Personal Development Skills

Participants identified personal development, or working on one’s qualities and abilities to help them grow personally and professionally, as essential for emerging leaders in global health careers. Related sub-themes that emerged included the need for self-confidence and self-awareness, communication skills, interpersonal skills, and adaptability.

Some working group participants described having doubts in their abilities or internal beliefs that they are not as competent as others may perceive, which they identified as impostor syndrome. The participants noted that self-confidence is critical for advocating for oneself, stepping into leadership roles, and speaking up in their work environments. They identified the common challenge that women often face where it can be difficult to build the confidence to speak up in meetings or on teams, admitting that they often spent too much time overthinking and missing opportunities to share. The participants shared that self-confidence and self-awareness were also crucial elements for identifying priorities at each stage of their life and career and for learning to set boundaries to establish and maintain work-life balance.

Participants also described the need for communication skills in leadership. These included proficiency in interpersonal communication and public speaking. The ability to communicate scientific findings to different stakeholders and communities was highlighted, and examples of this included communicating to vaccine hesitant groups or vulnerable populations or translating science into policy briefs.

When exploring essential components of interpersonal communication, group members stressed the importance of developing active listening skills as part of good communication to allow others to feel heard when working together. Participants emphasized the importance of learning how to interact with different personalities and work well with others, even when it is challenging. Working group members highlighted that learning how to respectfully disagree was another important element of personal development as a leader. Additionally, the participants identified being able to set boundaries and communicate boundaries as important skills for becoming an effective leader, especially when interacting with more “difficult personalities” by learning when and how to say “no”.

Networking Skills

The participants shared that members of the global health community are often altruistic individuals with similar inclinations to make a difference, opening the opportunity for collaboration. Members identified that personal initiative towards networking is needed, and that it is important to get out of their comfort zone to seek out and take advantage of opportunities to network. Participants agreed that networking is a continuous task where one must intentionally cultivate connections, and that it is important to develop and nurture interpersonal relationships in order to experience the benefits of networking. They suggested that emerging women leaders should get to know the culture of their institutions in order to meet potential collaborators, seek out mentors, and engage colleagues who want to work together to lift up others through networking.

One barrier that participants identified to developing effective networks was having feelings of uncertainty related to networking as junior professionals, sharing that networking events often felt siloed and reserved for senior leaders. One approach to overcoming the inhibitions identified among the participants was to find opportunities to present their work at conferences or meetings. The participants also identified social networks such as LinkedIn and Slack for keeping in contact with professional acquaintances after making initial connections. Another suggested way to cultivate relationships was to plan “social hangout times” such as happy hours, dinners, picnics, or other social activities where colleagues can casually interact.

Job-seeking dexterity

In the working group discussions, participants indicated the importance of the skills of developing cover letters, résumés, and CVs. They also described the need for interviewing and negotiation skills to successfully land jobs and advance their careers. The common sentiment was that there is the need to highlight and accurately represent the range of skills they possess. For example, participants shared that it was important to know how to present “soft skills’’ such as team building, leadership, and interpersonal skills on their job application documents and during their interviews so that they could effectively communicate the value of those skills to their employers. Participants noted, however, that this was challenging and they wanted opportunities to learn how to best present their varied skills.

The participants also shared challenges with negotiation during the job seeking process. The group highlighted that negotiating was often uncomfortable and that training to learn how to professionally and effectively negotiate salaries and benefits is critical for young professionals to be better compensated for their work.

Some participants suggested that academic programs should put an emphasis on incorporating job-seeking and negotiation skills training into their required course offerings. Others agreed, noting that many academic institutions do have career services available to students but that the services were often generic and lacking contextual relevance to their unique field.

Management Skills

The groups discussed the importance of learning both how to manage and how to lead, as well as distinguishing between the two. Practically, they shared that leaders need to learn how to carve out time for completing their own tasks while also managing others. The participants also discussed the importance of decision-making skills in the context of management and leadership. Learning how to make decisions regarding project budgets, personnel challenges and project management, according to the participants, is critical to being an effective leader. In order to build management skills, participants suggested that global health academic programs require management training as part of their course requirements.

