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Women, Healthcare, and the Global Economy

January 19, 2022

Challenges in areas ranging from education to the environment, gender to governance, health to housing don’t exist in a vacuum. Each month, Abt experts from two disciplines explore ideas for tackling these challenges in our monthly podcast, The Intersect. Sign up for monthly e-mail notifications here. Catch up with previous episodes here.

Around the world, there’s a vital need for healthcare services. At the same time, women are disproportionately excluded from the global economy. These two challenges are connected, and so are their potential solutions. In this episode of The Intersect podcast, Abt’s Caroline Quijada and Dr. Nicole Goldin explain how women can find economic opportunities by bolstering the healthcare sector, and why a stronger healthcare sector can enable women to pursue more economic opportunities.

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    Read the Transcript

    Eric Tischler: Hi, and welcome to The Intersect. I'm Eric Tischler. Abt Associates tackles complex challenges around the world, ranging from improving health and education to assessing the impact of environmental changes. For any given problem, we bring multiple perspectives to the table. We thought it would be enlightening, and maybe even fun, to pair colleagues from different disciplines so they can share their ideas and perhaps spark new thinking about how we solve these challenges.

    Today I'm joined by two of those colleagues. Caroline Quijada and Dr. Nicole Goldin. Caroline's an expert in family planning and reproductive health with a particular focus on private sector initiatives. She has over 20 years of experience designing, implementing, and managing health projects domestically and overseas.

    Nicole brings 25 years of experience in strategic and technical management, policy research, communications, and collaboration in global and local economics with an emphasis on youth as well as inclusive and sustainable growth and gender equity.


    Caroline Quijada: Hi, Eric.

    Dr. Nicole Goldin: Thank you. It's great to be with you both.

    Eric: The capacity for delivering health services and gender inequity are two challenges many countries face. There're several connections between the two, but some are more obvious than others. How can women help build capacity to provide needed health services, and how can the provision of needed health services help women pursue economic equity?

    Caroline, let's start with you. We know from our work in international health, particularly in the family planning and reproductive health space, that we need to increase the capacity for delivering important health services. Can you tell us what you've been seeing?

    Caroline: Yeah, so I think it's a great question. And I think one of the things that we know from family planning and reproductive health is that you need a healthcare worker in many instances, right? Whether it's the pharmacist who selling OCs or condoms over the counter, or the clinician who is inserting a postpartum IUD, or a midwife who's helping to deliver a baby. I think the healthcare worker is such an integral part of that delivery of the service that we need to be sure that there are enough to ensure equitable access across the world. What we see though, historically, is that there's a shortage.

    I mean, I think WHO estimates that, in order for us to meet our UHC--our universal health coverage--goals, by 2030, we need an additional 18 million healthcare workers. And COVID 19 is exacerbating the issue, many of the health workers are being diverted to address the acute need for vaccine delivery, and follow up, and care for people who are quite sick from COVID 19. So, I think we're seeing an issue with a shortage of healthcare workers that is becoming more dire because of the current pandemic.

    Eric: So, Nicole is somebody who works in inclusive economic growth. There are going to be opportunities and challenges here, right? What are you seeing?

    Nicole: Absolutely, and thanks for bringing this up. What's really interesting is that, as much as there are challenges--as Caroline outlined--in healthcare worker shortages, we're seeing that there are also employment and economic opportunity and balances that have been exacerbated by the pandemic, right? We know in particular that women worldwide have left the workforce in significant numbers. We know young women in particular have been hardest hit worldwide by economic shocks and by the pandemic. And this is not necessarily a new story from the pandemic. We saw similar impacts on young people and young women in the 2008 financial recession.

    So, the health system crisis that Caroline outlined really makes this a very unique situation. At the same time, the dynamics that Caroline described is also leading to greater employment and inclusive growth opportunities for women, and youth, and young women in particular, in health services and really the care sector at large. We know there are more than 2 billion people, whether they're children, the elderly, persons with disabilities, et cetera, in need of care broadly, and that this kind of care work itself, including in the health system, is something that is an opportunity. And we're seeing that global employment in the care sector is expected to grow to upwards of 350 million by 2030, according to some estimates. So, there's really a lot of opportunity that can come from this crisis.

    Caroline: Actually, you know what? One of the things I want to hone in on, too, Nicole, is that according to some estimates, 70 percent of healthcare workers now are, in fact, women. So when you're seeing those disruptions to that workforce, it is in fact affecting a lot of women healthcare workers. And I think at the same time, there are a lot... In fact, as you mentioned, there are a lot of opportunities. So we do see, for example, when you invest in women, when you invest in youth, that there are going to be greater advances in increasing access to healthcare services. By making things like access to capital for female facility owners, or business and financial training for midwives, you see that they are actually able to make greater investments in the quality of care of services that they're providing.

