Development Studies

Leadership Experiences and Practices of South African Health Managers: What is the Influence of Gender? -a Qualitative, Exploratory Study

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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.

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Detail Information

Publication Information

: ., 2018

Number of Pages

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ISBN

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Language

English

ISSN

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Subject(s)

Gender
Gender and leadership in health
Race and Professional Hierarchy and health Leaders
South African health leaders and gender
Intersectional social identities and health leader
Women managers

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Article

Part Of Series

Shung-King et al. International Journal for Equity in Health;(2018) 17:148

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