Individual Mentorship Skills

The participants also shared that learning how to be a good mentor and lifting others up is an essential skill for emerging women leaders. Leaders, according to the group, should take on mentees and empower them to overcome obstacles and improve their skills. Some participants highlighted the importance of lifting other women up to share their ideas, contribute to discussions, and participate in decision making.

“[In our working group] we talked a lot about lifting up others…and how you can be a leader that creates leadership spaces for other women and how we should do that…in a diverse way, making sure that particularly from a global health perspective, we’re thinking about how we can lift the voices of women in the countries in which we work to surface as the experts and maybe take a step back ourselves.” (Participant, January 2021 Working Group)

The participants also included that as a leader, it is important to recognize that there will be challenges to fulfill all mentees’ requests and that rather than taking on too much personally and possibly failing, it is better to ensure that their mentees have resources by connecting them to others who can help them on their journeys.

Cultural Competency

The ability to understand the culture, values and environment of an institution was emphasized as important for maintaining good cultural competency by the participants. Further, participants shared that it is important to demonstrate cultural competence when working with international colleagues and collaborators, respecting their customs, social norms, and ways of conducting business, among other differences. Another component of cultural competency identified by the participants was the practice of understanding the leadership structures of partner organizations and respecting local leaders, rather than assuming seniority or power. The participants also shared that cultural competency skills for emerging leaders should include the acceptance and celebration that people are different, and the ability to value diversity as a strength.

Institutional Level Support

According to the participants, one practical factor that helps women to participate fully in the workplace is the implementation of institutional policies that promote inclusion of the gendered experience. Women’s bathrooms and dedicated, comfortable nursing rooms available for lactating people were tangible examples of infrastructure to support women in the built environment. Other inclusive policies that help foster an enabling environment are those that provide support for working parents or caretakers of elderly or sick family members. Participants noted that these responsibilities fall disproportionately on women and that without supportive policies, they worry about falling behind or not being able to fully reach their potential in their careers. Participants mentioned that institutional supports such as student services, specific women’s resources, and provisions to avoid discrimination enhance feelings of inclusion and women’s abilities to successfully advance in their careers.

The participants suggested that by implementing structural support systems, more inclusive behaviors may be fostered, while toxic power and gender dynamics may be avoided. A more formal approach to achieving gender balance was suggested through the development of institutional requirements and/or governmental laws which require gender balance. Navigating power dynamics, according to our data, may also be addressed on both formal and informal levels by encouraging discussions that allow for greater engagement. Promoting discussion at the institutional level between male and female colleagues or between senior and junior colleagues can allow the challenges and concerns faced by specific groups to be shared among colleagues, foster understanding, and stimulate evolution by encouraging individual behavior changes within supportive institutional frameworks.

Workplace Culture

Participants identified four core factors that support the development of an enabling workplace culture for women. These include: (1) respectful communication in the workplace, (2) a supportive and affirming environment, (3) a culturally competent environment, and (4) a workplace that values work-life balance.

The participants noted that an enabling workplace culture is one that values respectful communication and clearly communicating expectations. They expressed that while women must build the confidence to speak up, those who are in a position of power should use their position to empower others. They also suggested that condescending attitudes, talking over each other, and dismissing opinions and ideas should be actively discouraged.

Participants indicated that a workplace culture should be supportive and affirming, especially when mistakes are made or help is needed. They shared that, in their experiences, it was easier to admit a mistake when working with a female supervisor. The participants also shared that a workplace culture in which colleagues with privileges (gender, race, age, seniority) support those in less privileged positions is one that helps women to find success in their roles. Women lifting up other women and men supporting women were noted as helpful examples of a supportive workplace culture.

“One way to support [other women] is to amplify their voices…so when a colleague shares an idea in a meeting or another forum, we can comment positively on their idea or circle back to it if it’s been pushed aside, allowing it to be heard again.” (Participant, March 2021 Working Group)

They also suggested that creating a sense of community and connecting with people in the workplace through formalized affinity groups and structured discussion and reflection are important strategies for creating a supportive environment. The participants also shared that a culturally competent workplace is key, and that diversity and differences should be valued as strengths. Finally, working group members said that an ideal workplace culture values work-life balance, in policy and in practice.