    Nicole: Absolutely. And I think that's something we can think about more broadly, which is, as we were saying, when women and young people, young women are not active in the labor force generally, or they're not active economically, it can be a real drag on economic growth and beyond the household. and the effect that it's having on healthcare systems and the ability to kind of meet these needs. And so, when you engage and provide women not only with the skills but the support they need to be in the health system and to be healthcare workers, you are also then bringing more people into the economy. And I know that's something we can talk a little bit more about on, that gender dividend we can see for inclusive growth at large.

    Eric: So, we've just talked about women building capacity in the healthcare sector, but Nicole, you've talked about women needing help from that sector and the broader care economy in order to more fully participate in the economy at large, you want to explain what you mean and maybe explain the term “care economy”?

    Nicole: Absolutely. So, as I mentioned, the care economy is essentially the broader industry that includes healthcare and services, but extends into elder care, early childhood and childcare, disability, and long-term care. It's essentially that system of activities and relationships involved in meeting physical, emotional, and psychological aspects of care. And so what we're seeing is that many women are actually providing unpaid care. And so support from the care economy to parents and children can free up women to pursue more economic opportunities, whether that's work actually in the healthcare and health services or more broadly.

    We know women bear a disproportionate share of the unpaid care and household work burden: more than 75 percent of total hours of unpaid work globally. And more than 600 million working-age women cannot undertake paid work because of the burden of unpaid work. And again, this has also been exacerbated by COVID, as Caroline noted earlier. For example, in India, where women already bear 10 times the brunt of unpaid work, COVID has disproportionately increased the time they spend on family responsibilities, including schooling and taking care of their extended families by another 30 percent.

    So this really is about, when you think about it, it's a double dynamic, right? It's the fact that women are disproportionately represented in care work and in healthcare in particular, as Caroline noted, but it's also that they are impacted by the lack of the care system support that they need in order to undertake work more broadly in economic activity, like Caroline mentioned, whether that's in enterprise and entrepreneurship or small business in any sector. So it really is kind of a critical, double dynamic that that affects women in particular.

    Caroline: And in our space, in the healthcare space, we often refer to what we call gender decision making, and it's this issue with regards to that unpaid care work, which is how you refer to it, right? Your responsibilities as a female provider for caring for your family, for caring for your small children, for making a decision to have another child, it can impact you negatively in the workforce.

    And so, I work a lot with the private sector, and the private sector, especially in the healthcare space, can be very attractive because it does offer female women providers flexibility, right? And it can provide them with pathways to leadership that maybe a more formal public sector system may not. And it is because of that double burden as you called it, Nicole, of having these responsibilities that have to do with being a mother and a partner and a spouse, and also being a career-minded individual. So that's interesting that we're seeing it from those two different angles, but it's the same issue.

    Nicole: And what's also really interesting that you mentioned is the private sector increasingly being the alternative, for lack of a better term, to the work that's in public sector health systems. And as another interesting aspect of this, especially, again, when you look at the care economy more broadly than the healthcare system, is that we know in most of the economies and the developing economies, the informal sector is a huge share of employment--and that includes kind of micro businesses, right? Micro small businesses--a huge share of employment and kind of dominates the market landscape.

    And so, one thing that's interesting is that, as the private sector, the kind of formal private sector, begins to grow and expand in this space it can create not only more job opportunities, but more quality job opportunities, right? Because we know the informal economy and, again, informal micro business, can often be unpredictable. It can be lower wage, it can be more uncertain in some industries. It can even be more dangerous and unprotected. And so not only is it creating more work, but as we like to say, better work for women and for young women going forward. So it's a really interesting dynamic, and it's great to see the private sector, again, not only increasingly provide these care support services for their employees, but being the actual source of income generation and better livelihoods for women.

    Caroline: I think one of the things that you and I have talked about in the past, Nicole, has been, in line with private sector innovation and expansion, is sort of the digital technology and the changes that the digital sort of wave is bringing to the healthcare industry. And in particular for that care economy. And I think about a service like counseling, and typically a woman or a couple or a teenager would go in, see a provider, be counseled on a method, be given that method, but more and more, we're seeing that there's experimentation and innovation in that counseling space where, especially among adolescents, they're relying on their mobile phone.

    And there's our program in India, the SHOPS Plus program in India that piloted a chat bot, where you would ask your phone the question that you typically would have asked a provider. And in some cases you would've preferred to ask a female provider, but now gender doesn't matter because it's this chat bot that is going to provide you with all the necessary information and even help refer you to where you can actually access the product itself. And so, one of the things I'm worried about--excited about, but also worried about--is what does this digital technology wave mean for that care industry? And for some of these women entrepreneur and women caregivers?

