Balancing access to care and care responsibilities among women healthcare workers

At health facilities across the coastal counties of Kilifi and Mombasa, Kenya, men and women queue patiently waiting to be seen by healthcare providers, many of whom are women. Mornings are the busiest.  

Less visible is the burden of unpaid care work shouldered by the female healthcare providers working in these facilities. COVID-19 and its mitigation measures increased already-significant care demands and pressure on women healthcare workers not only as first responders at work, but also in their homes and communities.  

For Rachel Muemi of Mombasa County, care work describes her struggle to balance both her responsibilities at home, as a mother of two boys, and her responsibilities at the Nganjoni Dispensary, where she oversees the promotion of community awareness of COVID-19 and tuberculosis. 

Every morning, she walks door-to-door, checking on residents who are unwell and referring those in need of further care to the dispensary. Then she is expected to shift her attention to her family:  

“I retire home at 6 p.m. in the evening and that’s when I attend to my family,” Muemi said. 

Maria Raider works in Mombasa County’s Moroto slum, where during the pandemic she was responsible for visiting about 100 households each month to encourage residents to get vaccinated. Her work is unpaid.  

“If you are lucky and a donor comes in, that’s when you are given a stipend, but this is voluntary work,” Raider said. 

Muemi and Raider’s experiences are common, balancing paid and unpaid care work and the associated risks to the health of them and their families. Beyond the risk of contracting COVID-19, women healthcare workers have faced considerable mental, physical and social health challenges, along with damage to their financial and professional well-being. 

The need to address the gendered impacts of COVID-19 is at the core of the CAD24 million Women RISE initiative, designed jointly by IDRC, the Canadian Institutes of Health Research (CIHR) and the Social Sciences and Humanities Research Council (SSHRC) and anchored in the UN Research Roadmap for the COVID-19 Recovery.  

“During the pandemic, we learned that local and global efforts need to go hand-in-hand, and this joint approach is needed in research now more than ever,” said Francine Sinzinkayo, Senior Program Officer in IDRC’s Global Health program. “These collaborative efforts also need to be anchored in ambitious global agendas that close global knowledge gaps but are also grounded in local realities that touch the lives of affected populations. 

Women RISE supports action-oriented, gender-transformative research for understanding how women’s health intersects with their paid and unpaid work.  

“Relevant research on the potential disproportionate impact on women’s health, livelihoods, paid and unpaid work is limited,” Sinzinkayo said. “Moreover, few research studies have evaluated the disproportionate impact of the pandemic and the public mitigation measures on the female health workforce in low- and middle-income countries.” 

Healthcare workers Rachel Muemi, Maria Raider and Sharlet Anzazi talk about balancing their care responsibilities at work and at home. Watch this video to learn more about their struggles.

Studying the gender equality and health equity gaps experienced by female health workers in Kenya 

In Kenya, the WHEELER project, implemented by the Agha Khan University and the University of Manitoba, focuses on the impact of COVID-19 on paid and unpaid female healthcare workers like Muemi and Raider, mentioned above, work-related health and safety changes and disruption to livelihoods.  

Historically, studies of unpaid care work prioritize women in informal employment, neglecting the experiences of women, including those in formal employment.  

“An unanticipated preliminary finding from our research in Kenya’s Kilifi and Mombasa regions is the extent of increased unpaid care work and the subsequent negative economic, physical and social consequences endured by the paid female health providers,” said Dr. Lisa Avery, assistant professor at the University of Manitoba and the Canadian principal investigator for the WHEELER project. 

Social protection is non-existent in Kenya’s public health care workforce. The lack of protections points to entrenched structural inequalities that perpetuate disadvantages faced by paid and unpaid Kenyan female health care providers. These inequalities were amplified during the pandemic. 

“During the peak of COVID-19, I would work for up to 18 hours a day, using my meager resources, camping in different parts of my community to educate and vaccinate people against COVID-19 often without pay,” said Sharlet Anzazi, a nurse at Mnarani Dispensary, Kilifi County.    

Like many other health care workers, Anzazi faced multiple challenges during the pandemic. At some points, she had to attend to patients despite not having access herself to personal protective equipment (PPE) or having to reuse PPE.  

“I had to risk and attend to them. I am the only one they trusted and if I didn’t attend to them, I would have failed them. This is how I ended up getting infected,” Anzazi said. “I had gotten my jab, so the infection was not severe.”  

Developing resilience in Malaysia’s essential care workforce and infrastructure 

In Malaysia, a Women RISE project led by the Women’s Aid Organisation (WAO) and the University of Alberta, is investigating the experiences of women performing paid and unpaid work during COVID-19 and assessing the effectiveness and relevance of policies that governed their working conditions.  

This study is critical because Malaysia “lacks data on what the experiences of essential care workers looked like during the pandemic and in the transition to endemicity,” said Anis Farid, principal investigator for the project and research project manager with WAO. “The care sector lacks investment, but to invest in the sector the government must have credible data on what is lacking.” 

The main objective of the project is to develop a better understanding of what ought to be done to support Malaysian care workers. “Our hope is that we will be able to highlight the programs and policies needed to support our essential care workers with or without a crisis,” Farid said. “We want to highlight this in their own words, making visible their experiences throughout the pandemic.”  
 
Response to the project so far has been positive. “We’ve received support from the government and care workers. This is important because good research is only possible when the affected communities and policymakers are engaged positively,” Farid said. 

“We’ve created modules to train our research associates, who come from the affected communities, and the training really functions more as a dialogue to further develop the modules and deliver the skills in a customized way,” Farid said. “We’ve also translated our guides into different languages, including Bahasa Malaysia, Bahasa Indonesia and Tagalog.”  

The projects in Kenya and Malaysia have much in common, including their participatory research processes, that they are grounded in feminist development and evaluation theories, and they prioritize the involvement of all end-users throughout the project life cycle.  

“The pandemic amplified health inequities globally — access to COVID-19 vaccines is an obvious example of this. The same inequities also apply to research, with different resourced contexts less prioritized,” Dr. Avery said. “What is remarkable about the Women RISE initiative is not only has it prioritized research in these contexts, but specifically the voices of women in these settings.” 

The IDRC-supported projects in Kenya and Malaysia demonstrate Women RISE’s commitment to fostering multisectoral collaboration to contribute to solutions that consider and address the gendered impacts of the COVID-19 pandemic on women’s health and well-being.  

The projects will also inform solutions to improve the health and wellbeing of women and build resilience across societies so women can reach their full potential. Ultimately, the findings from these projects will inform the development of gender-transformative health systems that can withstand future emergencies.  

Solutions will be welcomed by healthcare workers like Muemi, Raider and Anzazi in Kenya, who balance their care responsibilities at work and at home.  

“We just have to continue doing this work every day,” Muemi said.