Payment and Promotion Support

Participants noted the challenges they face with inadequate payment and lack of promotion support as barriers to advancing their careers. They suggested that workplaces engage in frequent and transparent discussions about salary pay scales and that they provide adequate compensation for their employees. They indicated that adequate compensation mechanisms should include equity in compensation and career advancement for women in both low- and middle-income countries (LMICs) and high-income countries (HICs), identifying sustainable funding mechanisms for professional advancement, and avoiding the use of stipend pay or volunteer work, which perpetuate norms that ultimately impede women’s progress. Participants also described a desire to see environments in which women are not afraid to ask for appropriate salary compensation.

They also noted the challenges of a lack of clear and comprehensive evaluations and promotion criteria for advancing within an organization. Participants in the academic sphere suggested the need for looking beyond traditional metrics such as authorship and receiving grants. Rather, they would prefer transparent promotion requirements and timelines and an environment in which it is acceptable and normalized to discuss these topics.

A Culture of Mentorship and Sponsorship

Mentorship was also highlighted as a core component of an enabling environment that helps emerging women leaders in global health to succeed and thrive in the global health leadership trajectory. While much of participating in mentorship is reliant on how mentors and mentees individually engage and take initiative in the mentorship process, the working group participants focused on the importance of having an environment in which mentorship is expected both formally and informally at the institutional level. Participants mentioned that it can be difficult to initiate and maintain mentorship, particularly outside of formal mentorship structures. While the majority of academic programs have formal structures such as academic advisors and mentors embedded in the system, the support infrastructure weakens when moving on to non-academic settings, making it difficult for early career professionals to identify mentors.

The participants developed solutions to improve mentorship environments. One participant suggested that institutions put a focus on networking during conferences and meetings to help junior colleagues meet potential mentors. Others agreed that deformalizing the mentorship structure would allow for mentors and mentees to have less rigid relationships. Participants noted the importance of having a diversity of mentors for different needs to sustain and enrich their leadership growth rather than relying on just one mentor for everything and suggested more fluid pairings. Some participants proposed that institutions implement “twinning” by pairing students at the same levels from different countries to work together as peer-mentors.

Participants also discussed the distinct differences between mentorship and sponsorship. Mentorship is viewed by the participants as support, guidance, and learning the ropes of a career, while sponsorship is seen as an individual investing in people to provide tangible opportunities to succeed in a career trajectory. While participants felt that mentorship is widely discussed, they identified a need to ensure sponsorship is embedded into systems as well to promote success and growth in the leadership journey. One example of sponsorship that the participants identified was amplifying the voices of others. One tangible example of this was for mentors to bring students or junior colleagues with them to high-level conferences and meetings, and ask them to present their shared work on behalf of, or along with, the mentor. The other participants agreed that gaining skills and experience writing and presenting work in front of high-level colleagues and stakeholders would be an impactful opportunity to make connections and have their voices heard as emerging leaders. Another example shared during the discussion was that mentors could directly connect trainees with professionals in other countries and ask them to provide an opportunity for a job or other connections that their mentee would benefit from. The participants indicated that enabling environments would formalize these systems.

An important caveat that emerged was the need for intersectionality in the mentorship environment. Some participants noted the importance of having either a female mentor or woman of color mentor who may have faced similar challenges or are able to identify with mentees of similar demographics. Other participants suggested that having a mentor from a similar culture may be important in navigating the global health landscape. Participants suggested that if institutions employed higher proportions of diverse senior global health professionals, they would be more available to junior colleagues seeking mentorship from diverse mentors.

Training opportunities

Citing the current COVID-19 pandemic, discussions occurred on capitalizing on the global movement to engage online and use technology to create supportive virtual environments that women in global health can use to connect and engage. These online platforms can create and enable ethical and reciprocal training opportunities between women in HICs with their counterparts in LMICs. The participants mentioned the possibility of creating a global training network approach by utilizing online groups on social media platforms such as Facebook, LinkedIn, or Slack channels as a way to foster these kinds of training opportunities.

