Barriers and Bridges: Women and Leadership in the Sierra Leone Public Health Sector
DOI:
https://doi.org/10.47604/ijgs.3591Keywords:
Gender, Gender Equality, Glass Ceiling, Leadership, Public Health, Women’s LeadershipAbstract
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.
Downloads
References
Abate, G. B., & Woldie, A. T. (2022). Breaking barriers to women’s advancement in the public sector in Sub-Saharan Africa. Canadian Bureau for International Education. Retrieved https://cbie.ca/wp-content/uploads/2022/04/ALT-Research-Report-Begashaw-EN-FINAL.pdf (date-20.11.2025)
Acker, J. (1992). Gendering organizational theory. In A. J. Mills and P. Tancred (Eds.), Gendering organizational Analysis. Sage Publications.
Adongo, P. B., Tapsoba, P., Phillips, J. F., Tabong, P. T. N., Sone, A., Kuffour, E., ... Akweongo, P. (2013). The role of community-based health planning and service strategy in involving males in the provision of family planning services: A qualitative study in southern Ghana. Reproductive Health, 10, 36. doi:10.1186/1742-4755-10-36
Ali, Z., Mahmood, B., & Mehreen, A. (2019). Linking succession planning to employee performance: The mediating roles of career development and performance appraisal. Australian Journal of Career Development, 28(2), 112–121.
Allen, T. D., French, K. A., & Poteet, M. L. (2016). Women and career advancement. Organizational Dynamics, 45, 206-216. doi:10.1016/j.orgdyn.2016.07.006
Alzougool, B., AlMansour, J., & AlAjmi, M. (2020). Women leadership styles in the public sector in Kuwait: The perspective of their subordinates. Management Science Letters, 465–472. https://doi.org/10.5267/j.msl.2020.9.021
Arar, K. (2013), Race, gender, and leadership in nonprofit organizations. Leadership & Organization Development Journal, 34(2), 196 198. https://doi.org/10.1108/01437731311321940
Baqutayan, S. M. S., & Raji, F. (2017). The way women lead educational industries: An evaluation of female leadership style. Peshawar Journal of Psychology and Behavioral Sciences, 2(2), 189–196. Doi:10.32879/pjpbs.2016.2.2.189-196
Bart, C., & McQueen, G. (2013). Why women make better directors. International Journal of Business Governance and Ethics, 8(1), 93
Bierema, L. L. (2016). Women’s leadership troubling notions of the “ideal” (male) leader. Advances in Developing Human Resources, 18, 119–136. Doi:10.1177/1523422316641398
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https:// doi.org/10.1191/1478088706qp063oa
Brieger, S. A., Francoeur, C., Welzel, C., & Ben-Amar, W. (2019). Empowering women: The role of emancipative forces in board gender diversity. Journal of Business Ethics, 155(2), 495-511.
Chang, H. (2017). Does leadership matter? Study of leadership style, job performance and job satisfaction. Poslovna Ekonomija, 11(2), 1–28. Doi:10.5937/poseko12-16191
Chisholm-Burns, M. A., Spivey, C. A., Hagemann, T., & Josephson, M. A. (2017). Women in leadership and the bewildering glass ceiling. American Journal of Health-System Pharmacy, 74, 312–324. Doi:10.2146/ajhp160930
Cullen, L. C. (2020). Female Combatants and the Post-Conflict Process in Sierra Leone. Journal of International Women’s Studies. 21(2), 114-125
Damman, M., Heyse, L. & Mills, M. (2014). Gender, occupation, and promotion to management in the nonprofit sector. The critical case of Médecins Sans Frontières Holland. Nonprofit Management and Leadership, 25(2), 97–111.
Darvin, L., Pegoraro, A., & Berri, D. (2017). Are men better leaders? An investigation of head coaches’ gender and individual players’ performance in amateur and professional women’s basketball. Sex Roles, 78(7–8), 455–466
Dhatt,R., Theobald,S., Buzuzi,S. et al., (2017). The role of women’s leadership and gender equity in leadership and health system strengthening. Global Health, Epidemiology and Genomics, 2, e8,1-9. Doi:10.1017/gheg.2016.22
Downs, J.A, Reif, L.K., Hokororo, A., & Fitzgeral, D. (2014). Increasing Women in Leadership in Global Health. Academic Medicine, 89(8):1103-1107 DOI: 10.1097/ACM.0000000000000369
Ely, R. J., & Rhode, D. L. (2010). Women and leadership. Handbook of leadership theory and practice, 377-410.
