Co-written by Dr Kamal Gulati, Senior Scientist at All India Institute of Medical Sciences, New Delhi
The Government of India’s Ministry of Health and Family Welfare publishes a National Health Policy (NHP) which guides future health programmes and priorities. The most recent NHP was published in 2017. This includes a change in health priorities such as acknowledging the increased burden of non-communicable and some infectious diseases, the emergence of a growing healthcare industry, increased healthcare costs as a contributor to poverty, and enhanced fiscal capacity.
In 2020, NITI Aayog, the lead public policy think tank of the Government of India, released the white paper Vision 2035: Public Surveillance in India. This paper explains India’s vision for continued work on strengthening health systems.
Both India’s NHP (2017) and Vision 2035 seek to establish a governance framework in healthcare which promotes political, policy, technical, and managerial leadership at national and state levels. However, to establish this framework, certain aspects of Indian healthcare leadership need to be addressed.
Doctors in India often reach executive leadership roles within the healthcare system based on seniority without ever receiving formal management training. This could mean that many individuals are in management positions but lack appropriate management and leadership competences and practices. Consequently, Indian healthcare may not be operating as effectively or efficiently as it could which hinders the implementation of necessary changes.
In addition to the existing leadership competency gap, India’s healthcare leadership faces gender-related challenges. A defining quality of a democratic society is equal opportunities for all its members, irrespective of race, gender, or ethnicity. However, in the World Economic Forum’s Global Gender Pay Gap Report (2023), India was ranked 127th amongst 146 countries worldwide.
Despite a thriving pharmaceutical industry and medical professional class, there is a distinct lack of women medical leaders in India. According to Statista data from February 2022, only 18% of healthcare leadership positions in India were occupied by women. This trend is not only seen in leadership positions, but throughout healthcare. World Health Organization (WHO) National Health Workforce data showed that only 14.2% out of more than one million doctors in India in 2020 were women. Moreover, WHO statistics indicate that in 2020, there were 7.27 doctors per 10,000 population in India. In Austria, the number is 53.52 doctors per 10,000 population in the same year. Clearly, there are important implications for individual and national well-being related to the shortage of women doctors and women’s health inequalities.
One encouraging trend globally and in India is that women are outnumbering men in medical schools. In India, however, there are certain societal expectations of women that can impact their full participation in the workforce and at senior leadership levels. It is expected that women should be primary caregivers and prioritize marriage and family life over their careers. This is often incompatible with the reality of working in medicine, which can involve demanding rotas and long shifts. The effect of these societal expectations on women’s participation in medicine is reflected in research which found that around 31% of women in 2018 with medical education in India were out of work because they were mainly engaged with household tasks.
Evidence shows that leadership competency gaps in medicine can be addressed through leadership development programs. Additionally, increasing diversity, equality, and inclusion in healthcare has been found to improve standards of care, quality of working lives, community relations, and the ability to combat challenges within healthcare systems.
Therefore, to address competency and gender gaps in healthcare leadership to reap the benefits, a much better understanding of leadership development and gender inequality regimes in India is needed. India needs effective policies and practices, which address normative and structural gender inequalities and the lack of leadership development at national, regional, and institutional levels in the medical workforce.
Four key priorities:
- Medical school admissions criteria and curricula, decisions on hiring, promoting, and rotating doctors must emphasize practical leadership potential for all doctors in India to include men and women equally.
- There should be mandated continuous leadership development for doctors at all levels. This needs to be underpinned by evidence-based medical leadership models, drawing on multi-specialty research collaborations and in partnership internationally with medical leadership providers.
- Systems within healthcare workplaces need to be adapted to provide women doctors and medical leaders with dedicated resources and flexible working arrangements that promote good work-life balance. This will help to shatter glass ceilings for women in the sector and make it easier for women to continue working in medical roles.
- There needs to be a better implementation of equality, diversity, and inclusion policies with anonymous systems for reporting misconduct and unprofessional behaviors. This will make healthcare organizations safer workplaces for all doctors as well as for patients.
In conclusion, to achieve leadership development objectives set out in India’s National Health Policy and Vision 2035, leadership competency gaps and gender inequalities in healthcare must be addressed immediately.