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To cite this article: Soniya Rijal & Sharada Prasad Wasti (2018): Factors influencing career
progression of working women in health services: A case from Kathmandu Valley in Nepal,
International Journal of Healthcare Management, DOI: 10.1080/20479700.2018.1444952
Introduction
gender stereotypical belief of ‘think manager-think
Economic, socio-demographic, cultural, and geo- male’ is found, which still holds back women with
graphical factors contribute to transforming society feminine characteristics from moving up the career
and hence have a direct or indirect impact on health ladder and restricts women from entering, being pro-
workforce issues. Globally, the labour force partici- moted, and training in the industry [7]. Male and
pation rate for women is 50% [1]. In the upper- female middle-level managers were different in their
middle-income countries, more than one-third (34%) career preferences; females had more preferences for
of them are employed in wholesale and retail trade, family, whereas males were significantly more willing
whereas in high-income countries mostly women are to consider promotions and reach a higher level[8].
engaged in the health and education sectors [1]. Gen- Having children often results in slowing down of
der diversity at senior management levels is important career for female managers compared to male man-
not only for women; it also has numerous benefits for agers in most cases. Female managers who are parents
organizations, including increased availability of skilled take most of the leaves: the median for female man-
employees, stronger employee engagement, and higher agers is 24 months but for male managers it is only
productivity [2]. Stereotypes and subtlety are often hid- 1–2 months [8].
den forms of discrimination, which continue to limit The complexity of women’s careers in the healthcare
women’s advancement [3]. Although the USA com- sector can be best understood using a relational
prises 78% of the workforce in the healthcare sector approach that highlights the inter-sectional between
[4] and more than 90% of the general nursing work- gender, agency, socio-cultural realities, and organiz-
force in the United Kingdom [5], they are under-rep- ational boundaries [9]. In India 5% of the women
resented in decision-making positions. Women at responded that the attitude of the boss towards
various levels highlighted the importance of not assum- women employees was abusive and more than half
ing that under-representation and constraints experi- (53%) of the females hesitate to work with male col-
enced by Asian women employees throughout their leagues because they may get sexually harassed [10].
career are similar to those reported elsewhere [6]. African cultural practices are also a great hindrance
Based on time, sector, or culture of a country, the to the advancement of women’s career where family
CONTACT Soniya Rijal rijalsoniya@gmail.com Texas Woman’s University, Denton, Texas 76204, USA
© 2018 Informa UK Limited, trading as Taylor & Francis Group
2 S. RIJAL AND S. P. WASTI
structure and women’s commitment to the family are Table 1. Socio-demographic characteristics.
the most significant barriers perceived by executive Variables Frequency Percent
women [11]. In the context of Nepal, not many efforts Marital status
Unmarried 40 36.3
have been made in identifying the factors influencing Married 70 63.7
career progression for Nepali women employees Have children
Yes 27 38.6
especially working in the health sector. In Nepal, Types of job positions
women developing their career is facilitated by their Hospital clinical staff 70 63.6
own hard work and performance, education, and Administrative and finance staff 23 20.9
Public health officers 12 10.9
exposure, which makes them confident. Women work- Others dietetic/faculties 5 4.5
ing in administrative jobs perceived organization- Types of healthcare organizations
General hospital 71 64.5
related barriers as most prominent, whereas women I/NGO 13 11.8
in other responsibility areas perceived the society- Teaching hospitals 16 14.5
Others (hospital management-related and 5 9
related barriers as the most prominent barriers [12]. health science academic institutions)
Qualification of respondents
Doctoral 7 6.4
Methodology Masters 45 40.9
Bachelor 58 52.7
A cross-sectional mixed-methods study was con-
ducted in early 2017. It included a quantitative survey
with 125 women working in 32 different healthcare who hold positions equivalent to officer or above are
organizations from Kathmandu. Similarly, a total of highly learned and qualified and more than 93.6%
15 in-depth interviews were also conducted with had attained a bachelors and a higher degree, with
women working in healthcare organizations primarily 7% holding a doctoral degree.
involved in the managerial level. The study was con-
ducted concurrently and both data (quantitative and
qualitative) were collected at the same time and the Individual factors
findings have been integrated in the results and dis-
More than half (50%) of the respondents strongly
cussion sections [13]. Literature shows that mixed-
agreed that they have to advance their career but
method research designs have offered strength of con-
only 12.8% women did not think that it is important
firmatory results drawn from quantitative analysis,
for them, Table 2.
along with ‘deep structure’ explanatory descriptions
Qualitative findings further stated that:
as drawn from qualitative analyses [12]. Structural
questionnaires were administered in the quantitative Due to family responsibility I have to leave many
survey. Statistical analyses were conducted using the opportunities to work because my first priority is my
Statistical Package for the Social Science (SPSS) soft- child and family then only my career.