    Nicole: It's such an interesting nexus, you're right, Caroline, between ICT and digital economy and healthcare and the care system at large. And it's also really another growth sector with inclusive growth potential. And you're right. There is, like, the automation concerns in kind of every industry, there's excitement of opening up access for people, but there is that concern. But what we’re seeing in ICT is that there really is more opportunity than there is concern.

    Eric: Hey, Nicole, can I ask you to define ICT just in case...

    Nicole: Absolutely, sorry. The Information Communications Technology.

    Eric: Thank you.

    Nicole: Broadly speaking, ICT is within and related to the digital economy or the digital sector. And what's really interesting is that, like we were talking about the opportunities in the care economy, there's also those opportunities in the digital economy and the nexus between those two is really, I think, exciting if we tap into it, right?

    So that's the key, is the test, which is to say we may think of traditional increasing number of digital ICT oriented jobs, whether it's systems engineers, or coders and programmers, which are, again, in every sector, and increasingly in the health sector. But there's also just the basic use of digital tools in everyday jobs, right? We're processing internet email.

    So, you may be a nurse or a midwife, and then you are increasingly needing to have and use these other tools as well. And so the implications, going back to a little bit of where we started on workforce capacity, is that, like other professions and vocations, training in medical and health services will increasingly need to integrate digital literacy and skill building as well, in order for it to be an opportunity and not a concern or a challenge that these jobs will actually go away. In the end I think there will be a benefit if we take advantage of it.

    Caroline: And actually now, having said that I was concerned, now actually listening to you, I think it can actually help address the healthcare worker shortage issue by replacing the need to actually have a person or a particular cadre and exploring more the telemedicine, the use of Information Communication Technologies, in the delivery of some of these traditionally human-held positions, for lack of a better term. So, you've convinced me. I'm not concerned. Now I'm like, “Let's go all in!”

    Nicole: Interestingly, the care economy at large is often also associated with the term “the empathy economy,” right? And it's, to use your word, human. It's that human interaction. And I think it's where that human plus digital, as opposed to digital instead of human, is where we can see some really interesting opportunities to, again, both increase access for users but also to increase opportunity--in particular, inclusive opportunities--for women and young women, as they move forward in creating new career options and new pathways that might not have been thought of or even possible before.

    Eric: That's great. So, to wrap up, we've talked a lot about what the challenges are, what possible solutions are. What are we doing? What are we seeing that works to help reach those solutions? What can we be doing?

    Nicole: I think that generally, and I know, Caroline, hopefully, I know you probably have some thoughts from what you're seeing already in our projects, but more broadly it gets back to what we're talking about in making sure that women, and young women, as they are doing their education and their training and their preparation to go forth in the workforce, are receiving more broadly the supports that they need.

    Not only to be employed or to run a small business in the care economy, to work in the care economy but also, because what we know is that women can not only drive growth the more that we are able to activate them in the workplace, but also women have, especially in the developing economies that we work in, have tremendous buying power, right. In many places they are actually holding the purse strings, so to speak. And so, the more of that money that we put into women's hands and women's pockets, the increase from the consumption side of things, we can see that contribution to growth as well. So at that more macro level, so it really is an opportunity to have that gender dividend, as well as that demographic dividend that we often refer to when young people and youth are better engaged and being part of a dynamic, productive, diverse economy.

    So it's really exciting. And I think it comes back to what we were saying about making sure that we're thinking in a holistic and an inclusive and cross-disciplinary way, when we're think about how we're supporting and strengthening our health systems and how we're working through and with the private sector, and how we are paying attention to those local dynamics and making sure that we're really bridging, as an economist, the supply and the demand and all of those mediating factors and making sure that we're educating and training people for the jobs that are available now, for the job that will be available going forward.

    And I know that that's how we're thinking about it at Abt, but I defer to Caroline on the ground and for what that looks like in our current portfolio and beyond.

    Caroline: Yeah, I think I would echo the need for investments and having inclusivity as the lens through which we provide our technical assistance and support. I think we've seen that gender dividend pay off with regards to access to capital, access to business and financial management training, translate to better quality healthcare services. As a public health expert that's what's important to me, right?

    And so I think I would definitely agree, and continuing the work that we've been doing for so many years with the private healthcare sector and with improving quality of care just generally and help to achieve the Universal Health Coverage goals, as well as the SDGs that we do in our work for the clients that we serve.

    Eric: Well, I love it. We started talking about some really scary challenges and ended with some apparent possible solutions. That's a pretty good story there. Thank you both for joining me.

    Caroline: You're welcome. Thanks for having us, Eric.

    Nicole: Thank you, it’s been great.

    Eric: And thank you for joining us at The Intersect.

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