There is a clear link between gender diversity and good business performance, and the promotion of more women into leadership positions boosts the entire economies of countries. This was the strong Women's Day message put forward by Professor Agnes Binagwaho, the Vice Chancellor and cofounder of the University of Global Health Equity (UGHE) in Rwanda.

Binagwaho (MD, MPed, PhD), a former Rwandan Health Minister who was named as one of the 100 Most Influential African Women for 2020, was the keynote speaker at the Women's Day 2021 webinar, hosted by the Stellenbosch University's (SU) Faculty of Medicine and Health Sciences (FMHS), on 5 August.

In an address entitled Advancing Opportunities in Women's Health and Education, she highlighted the importance of enrolling girls in education as a means to increasing the wealth of countries.

“Investing in girls and women is smart. It is known that when 10% or more girls go to school, a country's GDP increases on average by 3%."

Binagwaho said gender equity is a powerful tool that can generate change in society. “We have made some progress but much more needs to be done."

Binagwaho cited studies to demonstrate how gender equity improves business performance. “A study conducted in California found that, among 400 companies, the 25 firms with the highest percentage of women in leadership positions had returns on assets and equity that was 74% higher than the overall group. In a study among 11 000 publicly traded companies across the globe, companies run by women performed much better than those run by men."

She stressed that health systems also function better when women are in leadership positions.

“Women expand the agenda for the vulnerable and give more attention to issues that disproportionately affect women."

Yet medicine, as a historically all-male profession, is still affected by negative stereotypes about women's capability.

“Salaries for female academic-physicians are 8% lower than that of their male counterparts. Women are generally viewed as support staff, not leaders.

“Currently only 25% of global health leadership positions are held by women. We, as female global health fighters, need to keep challenging the negative stereotypes about the capability of women; to take ownership through action and evidence-based data and to use our positions to influence attitudes. We must serve as role models and train other women in leadership skills."

Binagwaho cited the phenomenon of the 'leaking pipeline' which prevents women from advancing in their careers.

“We need to identify how to fix this leaking pipeline and ensure the high interest from women in undergraduate and graduate school translates into an increase in similar representation in leadership positions in the health sector.

“We need to ensure young women seek career advancement opportunities and help them build leadership and management skills while in university. 

“Mentorship is also a clear component of fighting the status quo. Mentors should provide holistic advice – not just academic but also advice for life."

Binagwaho offered advice on how to engage in the ongoing 'fight' for equity. “Don't fight to be excluded at the first battle… but to advance the agenda because you might be replaced by a misogynist man or careless woman. Don't take gender bias personally. You cannot let it destroy you. This is a long-term war not a single battle so don't create unnecessary enemies that will block your progress. Lastly you need to teach others the skills you have learnt. Advocacy is crucial."

Citing Rwanda's own journey towards gender parity, Binagwaho said the adoption of policies and strategies that incorporate gender equity into the legal framework has been key. Rwanda ranked ninth globally and first in sub-Saharan Africa in closing gender gaps.

“The constitution, aligned with our national vision, requires that no less than 30% of any gender are in leadership positions.

“We have established various laws that protect women's rights, including, in 2008, a law for the prevention and punishment of gender-based violence; while in 2013, a law requiring gender to be included in education, infrastructure, health and agricultural budgets was passed. In 2018 we also passed a law institutionalizing financing for gender equality. By requiring this aspect to be considered in each budget, Parliament and the nation can examine where we need to allocate budget to more issues of gender equity."

Binagwaho said it is also critical to mitigate gender inequity in education. At her university, UGHE, women constitute 70% of MBBS (Bachelor of Medicine, Bachelor of Surgery) students. “While government and individuals have the responsibility to advocate for gender equity, universities also have a role."

Opening the webinar, Professor Nico Gey Van Pittius, FMHS Vice Dean Research and Internationalisation said the Covid-19 pandemic was having a huge impact on women in academic science. While there were increased research outputs from males, there was a decrease from females who were struggling to balance work and home demands.

“It is imperative that the recruitment, promotion and retention of women in academia be redressed."

In a panel discussion chaired by Professor Rene English, PhD candidate Silindile Ngcobo, described how, while female graduate students take up the STEM (Science, Technology, Engineering and Mathematics) subjects, the numbers decrease at PhD level. Early leadership development and institutional support for women are vital in addressing the leaky STEM pipeline, she stressed.

PhD candidate Hannah Simba spoke about how Covid-19 has created vulnerability for women's health and careers and had exacerbated inequalities.

Dr Zethu Mtimkulu described her personal journey “surfing the waves" of the healthcare environment, including the challenges she faced in a male-dominated sector and the unconscious biases she encountered against women. She described, the phenomena of the “glass ceiling"; the “glass cliff" (where women were set up for failure); the “sticky floors" phenomenon (where women hold themselves back) and the “queen bee" syndrome, where women do not want to see other women succeed.

Dr Therese Fish, FMHS Vice Dean: Clinical Services and Social Impact, concluded that everyone should be advocates for gender equity. “Our work is not yet done," she said.