Terms of Reference for National Consultant / Firm to undertake Study on Gender Equality in Health Sector (Women in Health Leadership) in Pakistan
Pakistan has a comprehensive health system comprising of an elaborate Health Regulatory machinery, health surveillance system, and a network of health facilities including Rural Health Centers, Basic Health Units (BHU), secondary and tertiary hospitals. While some hospitals work directly under the administrative control of Health Departments, there are a number of health facilities working under Employees’ Social Security Institutions in each Province. Apart from a large Public sector health network, there is an equal number of private health facilities. In 2019, the Government of Pakistan initiated a process to provide ‘Universal Health Coverage’ to all citizens – starting from KP Province (completed in 2020) and now expending in Punjab Province.
As per 18th Constitutional Amendment, the Federal Health Ministry was devolved to the Provinces. While there are strong Health Departments in each Province, there is a Federal Ministry for National Health Services Regulation and Coordination – primarily to deal with international matters and coordination.
Gender Equality in Health Sector (Women Leadership in Health) in Pakistan
For the past several years, the International Labour Organization (ILO) has built a case for higher representation of women in decision-making positions. ILO’s global report on “Women in Business and Management: Gaining Momentum” presents the business case for gender diversity, provide information and data on the evolving situation of women in management and boardrooms and showcase good practice examples from enterprises on their measures and strategies to shift the status quo. Improving gender diversity in the workplace does not only benefit women. Mounting evidence shows that it is a boon to societies, economies and enterprises themselves. The ILO in its Centenary Declaration called for a human-centred approach to the future of work, which includes the effective realization of gender equality in opportunities and treatment.
The health sector constitutes an important and growing employer for women and can greatly contribute to gender equality. The United Nations Secretary-General High-Level Commission on Health Employment and Economic Growth in its ten recommendations to transform the health workforce for the SDGs called for maximizing women’s economic participation and foster their empowerment among others through institutionalizing their leadership.
Gender inequity in health and social care work remains a challenge. Women are overwhelmingly the decision makers for meeting the health needs of their families, making four-fifths of health purchases. Given this, it would seem beneficial for all if women were strongly represented in the senior leadership of health systems. Yet this is not the case. Despite women’s employment as doctors, nurses, pharmacists, midwives, Lady Health Workers, and other health care personnel, available data consistently shows a lack of gender parity in leadership and decision-making positions. Women comprise an estimated 70 percent of the global health workforce but hold only 25 per cent of senior roles. 69 per cent of global health organizations are headed by men, and 80% of board chairs are men. The gender leadership gap in health is inequitable, a barrier to health systems and holds back achievement of the SDGs and Universal Health Coverage.
Besides the fact that women make up a large part of the health workforce, their role as drivers of health is often not acknowledged. It is also common in South Asia that women play an important role as frontline workers (e.g. Lady Health Workers in Pakistan, ASHA workers and Anganwadi workers in India, and Community Health Volunteers in Nepal), they lack recognition as workers and they do not enjoy the rights and entitlement in relation to their work. Globally, women experience a disproportionate burden of disease and death due to inequities in access to basic health care, nutrition, and education. In the face of this disparity, it is striking that leadership in the field of global health is highly skewed towards men and that global health organizations neglect the issue of gender equality in their own leadership. Randomized trials demonstrate that women in leadership positions in governmental organizations implement different policies than men and that these policies are more supportive of women and children. Other studies show that proactive interventions to increase the proportion of women in leadership positions within businesses or government can be successful. Therefore, the authors assert that increasing female leadership in global health is both feasible and a fundamental step towards addressing the problem of women’s health. In addition, women also carry a largely unacknowledged burden of unpaid health and social care work. It is estimated that women’s unpaid care work represented 6.6 per cent of global gross domestic product (GDP), while men’s contribution amount for 2.4 per cent of global GDP.
Key dimensions of gender inequity and leadership gap in health included among others gender pay gap; gender based disparities in job recruitment, induction, retention and promotion procedures and policies in the health sector; gender insensitive and discriminatory work place environment including violence and harassment at the work place; lack of gender responsive policies and systems; and unequal opportunities for capacity building. Workplace gender biases, discrimination, inequities, and gender disparities are persisting and COVID-19 continues to exacerbate existing inequalities and place a disproportionate burden on women, including in health-care settings. Women health workers are faced with increased workloads, a gender pay gap, shortages of personal protective equipment that fits them, increased care responsibilities at home, and harassment and violence as they respond to the pandemic on the frontlines. Women deliver global health while men design and lead it. Women remain largely absent from national or global decision-making on the COVID-19 response.
Though Pakistan has a long history with health workforce regulation, especially for physicians and dentists, the system needs a thorough review and strengthening with updated practices. Health workforce information is fragmented and incomplete. Registration data of the professional councils is not updated and does not provide information on the status. There is inadequate research, which is critical for health workforce planning, implementation and monitoring. A national HRH Vision 2030 was launched in 2018 and provincial health workforce strategic plans are being developed.
At the moment, there is no comprehensive baseline study identifying gender situation in health leadership – particularly, women’s leadership role on health system in Pakistan. In this background, the ILO through the joint ILO-OECD-WHO ‘Working for Health (W4H)’ Programme in Pakistan undertakes and supports a study on ’Women Leadership in Health Sector’. The study will look at women’s leadership in health sector in all avenues including within health institutions and within hierarchies in public health institutions, in staff associations and trade unions, and in other settings.
