As the world braces for future pandemics and health emergencies, a groundbreaking study highlights a glaring gap in emergency preparedness: the neglect of female healthcare workers who form the backbone of healthcare systems. The Women in Health and their Economic, Equity and Livelihood statuses during Emergency Preparedness and Response (WHEELER) study reveals that while health systems heavily rely on women for healthcare provision, they fail to address the gender-specific burdens and inequities these workers face.

Funded by Women RISE | IDRC – International Development Research Centre and conducted by Aga Khan University’s Centre of Excellence in Women and Child Health, East Africa (CoEWCH EA), in collaboration with the University of Manitoba and the Health Departments in Mombasa and Kilifi counties, the research sheds light on the often overlooked experiences of both paid and unpaid female health workers during healthcare emergencies. The study findings, derived from surveys and interviews with healthcare providers across Kilifi and Mombasa counties, highlight the disproportionate economic, health, and societal impacts faced by women, particularly community health promoters (CHPs), during the COVID-19 pandemic.

The study confirms that while male and female healthcare workers both faced challenges during the pandemic, unpaid female CHPs carried a heavier burden. Juggling voluntary healthcare roles, informal sector jobs, and domestic responsibilities, they navigated a high-risk reality with little systemic support. Additionally, health systems remain inadequately responsive to the unique needs of female health workers despite being heavily dependent on their contributions.

“Our study revealed that the preparedness and response to COVID-19 in Mombasa and Kilifi counties involved a complex interaction of resource management, psychological resilience, community engagement, and ethical decision-making. Healthcare workers and leaders were forced to navigate an extremely unpredictable situation, making difficult decisions with limited knowledge and resources, reflecting the broader systemic challenges. Deep-seated fears and anxieties within the health workforce were reported, with some having long-term consequences. Together, these experiences highlight the significance of strong contingency planning, equitable resource distribution, prioritization of health care workers’ safety and wellbeing, and sustained community engagement in dealing with public health crises,” said Evaline Lang’at, the Principal Investigator of the study from CoEWCH EA.

These insights are critical as Kenya and the global health community seek to build more inclusive, resilient healthcare systems capable of protecting those on the frontlines of future emergencies. “Globally there is a tendency within health systems to view frontline providers according to their professional status – nurse, physician, volunteer. The influence of sex and gender, in particular socio-cultural gender norms, and how these shape the diverse experience of women paid and unpaid health care providers, remains neglected as a critical factor that influences health systems functionality. Consequently, health systems fail to support and protect their primary care givers – women. Our study has very clearly shown that gender responsive policy making that prioritizes the experiences and voices of women is urgently required to achieve health for all, both in times of crises and non-crises,” said Dr Lisa Avery, WHEELER study’s co-principal investigator from the University of Manitoba.

The study results and recommendations were shared through an innovative and compelling medium: community theatre. The performances by S.A.F.E. (Sponsored Arts for Education) brought to life the real stories and struggles of healthcare workers during the pandemic. This approach sought to spark meaningful conversations about safeguarding healthcare providers in future emergencies, inspire actionable change, and amplify the voices of those most impacted.

The findings underscore the urgency of investing in gender-responsive and transformative emergency preparedness. Recommendations include addressing structural inequities within health systems, ensuring equitable pay and mental health support for all healthcare providers, investing in participatory and community-led processes, and recognizing the invaluable contributions of community health promoters.

“The WHEELER study created a whole new level of experience for both the research team and the study participants. It not only allowed the stakeholders to relieve their experiences but to also take the lead role and shape the trajectory of the study. It created a sense of ownership through the platforms that were created to govern the study implementation, i.e., the Community Research Advisory Group and the Local Advisory Board. It has also influenced our vision for conducting similar studies in the future. The study built capacity of the health care workers through training such as ‘Gender Equality Workshops’ that enabled participants to acknowledge the role gender plays in our day-to-day lives,” said Dr Bilali Mazoya, the Co-Principal Investigator from Kilifi County’s Department of Health.