Global Gender Gap Report (2024). Insight Report. Retrieved from https://www3.weforum.org/docs/WEF_GGGR_2024.pdf
Guptill, M., Reibling, E. T., & Clem, K. (2018). Deciding to lead: A qualitative study of women leaders in emergency medicine. International Journal of Emergency Medicine, 11(1), 1865–1372. Doi:10.1186/s12245-018-0206-7
Haile, S., Emmanuel, T., & Dzathor, A. (2016). Barriers and challenges confronting women for leadership and management positions: Review and analysis. International Journal of Business & Public Administration, 13(1).
Haile, S., Emmanuel, T., & Dzathor, A. (2016). Barriers and Challenges Confronting Women for Leadership and Management Positions: Review and Analysis. International Journal of Business & Public Administration, 13(1).
Heise L, Greene ME, Opper N, et al. (2019). Gender inequality and restrictive gender norms: Framing the challenges to health. Lancet; 393 (10189):2440–2454.
Joshi, A., Son, J., & Roh, H. (2015). When can women close the gap? A meta-analytic test of sex differences in performance and rewards. Academy of Management, 58(5), 1516–1545. Doi:10.5465/amj.2013.0721
Kalbarczyk, A., Banchoff, K., Perry, K.E. et al. (2025). A scoping review on the impact of women’s global leadership: evidence to inform health leadership. BMJ Global Health;10:e015982. Doi:10.1136/ bmjgh-2024-015982
Kanu, A. (2025). Health Sector Succession Planning and Management Practices in Sierra Leone: A Situation Analysis to Inform Health System Strengthening. International Journal of Leadership and Governance, 5(4), 40–62. Doi:10.47604/ijlg.3501
Kasey, B.(2019). Fixing the Leaky Pipeline: Strategies for Making Economics Work for Women at Every Stage. Journal of Economic Perspectives 33 (1): 43–60.DOI: 10.1257/jep.33.1.43
Kayembe, B. (2023). Advancing Gender Equality in Sierra Leone: A Case Study. Accessed https://ministerialleadership.harvard.edu/wp-content/uploads/2025/02/2023-Forum_Sierra-Leone-Case-Study_FINAL.pdf (Date retrieved 23.11.2025)
Khwela, B. C., Derera, E., & Kubheka, Z. (2020). Women in leadership and the glass ceiling effect: A comparative study of the private and public sectors in KwaZulu-Natal, South Africa. International Journal of Social Sciences and Humanity Studies, 12(2), 368-383.
McFerson, H. M. (2012). Women and post-conflict society in Sierra Leone. Journal of International Women's Studies, 13(1), 46-67.
Mekasha, K. G. (2017). Women’s role and their styles of leadership. International Journal of Educational Administration and Policy Studies, 9(3), 28–34. Doi:10.5897/ijeaps2015.0415
Moak, T. N., Cress, P. E., Tenenbaum, M., & Casas, L. A. (2020). The leaky pipeline of women in plastic surgery: embracing diversity to close the gender disparity gap. Aesthetic surgery journal, 40(11), 1241-1248. Doi:10.1093/asj/sjz299
Nash, M., Davies, A., & Moore, R. (2017). What style of leadership do women in STEMM fields perform? Findings from an international survey. PLOS ONE, 12(10), e0185727. Doi:10.1371/journal.pone.0185727
Osituyo, Oladapo O. (2018). Deliberate Ceiling for Career Progress of Female Public Service Employees: A Contemporary Transformation Trend in South Africa. Journal of International Women's Studies, 19(3), 172-186. Available at: http://vc.bridgew.edu/jiws/vol19/iss3/13
Osterloh, M. & Rost, K.(2025) Exploring the leaky pipeline: Tokenism, status group effects, or self-selection? European Management Review, 1–23. Doi:10.1111/emre.70021
Ouahid H, Sebbani M, Cherkaoui M, Amine M, & Adarmouch L. (2025). The influence of gender norms on women’s sexual and reproductive health outcomes: A systematic review. BMC Womens Health; 25(1):224. Doi: 10.1186/s12905-025-03768-2
Purkayastha, S., Salvatore, M., & Mukherjee, B. (2020). Are women leaders significantly better at controlling the contagion? Journal Health Social Science, 5(2), 231–240. https://doi.org/10.1101/2020.06.06.20124487
Resmini, M. (2016). The ‘leaky pipeline′. Chemistry–A European Journal, 22(11), 3533-3534.
