in health specializations – women doctors are primarily in primary health care and, if they're in a specialization, it's typically pediatrics. These occupations and specializations often have lower status, lower pay, and less ability to influence decision making. We estimate, with partners like WHO and ILO, that health occupational segregation contributes to a gender pay gap [in health] of 24%, which is much higher than many other sectors.

Research by Women in Global Health has shown it would take about 100 years for women to attain equal leadership roles in global health as the current rate of progress. What are some of the immediate actions that could be taken to redress gender inequality in global health leadership?

Dr. Dhatt: We need to take bold steps like creating all-female shortlists or committing that the next person appointed for a government-appointed role such as the WHO executive board or head of a delegation to the World Health Assembly will be a woman. That's a decision a government can make. Every country has incredibly qualified, talented, experienced women in the health sector. We like to say that the health sector can be the exemplar sector because we don't have the talent pipeline issue some other sectors have about educating and bringing women into the workforce. We have them in the pipeline already.

The second thing that’s needed are champions to recognize what women are contributing. Women are often urged to get mentors, leadership coaches or leadership training. So many of these efforts say, 'Let's train women to be better leaders. Let's focus on fixing women.' But one of the things that can be game changing is having male champions. How can men in power be activated to practice truly male allyship? Not mentorship, but actively saying, 'I'm going to use my influence to get a woman into the seat that I'm going to vacate.' It's everyone's responsibility to support women and champion them.

Political sponsorship of women is also lacking. I’m thrilled that GAVI will have its first female CEO, Dr. Sania Nishtar. But women are often excluded from these top roles because they lack political sponsorship. Even for senior technical appointments that are not political appointments, there's always an element of political sponsorship. This is something we're trying to sensitize women to – the fact that there are always politics at play and that merit alone will not break glass ceilings.

What role can donors play in addressing this imbalance?

Dr. Dhatt: If you're looking to support women's movements to accelerate collective action, local and global women's organizations are the best place to start, but they often lack the necessary political and financial resources. Just to give you some hard numbers – even though there's a lot of rhetoric and commitments at the UN General Assembly and other big global events, women's rights organizations receive only 0.13% of total overseas development assistance funding. Not even a full percentage point. When you look at all gender-related aid it's only 0.4%. I'm not talking solely about the health sector. I'm talking about all sectors that focus on women's rights. It just shows you how severely underfunded it is.

If we look at what changes societies, it's movements. When I founded Women in Global Health, we talked a lot about what we were going to do collectively as a group of early-career women that wanted to transform the sector to be more gender equal, make it value women's contributions, and view them as leaders. We brainstormed. Do we write a paper? Do we write a report? Do we have a conference? The clear consensus was that we needed collective action – and that was going to take a movement. Movements are what have transformed societies and [remedied] social injustices. Yet when it comes to funding, women's rights and feminist organizations are living year to year. Fifty percent of women’s organizations don't have funding for the following year. Women in Global Health have been in that situation ourselves. But many people don't recognize this reality because they say, ‘MeToo happened. Or we're seeing the HeForShe campaign or we're seeing this other feminist campaign.'

Donors, governments, and private philanthropy should assess how much money is truly going to gender equality and how much is going to real women's rights work. Organizations often tick their women's rights box because they've done one tiny gender activity. We need more accountability in funding and major announcements need to be backed with real financial investments. Then the next step [for donors] would be recognizing multiple forms of marginalization. Women that are indigenous, migrants, refugees, LGBTQIA, part of certain ethnic groups, have disabilities, or are sex workers, are all even more marginalized and receive even less financial support from major institutions.

What is ‘male bonus syndrome’ and how can it be eliminated?

Dr. Dhatt: Male bonus syndrome is when men benefit unfairly in their leadership progression because well-qualified women are viewed as carers and excluded from the competition. Since men aren't viewed as carers, they benefit from more opportunities, leadership acceleration, and more sponsorship to the next level.

Women in Global Health released a report last year called The State of Women and Leadership in Global Health that confirmed there's been a marginalization of women in [health] leadership, especially during the pandemic, when the stereotype that men are natural leaders really took hold. There have been several different studies, some of which we've led and some of which we took part in, demonstrating that because we were in a health emergency and a pandemic setting, the idea took hold that we needed men to lead because it was a crisis. This resulted in women being sidelined from decision making. For example, the WHO executive board and [WHO] member state-appointed roles were 25% to 30% women [prior to the pandemic], but that number declined to 6% in 2022.

So how do we get rid of this male bonus? I’ve already mentioned using quotas and promoting all-women shortlists. What also works is highlighting examples of what's been effective in increasing women in political leadership and bringing those examples to global health. This is how governments have successfully been able to get close to gender parity. Rwanda is often cited as an example. Kenya also has a 30% parliamentarian quota for women.

Other ways we can eliminate this bias is intentionally highlighting women. We need to make active efforts to increase the visibility of what women are doing as leaders. We need to challenge and change the narrative [to show] that women community health workers are leaders in their communities and that's why we're seeing gains in areas such as maternal mortality, or immunization, or polio eradication. It's actually those women that risk their lives in conflict crises, fragile state settings, and are ensuring critical health services. That's leadership.

And how can men be mobilized as allies?

Dr. Dhatt: I talked about how men can recognize they are benefiting from a male bonus and how they can foster healthy forms of masculinity. They understand gender transformative leadership and are comfortable talking about male bonus syndrome and not denying it. Just having that conversation can be heavy and difficult.

Male leaders can highlight the harms of a male bonus syndrome and sensitize the public health system welfare and service providers to the negative effects. They can weaken the cultural grip of this expectation that men are supposed to excel because they are the breadwinners and it's more important for a man to bring a salary home than a woman. These are the drivers of some of the cultural and gender norms that we're trying to change long term – they harm everyone of all genders.

We also need them to promote alternatives. They can model a more positive masculinity role and style of leadership. They can be comfortable talking about issues that are often viewed as women's issues, such as sexual and reproductive health, menstruation, and menopause. A lot of the life course of women's health issues should be in normal conversations and terminology for all leaders. True male allyship is about using your power and privilege to create space and opportunities for women.

This interview has been edited for length and clarity. Read part one here.