There has been much political discourse on strengthening health systems and economic development in Sub–Saharan Africa. This momentum comes against the backdrops of the HIV/AIDS pandemic and the failed structural adjustment programs implemented during the 1980s and 1990s. Major UN agencies and other humanitarian organizations have worked to improve health systems and healthcare delivery in the region. However, little has been noted about the role of women in these developmental processes.
In Africa, women and their children disproportionally bear the largest burden of diseases, which is often linked to sanitation, nutritional deficiencies and lack of care during childhood and pregnancy. Poor health among women is largely explained by social and gender inequalities in the allocation of resources, income, access to health care and education. These structural barriers and inequalities can exacerbate women’s poor health, impede social mobility, and increase vulnerability to morbidity and mortality. It is also important to note that women provide the larger proportion of health care services, both at home and in formal health care settings. Yet, health systems are often unresponsive to their needs. Women in health care settings mostly assume nursing and midwifery positions, while men dominate in physician and managerial positions that are crucial in decision-making processes. This imbalance creates environments in which women who are the main healthcare providers and those most impacted by health policies are not heard by those in authority. Marmot and colleagues have documented the gradient in health outcomes due to adverse relationships resulting from employment hierarchy, decision-making opportunities and other inequalities. These inequalities also prevent women from accessing family planning opportunities; accentuate reduction in care due to gender sensitive communication between male doctors and female patients; ignore the rights of a women to choose competent alternative care; and result in inadequate prioritization of maternal and child health.
The strengthening of health systems in Sub-Saharan Africa will be successful if women are empowered and are full participants in healthcare systems. It is essential that women’s voices are central in setting the healthcare agenda and policymaking process. As the international community focuses on strengthening health systems in resource poor settings, it is imperative that the gender imbalance is not reinforced. Women can be competent managers and doctors and can excel in leadership roles. Women are also more efficient and empathetic care providers. Women would also make great advocates for prioritizing funding and commitments towards women’s health. We should take advantage of these traits and work to build more equitable health systems. Involving women in decision making will make it more likely that health systems respond to the needs of both men and women.
A health system consists of the organizations, institutions, resources and people whose primary purpose is to improve health (WHO). The WHO has created a framework that describes health systems in terms of six building blocks: (1) service delivery, (2) health workforce, (3) health information systems, 4) access to essential medicines, (5) financing, and (6) leadership/governance. I find the sixth block most important as it involves developing effective health policies and strategies that affect both men and women, however as discussed above women are poorly represented in this aspect. Women are part of the health system and should therefore be fully integrated in all blocks of the health system. In advancing the well-being of women and girls in society, we advance the well-being of all members of society. Kudos to organizations like Management Sciences for Health and the Leadership Management and Governance Project (LMG) that strive to create opportunities for women to move into leadership positions within health systems. Like many others, they believe that strong women leaders build strong health systems.
 WHO, 2009; Women and health: today’s evidence, tomorrow’s agenda. Geneva, WHO
 Empowering Women leaders for Improved Family Planning and Reproductive Health
 Birn et all, 2009; Textbook of International Health Global Health in Dynamic Work, Third Edition; Oxford University Press
 Strong women leaders build Strong health Systems; Jonathan D Quick, MD, MPH
 Creating conditions to allow women to move into health leadership, Belkis Giorgis, Phd