Rubio-marin, Ruth. What Happened to the Women?. Gender and Reparations for Human Rights Violations. Columbia University Press, 2006.
Samulowitz A, Gremyr I, Eriksson E, Hensing G. (2018). “Brave men” and “emotional women”: A theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. Pain Research and Management;2018:6358624. Doi:10.1155/2018/6358624
Shafritz, J. M., Ott, J. S., & Jang, Y. S. (Eds.). (2016). Classics of organization theory. (8th ed.). Cengage Learning.
Shaked, H., Glanz, J., & Gross, Z. (2018). Gender differences in instructional leadership: How male and female principals perform their instructional leadership role. School Leadership & Management, 38(4), 417–434. https://doi.org/10.1080/13632434.2018.1427569
Sen G. & Östlin P. (2008). Gender inequity in health: Why it exists and how we can change it. Global Public Health;3(Sup 1):1–12
Sinclair, A. (2014). A feminist case for leadership. Diversity in Leadership: Australian women, past and present. doi: 10.22459/DL.11.2014.01
Smith, S. G., & Sinkford, J. C. (2022). Gender equality in the 21st century: Overcoming barriers to women's leadership in global health. Journal of Dental Education, 86(9), 1144-1173. DOI: doi.org/10.1002/jdd.13059
Stringfellow, E. (2017). A theory of social roles in addiction and recovery suitable for dynamic simulation modeling. Drug and Alcohol Dependence, 17, 199-206. doi:10.1016/j.drugalcdep.2016.08.545
UNWOMEN (2025). Fostering Gender Equality And Empowering Women And Girls in Sierra Leone. Retrieved from: https://africa.unwomen.org/sites/default/files/2025-05/unwomen_brochure_13_02_2025.pdf (date: 23.11.2025)
Tabassum, N., & Nayak, B. S. (2021). Gender Stereotypes and Their Impact on Women’s Career Progressions from a Managerial Perspective. IIM Kozhikode Society & Management Review, 10(2), 192-208. https://doi.org/10.1177/2277975220975513 (Original work published 2021)
Vo, L. V., Nguyen, H. T.-H., & Le, H. T. T. (2021). Do female CEOs make a difference in firm operations? Evidence from Vietnam. Accounting & Finance 61(1), 1489-1516 https://doi.org/10.1111/acfi.12634
Vyas-Doorgapersad, S., & Bangani, A. (2020). The implementation of gender equality within the South African Public Service (1994–2019). Africa’s Public Service Delivery and Performance Review, 8(1), 1-10.
Weber AM, Cislaghi B, Meausoone V, et al. (2019). Gender norms and health: Insights from global survey data. Lancet; 393(10189):2455–2468.
Welzel, C. (n.d.). A theory of emancipation. Freedom Rising, 37–56. https://doi.org/10.1017/cbo9781139540919.004
WHO (2019). Sierra Leone Health Labour Market Analysis in Sierra Leone Retrieved from https://files.aho.afro.who.int/afahobckpcontainer/production/files/Sierra_Leone___Labour_Market_Analysis_Report_for_Sierra_Leone__25Nov2019_post_V.pdf (Date retrieved-15.07.2025)
Young, J.L., & Chang, K. L. (2015). Gender gap persists in nonprofit leadership positions. Nonprofit Business Advisor, (314), 7–7. https://doi.org/10.1002/nba.30128
Zenger, J. H., & Folkman, J. R. (2017). Tactics to increase leadership speed. Leader to Leader (86), 23-28. https://doi.org/10.1002/ltl.20317
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Dr. Alhassan Fouard Kanu, Dr. Francess Fornah

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.