Practicing decolonization and intersectionality

The working group participants noted that in order to approach leadership development in the field of global health equitably, all of the previously suggested solutions should emphasize a decolonization approach. Concerns were raised surrounding tokenistic volunteering and internships, experiences that are used to bolster CVs and perhaps lead to career advancement by those who tout them (usually students and professionals from HICs working in lower income countries). The participants noted the perpetuation of vicious cycles of unequal power dynamics in which roles, jobs and experiences are prioritized to students, volunteers, and visitors from HICs rather than providing opportunities to local talent. The group agreed that when working internationally, existing local leaders should be identified and local structures should be built upon rather than implementing parallel programs. Other solutions included ensuring ethical and reciprocal projects and research opportunities. However, there were still concerns about the complexity of ensuring that unequal power dynamics are not reproduced within those partnerships. Pre-departure and cultural competency training for anyone working in an international context were amongst the targeted solutions discussed. Participants also called for an “intersectional approach,” with a “strengths-based lens” when implementing solutions.

“Even if it’s hard and there are lots of barriers; I think we should keep bringing up the need for true reciprocity over and over again. I’ve seen it happen only when there is a persistent commitment to it. It involves pretty radical reinvestment of resources, but that is what decolonizing global health is about in my opinion.” (Participant, March 2021 Working Group)

Essential Skills

The two working group sessions analyzed here revealed key insights into the essential skills that the group felt are foundational for advancing as global health professionals. While leadership skills have been previously surveyed among academic and community health settings, solutions to successfully foster women’s essential skills have been under-reported [21]. Our analysis shows that participants value developing several overarching areas of individual-level essential skills that are needed for advancing as a leader in a global health career such as personal development skills, job-seeking dexterity, communication abilities, the ability to successfully network, and an understanding of cultural competency.

Putting barriers to the individual into an institutional context

A number of challenges to women’s leadership were described by the working group participants. It is important to note that the barriers that we mention above exist within the context of larger, systemic barriers. Most barriers cannot be solved without systemic changes; the burden of rising to leadership, thus, is not on women individually or as a group. Ecological, societal, and organizational changes are needed to ensure individuals have opportunities to successfully develop their strengths as leaders and optimize individual capabilities. Meta-level solutions are essential to address the many institutional, community, and public policy factors that create barriers against women’s advancement in leadership positions in global health.

Deep-rooted institutional structures often contribute to power imbalances and disparities in leadership opportunities within the health sector [22]. Though evidence suggests otherwise, societal definitions of the qualities found in a good leader are often skewed towards a more traditionally masculine approach [23, 24]. On the other hand, gender transformative leadership addresses social and cultural norms, bias, and deep-rooted inequalities with the goal of advancing gender equality and women’s rights [25]. In the context of global health, this may involve challenging imbalances in power to address gender disparities and creating opportunities for women to strengthen their confidence, skills, and access to tools needed to succeed and advocate for themselves, key areas identified by working group participants. Expanding the definition of a leader at the meta-level, advocating for greater awareness, and addressing bias and system-wide barriers can allow women to define and succeed at leadership on terms that are meaningful to them.

Workplaces should also be structured so that women feel included, safe, respected, and valued to empower them to have a voice in directing their work. Equity of rights, benefits, opportunities, and obligations is critical for encouraging different approaches and creating supportive, productive environments where one can optimize their skills [26].

Solution: Use of technology for women-inclusive training and networking opportunities

The importance of availability and access to training and networking opportunities was highlighted by the members of the working groups. The WHO maintains that to enable women to achieve leadership in global health, there is a need to develop formal and informal networks for women’s leadership development [5]. The working group participants suggested that institutions should support and enable opportunities for methods of networking. One of the prominent solutions suggested by the working group participants was taking advantage of internet technology to include more women in leadership training and networking opportunities.

This apparent affinity for virtual opportunities may have been because the working groups were conducted virtually and supported by a virtual leadership program that was created out of a desire to connect while socially distancing during the COVID-19 pandemic, or perhaps due to the gap in access that women face as it relates to such opportunities. It has been previously established that women find it harder to access training for career advancement due to reasons such as cost, timing, location, conflicts with other responsibilities outside work, and gender-bias in sending staff for training [1]. The unprecedented use of internet technology for communication in the wake of the COVID-19 pandemic has the potential to strengthen leadership preparation for women, especially in the field of global health, providing distance training and networking that would not have been possible if travel was required [27] However, while online meeting platforms such as Zoom have been helpful to connect people in more inclusive ways, “Zoom fatigue” can be a challenge and there is evidence to suggest that this phenomenon is felt more severely by women compared to men [28].

