Failing to pay or underpaying 6 million women 'threatens global health security'

Covid-19 pandemic has highlighted endemic practice in low-income countries

A nurse checks the oxygen level of a patient inside a mobile medical van on the outskirts of Hyderabad, India. AFP

Global health security is being undermined by the practice of underpaying or not paying female health workers, a report has said.

More than six million women are propping up health systems around the world without being paid in full, Women in Global Health reported, and the negative effects are widespread.

At the start of the Covid-19 pandemic, some countries were unable to estimate their need for personal protective equipment (PPE) due to a lack of data on the number of health workers delivering critical public health services in communities, the report, titled “Subsidising Global Health”, said.

The coronavirus crisis also exposed the magnitude of the “informal” workforce propping up health services, particularly in low income countries where female workers are often put into the categories of “volunteers” or “community activists”, and are therefore generally unrecorded in formal labour market statistics.

“Workloads during the pandemic increased suddenly for many unpaid women workers, causing exhaustion and stress as women juggled multiple responsibilities,” the report stated.

Sunita, a community health volunteer in India, was quoted in the report as saying that she and her colleagues “are the main reason for the reduction in the number of Covid-19 cases in [her municipality] and Mumbai”.

“They have worked hard at grassroots level but didn’t get recognition from our leaders and politicians … [volunteers] are very upset,” she added.

The findings of the new report mirror those of the Lancet Commission on Women and Health, which calculated that women's contribution to the global economy was $3 trillion, with half of that in the form of unpaid work.

Ann Keeling, senior fellow with Women in Global Health and the main author of the report, told The National that the pandemic “exposed the deep injustice” suffered by undervalued women in the workplace, a practice which she said is unacceptable.

“Unpaid women community health workers are justifiably proud of the work that they do,” she said. “But it adds to the already heavy burden of unpaid work they have as women.

“Their reasons for accepting it are quite diverse, for many it represents a real opportunity that they might move into a formal sector paid job or they might earn some income, however small. Working unpaid, however, keeps them poor.”

She added that women accept unpaid work as they have few other options, as they are often “limited by lack of mobility or cultural ideas of decent occupations”.

“It is unacceptable that some of the world’s poorest women are subsidising global health with their unpaid labour,” Ms Keeling added.

“We are calling on governments to fulfil the commitments they have made to safe and decent work and to bring the valuable jobs being done unpaid by women into the formal labour market.”

Magda Robalo, managing director of Women in Global Health — a movement that campaigns for gender equality — said, given the statistics, it is unsurprising that many experienced female health workers are seeking new and better opportunities in other fields.

“We know that women make up 90 per cent of frontline health workers globally and there is a very clear connection between the failure to adequately pay health workers, mostly women and what’s being termed the 'Great Resignation' of health workers, putting health systems under extreme stress,” she said.

“Women would choose to be paid if they had that choice. Underpaying or not paying them is not only a violation of economic justice, it is poor policy to engage a large proportion of your workforce under unacceptable working conditions. It is no wonder that so many are leaving the profession.”

The report’s authors conducted research and interviews with health workers in Ethiopia, India, Malawi, Zambia and Mexico and found a striking lack of official data about women working for no pay.

The report recommends that women in health care who are unpaid or grossly underpaid be counted to reflect the true figure of employees delivering services.

Creating decent jobs for all women in the formal health workforce would address the projected 18 million-worker gap that is threatening global health security, the authors said.