Barriers and Bridges: Women and Leadership in the Sierra Leone Public Health Sector

Purpose: The study examined gender and leadership in the public health sector to understand equality practices and the extent to which women are being considered for top leadership roles in the MoH. Methodology: A mixed-method cross-sectional study design was used, including document reviews. A total of 402 respondents (grade 9-14 civil servants) completed the online survey, and 18 purposively selected individuals were interviewed. SPSS version 25 and Braun and Clarke’s (2006) step-by-step framework for performing thematic analysis were used for the quantitative and qualitative analyses, respectively. Findings: There is a perception among the participants that women are inadequately considered for senior and top management positions in the MoH. There is a significant relationship between gender and perceptions about women being considered for leadership positions, X2 (3, N = 402) = 8.88, p < .05. However, the relationship between gender and the other variables (professional roles and service grade) shows no statistically significant difference (p > 0.05). Participants shared practices they perceived as barriers to women’s advancement to leadership positions. The findings from documents review in relation to gender representation across the various functional roles in the MoH, however, revealed significant effort by the leadership to close the gender gap in compliance with the mandated 30% women’s representation by 2023 GEWE Act. Overall, women account for 34% and 22% in the senior management level and the top management level, respectively. The political leadership has a 33% female representation, while the professional and administrative leadership remains male-centric, with no female representation. The proportion of females that are currently serving as directors and program managers are 29% and 47% respectively. The least represented roles by women are the District Medical Officer and Medical Superintendents, with only 12% and 14% female representation, respectively. Despite the perceived barriers to women’s career and leadership advancement in the MoH, the 2023 GEWE Act is considered an opportunity towards bridging the gender gap in the public health sector. It is imperative that gender equality and women’s empowerment initiatives go beyond token measures and result in meaningful and measurable changes in advancing women to top leadership positions not only in the public health sector, but also in all government ministries, department, and agencies. Unique Contribution to Theory, Practice, and Policy: Utilizing Acker’s Gendered Organizational Theory, this study examined the barriers and opportunities for women’s career advancement to senior leadership positions in the public health sector. This is the first study in post-war Sierra Leone to examine the gender landscape in the MoH. This study is significant to policy and practice for providing insights on the barriers and facilitators for women’s career advancement in the MoH. The study findings demonstrate the importance of multi-level strategies that address the entrenched gender norms and systemic barriers that undermine women’s career advancement to senior leadership positions in the public health sector.