The BMJ’s international community
September 10, 2021
Ethiopia, which is one of the most populous countries in the world, has one of the most acute shortages of physicians in sub-Saharan Africa. Across the country the number of female doctors remains shockingly low due to gender based obstacles. Increasing female leadership in healthcare is a vital step to combating the shortages the country continues to face, say Johann Malawana, George Miller, Kalkidan Alachew, and Lia Tadesse
In Ethiopia, a country with a population of just over 112 million people (almost double that of the UK’s), the number of doctors, nurses, and midwives per 10 000 population stands at just three—that’s 20 below the critical threshold. The number of medical doctors per 10 000 population alone is 0.77 (to put it into context, in the UK the figure is 28.12). As Africa’s second most populous country—and one that has been afflicted by major crises, droughts, epidemics, and armed conflicts in the past two decades—Ethiopia faces an urgent need to build and sustain a skilled workforce in order to address the pressing health concerns the country faces, which have been compounded by covid-19. This begins by expanding access to medical education and, in a country where women continue to be strongly disadvantaged compared with men in areas such as their health, by promoting gender equity in academic medicine.
Globally, the share of female doctors has been increasing, and today the current overall health workforce is mostly composed of women. However, the distribution varies considerably among different countries, and female health workers remain hugely under-represented in certain roles and specialties such as surgery. In Ethiopia, there is still an incredibly low percentage of women doctors (18%), indicating a particular need for greater empowerment of women in the Ethiopian medical workforce.
Empowering women in medicine
Education is the foundation of this empowerment. However, research shows that only around one in 10 Ethiopian girls will advance to post-secondary education in Ethiopia; and even fewer will complete graduate or professional training. Furthermore, to complete these milestones women must often overcome significant obstacles related to their gender, including cultural expectations, gender discrimination, and gender based violence (GBV).
GBV has existed for a long period of time and has various sociocultural impacts on many aspects of life. Findings from one study suggest that GBV affects female students’ academic capabilities, thus impeding their education and future career prospects. A 2020 study aimed at assessing the prevalence of GBV among female high school students in Wolaita Sodo, Ethiopia found the lifetime prevalence of GBV to be 63.2%.
The Ethiopian Medical Women’s Association (EMeWA), which was set up to support women in medicine and encourage equal access and opportunity, puts a great emphasis on empowering women in medicine (and women in general) by campaigning on GBV. The association works on the professional development of female physicians by optimising their knowledge and skills through high value training and workshops. A 2017 paper showed that targeted brief training programmes can enhance women’s motivation and skills to become effective leaders in academic medicine in Ethiopia. So we hope that with these workshops we can increase women’s representation in human resources for health (HRH) leadership positions and create an adequate number of well qualified female professionals and managers. This will help create and shape the leaders and role models of Ethiopia’s future.
How we are helping
Women in Ethiopia have been held back for many years by lack of access to leadership and decision making opportunities. Ethiopia has one of the lowest gender equality performance indicators in sub-Saharan Africa, and across the country only about 2% of general management and decision making positions are held by women.
Within healthcare, the severe under-representation of women in leadership positions limits the country’s ability to effectively respond to the diverse needs of the population, particularly that of women and young girls. Improving maternal and newborn healthcare, for instance, remains a priority of Ethiopia’s when it comes to the sustainable development goals (SDGs). Yet although the number of deaths has fallen in the past 10 years, Ethiopia still has a high maternal mortality ratio of 401 per 100 000 live births.
There is, however, good progress that has been made in recent years that is helping to lay the groundwork for change. In 2018, the country appointed its first female president, Sahle-Work Zewde (who pledged to work hard to make gender equality a reality in Ethiopia). This came only a week after Ethiopia’s prime minister Abiy Ahmed announced a political reshuffle that means women ministers now make up a record 50% of the cabinet. One of us (Lia Tadesse) has been minister of health since March 2020. As a trained medic who brings extensive experience of working to improve women’s health, LT is playing a key part in improving maternity outcomes in Ethiopia. These are all great advancements.
But many challenges still remain and overcoming these requires a holistic approach. Within health—an area where women are still disadvantaged—the EMeWA is helping to tackle these inequalities head on. Medics.Academy is pleased to be working with the EMeWA to help deliver a tailored education programme that can combat these challenges, drive improvements in skills, and diversify the country’s healthcare workforce. Our aim is to develop the leadership and management skills of the many clinically capable, culturally competent, and socially conscious female Ethiopian physicians who are well placed to address the needs of underserved women and young girls across the nation.
We want to create a culture in which Ethiopian women in medicine can enjoy equal rights, and where they can safely gain access to leadership and management training that enables them to advance professionally and participate more equally in decision making. By giving Ethiopian women in medicine a greater voice and platform, they can improve the care that women receive across the country.
Johann Malawana is the CEO of Medics.Academy, which has committed to invest £250 000 to support the Ethiopian Medical Women’s Association over the next five years to develop gender empowerment programmes for female physicians in Ethiopia. Johann is the managing director of the Healthcare Leadership Academy, a nonprofit organisation that runs a programme supporting female leadership in healthcare (the Women in Healthcare Leadership campaign). He is also a senior fellow at the University of Central Lancashire and a board member of the Institute of Leadership and Management.
George Miller is the director general of the Healthcare Leadership Academy, a fellow of the Institute of Leadership and Management, an honorary clinical lecturer at the University of Central Lancashire, and a public health registrar in London.
Kalkidan Alachew is a founding member of EMeWA, serving as secretary of the association for the past two years. She is one of four female endocrinologists in Ethiopia and has also represented EMeWA and served in the advisory council that was set up to assist the Ministry of Health during the covid-19 pandemic.
Lia Tadesse Gebremedhin is currently serving as minister of health in the Federal Democratic Republic of Ethiopia. She is an obstetrician and gynaecologist. Before joining the ministry of health, Lia served as programme director at the University of Michigan’s Center for International Reproductive Health Training.
Cooperation to strengthen women physician leaders across Ethiopia