This is well articulated in the development and use of platforms such as the Women in Global Health Slack network, which is an initiative that has the capacity to provide information on opportunities for growth such as mentorship, networking events, and career opportunities that are key to progression in both academic and non-academic careers. In addition, the Women’s Global Health Leadership seminars provide invaluable opportunities for women to learn from each other, particularly from more experienced women leaders as well as from peers. These two opportunities have the potential to provide women a platform to create alliances with other women for support and catalyze organizational change [5].

Solution: Intersectionality in mentorship and sponsorship

While mentorship is an integral component in providing guidance and support to early career women, sponsorship can be career-defining and monumental [29, 30]. Specifically, sponsorship refers to having an advocate/sponsor that is actively recommending high visibility, career advancement opportunities including leadership involvement, invitation panels, and awards [30, 31]. The findings of this study show that there is a need to amplify voices and intentionally bring hyper-visibility for female students and junior colleagues. This is critical in promoting confidence among young individuals who are doing the work and getting rewarded as a result of the opportunity.

Additionally, men can play a critical role in ensuring that women leaders’ voices are heard and represented. Studies have indicated that men are more likely to be sponsored by senior colleagues compared to women [32]. As suggested by the working group participants in this study, men should openly advocate opportunities for their female counterparts. One way to be a better advocate is to refuse to participate in conferences or other venues that do not intentionally include diverse colleagues or offer the opportunity to their female colleagues who are often under-represented on platforms such as panels, speaking agendas, or high-level meetings. Promoting active collaboration with men and senior colleagues is a pathway to improving the leadership career trajectory for women in global health. Structural changes in the workplace to incentivize mentorship and sponsorship are also recognized ways to elevate women leaders [14].

There are other power dynamics that exist among women themselves in which an intersectional approach is important to elevating women of diverse race, religion, age, ability, gender identity, and sexual orientation [33]. Cisgender white women should also play critical roles to elevate their non-cisgender, non-white counterparts.

Solution: Combating imposter syndrome

Some working group participants described having doubts in their abilities. This struggle with self-silencing or a lack of self-belief in one’s abilities can contribute to “Imposter Syndrome” where one feels she is not deserving of the power, credibility, or authority to lead [19]. To combat these internal doubts in one’s ability, participants stressed that emerging global health leaders need to be able to identify what they need to succeed and gain the confidence and skills to advocate for the things they require to support their success. On an individual level, coaching and mentoring can help women increase their confidence and believe in themselves and their abilities. Peer networks, professional associations, and leadership trainings that take women’s unique strengths and perspectives in mind can also boost women’s confidence and preparation for advancing their careers as leaders in global health.

Solution: Work-life balance and family-forward policies

The working group participants believe that women generally carry a greater burden of household and family responsibilities and frequently spend disproportionate amounts of time doing unpaid care work in addition to their formal employment, leading to difficulty with work-life balance. This is a sentiment consistent with the literature [27, 34, 35]. Work-life balance and successful integration of one’s life priorities is crucial for an individual’s well-being and livelihood as well as having broader impacts on gender equity, health systems, and the delivery of quality care [1].

On a systemic level, steps that foster an organizational culture that promotes norms that support all employees in successfully integrating their careers with responsibilities outside of the workplace can provide some of the foundations for building a career that allows for time management in a personally meaningful way, one of the key themes highlighted by working group participants. Family-friendly policies that promote a flexible work environment and structural solutions such as childcare and funding for parental leave as well as addressing institutional barriers such as wage gaps can create conditions that are more conducive to balancing work and home life [36]. There must be a workplace culture of respect, support, and valuing for women who take a “non-traditional” career path in global health to balance other responsibilities in their life. This may involve adjusting the culture of metrics for advancement, normalizing flexible work hours and telecommuting, and incorporating equity into policies at all levels.