This analysis is undertaken within and in support of the implementation of the ILO-OECD-WHO ‘Working For Health’ (W4H) Programme – funded by ‘Working for Health Multi-Partner Trust Fund.’ Findings of this study will be submitted to the Government for considering possible improvements in health regulations and creating more opportunities for women’s leadership.
This analysis contributes to the Pakistan Decent Work Country Programme 2016-2020 (extended to 2022), Priority Area 4: “Extending Social Protection”, with international Labour Standards being a cross-cutting theme.
Globally, this work contributes to Outcome 2 “International Labour Standards and authoritative and effective supervision” and Outcome 8 “Comprehensive and sustainable social protection for all” as envisaged in the ILO Programme and Budget for 2020–21. This work will also contribute to Outcome 6: Gender equality and equal opportunities and treatment for all in the world of work. Output 6.1 addresses: Increased capacity of the ILO constituents to promote investments in the care economy and a more balanced sharing of family responsibilities – under which health personnel falls as well.
In turn, the work would contribute to UN Strategic Development Framework 2018-2022 (Pakistan), Outcome 10 “Social Protection” and the SDG target 1.3
Objectives of Study
The Study will achieve the following objectives:
Specific objectives/ Areas of Inquiry:
The study will provide baseline information on women’s leadership situation in the health sector (line management as well as in other areas e.g. staff associations and trade unions) and identify the factors inhibiting and favouring the leadership journeys of women in health in Pakistan, who have successfully made it to the top, to help develop policy interventions enabling women to reach to leadership positions more easily.
Scope of Study and Required Work for National Consultant
The study is primarily a desk review of secondary data with some key informant interviews and consultation for data validation and collection of primary data of qualitative nature. The assessment report would provide both qualitative and quantitative analysis of dimensions given in areas of inquiry.
ILO intends to engage a national Technical Consultant or Consulting Firm to undertake a study on Gender Equality in Health Sector, including women’s representation in Leadership positions (Women in Health Leadership), by reviewing existing administrative records, legal and institutional frameworks and conducting key informant interviews with important stakeholders to achieve study objectives mentioned above. The study will cover only Public Sector health system.
The Consultant will be required to map all relevant administrative data and records related to workers in the health sector both in formal and informal employment and draft a detailed review of existing legislation related to health workforce (at Federal and Provincial levels) and how this legislation support or hinders women’s career progression in the health sector. The Consultant will also organize bilateral consultations with WHO; senior health officials, tripartite partners (including government, employers, workers, women workers); existing institutions, and other relevant stakeholders (e.g., health professional associations including All Pakistan Lady Health Workers Association, academia, civil society organizations, etc.) and identify barriers and facilitators for gender equality in health leadership as well as key areas for improvement. The Consultant may also undertake quick online survey on any specific questions (after consulting ILO) to get first-hand information from certain group of stakeholders. The Consultant will be required to study/examine following important measures for the study:
Terms of References, Tasks & Deliverables:
The Consultant will be required to undertake following tasks :
Consultant will be required to deliver the following:
The study will be conducted during July – Oct 2021.
The Consultant / Consulting Firm will be required to identify number of workdays and fee per day for the assignment – keeping in view the scope of work.
Required Qualification and Experience
The Consultant should have the following qualification and experience:
How to submit:
Interested individuals are requested to submit the Expressions of Interest, along with following supporting documents (duly dated and signed) through email to: firstname.lastname@example.org, cc: email@example.com by 10-August-2021.
Kindly mention the RFQ reference W4H-MPTF/ILO/2021/001 in the subject of email/submission. Any proposal received without this number and received after the official closing time and date will not be accepted.
Questions and replies:
Should you have any questions, please contact us at the latest by date only by email (firstname.lastname@example.org; cc email@example.com) quoting the RFQ reference.
 ILO (2019): The Business Case for Change
 ILO (2019) ILO Centenary Declaration for the future of work
 WHO (2016): Working for health and growth: investing in the health workforce. Report of the High-Level Commission on Health Employment and Economic Growth
 International Finance Corporation (IFC) study “Women Leadership in Health”
 WHO (2019) Delivered by women, led by men: a gender and equity analysis of the global health and social workforce
 US National Library of Medicine (2014): Increasing Women in Leadership in Global Health
 ILO (2018) Care work and care jobs for the future of decent work
 WHO. Delivered by Women, Led by Men: A Gender and Equity Analysis of the Global Health Workforce produced by the Global Health Workforce Network’s Gender Equity Hub, 2019
Job Description The Assistant Finance Manager will play a vital role in improving and maintaining the financial standing of our...
3 year(s) or above experience Islamabad Responsibilities: Designing and implementing new...
Location Shahalam Market lahore Timing 9am to 9pm Share ur resume on whatsapp 03000-84-7831 Receiving Clerk...
Required Skill Set Thorough understanding and working knowledge of the following: · Tracking Budget Expenses ·...
Urgently require Accountant cum HR Generalist Skills: Must be Graduate and Masters degree will be added advantage Experience:...
Employer: The Lady Dufferin Hospital Industry: Health and Medical Location: Karachi The Lady Dufferin Hospital...
Zonal Manager Sales- Multan Responsibilities / Duties Achieve Sales and Recovery Target as per given by company monthly, Quarterly...