ware. Similarly, in-depth interviews were conducted [IDI 3: Academic Director, Healthcare Management]
with the aid of an interview checklist and probes to
cover the questions for understanding the impact on An individual’s skill, tenure, and hard work have a
women’s career growth in healthcare organizations. significant effect on career progression. Almost all
The interviews were transcribed verbatim and coded (92.7%) women believed that one must have individual
using a thematic analysis. The quotations included skill, tenure, hard work, reputation, and performance
below best represent the range of ideas voiced around (Table 3). This finding is supported by a participant
key themes. working in a private hospital:
My own hard work, working skills and performance
have advanced my career the most. [IDI-4, Lab
Results technologist]
Table 1 shows 110 samples, which represent both mar- It shows that individual factors such as hard work and
ried (63.7%) and unmarried (36.3%) respondents. This working skill have a positive effect on career pro-
can largely be attributed to the fact that many married gression of working women. More than one-fourth
women these days continue working to advance their (27%) stated that their career goal had changed after
careers. Out of the total respondents, the majority of getting married and about half (51.8%) of them
respondents were clinical employees (63.7%); others reported that their career was affected after having chil-
were non-clinical working women (36%) working in dren (Table 3).
various types of organizations such as General Hospi-
tals (64.5%), Non-Government Organizations
Social factors
(11.8%), Teaching Hospitals (14.5%), and other aca-
demic institutions (9%). The findings indicate that Participants who were interviewed explained that
the women employees in the healthcare organizations women have difficulty in managing the double roles
INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 3
Table 3. Distribution of marriage influencing career goal. women have to work both at office, home, and have
Response Frequency Percent dual responsibilities when compared with men.
Did your marriage influence your career? (N = 70) A participant stated that women are bound by
Yes 19 27.0 different social norms. She stated that:
No 51 73.0
Did having children influence your career? (N = 27) All rules and regulations are made only for women
Yes 14 51.8 they are bound to follow including their ‘initiation
No 13 48.1
rites.’ They are taught to be obedient mother, wife, sis-
ters and work for their family day and night. But what
often we forget is she cannot always give her fullest
and maintaining a work–life balance after getting both at home and office. [IDI5: Wellness Officer,
married. Hospital]
Flexible work hours and career progression Table 7. Distribution of organizational practices affecting
career progression
Two-thirds (66%) of the respondents said that the Not Very
organization does not have a provision for flexible Responses at All Neutral Somehow Much Much
working schedules to accommodate female employees. Credibility of fellow # 13 16 45 29 7
staff % 11.8 14.5 40.9 26.4 6.4
This finding was supported by the statement of the Autocratic # 2 12 42 35 19
director in a healthcare organization. management % 1.8 10.9 38.2 31.8 17.3
style
In health care setting, every employee have to work Gender inequality # 8 23 32 24 23
from 8 am to 9 pm. There is no problem for male % 7.3 20.9 29.1 21.8 20.9
Male chauvinism # 7 18 33 33 19
staff because they have less family responsibilities (feeling of % 6.4 16.4 30.0 30.0 17.3
compared to women. So, organization values the superiority)
employees who work for late hours. [IDI 3: Academic Sexual harassment # 29 11 61 25 13
Director, Healthcare Management] % 26.4 10.0 55.5 22.7 11.8
Organizational # 7 8 44 33 25
Working with a male supervisor also impedes the pro- structure % 6.4 7.3 40.0 30.0 22.7
Discrimination # 15 12 39 30 29
gression of women’s career. A participant stated that: % 13.6 10.9 35.5 27.3 26.4
Culture # 15 13 50 30 17
Male supervisors with female subordinates or vice % 13.6 11.8 45.5 27.3 15.5
versa generally feel very awkward on providing men-
torship. And this will limit the knowledge and capacity
of female employees and has effect on career pro-
gression of women. [IDI 7: Nursing Department Male members also try to extract sexual favours, if
Incharge, Hospital] they do not respond positively to their proposal they
start spreading rumours on women’s characters. In
More than one-third (39%) of the respondents indi- this process not only male colleagues report these
cated that they had changed employers because of types of rumours even females follows it and become
judgmental of such type of mental torture and harass-
being offered a higher pay, fewer working hours ment. [IDI8: Nursing Incharge, Hospital]
including weekends, family commitments, occu-
pational stress, sexual harassment at workplace, and
lack of promotional opportunities (Table 6). Barriers to career progression
All the above factors mentioned in Table 8 are barriers
to career progression of working women. Among all
Existing practices of health service organizations the factors, respondents have identified sexual harass-
Table 7 shows that the practice of an autocratic man- ment as a major barrier to career progression.
agement style organizational structure, male chauvin- Women responded that lack of a support system at
ism, credibility of fellow staff, discrimination, and work is another factor, which is a major barrier to
sexual harassment were the key factors which directly career progression.
affected the career progression of women in healthcare. Women significantly face lack of equal promotions;
Among the total respondents, 44.5% of women had training and job opportunities in my organization
faced some kind of sexual harassment in the workplace and this have greater effect on confidence and self-
and it had affected their career progression. Interviews development of women and they work as an obstacle
for career progression. [IDI10: Laboratory Technol-
with a respondent working in a nursing department
ogist, Hospital]
also revealed that women faced sexual harassment in
healthcare organizations:
Table 8. Distribution of barriers to career progression
A
Not a Minor A Major
Table 6. Factors influencing the decision to change the Variables barrier Barrier Neutral Barrier Barrier
employer. Conflict with # 20 27 13 40 10
family % 18.2 24.5 11.8 36.4 9.1
Factors influencing Not Very responsibilities
job change at all Neutral Somehow Much much
Job characteristics, # 14 18 16 45 17
Higher paying offer # 2 3 18 11 9 e.g. irregular % 12.7 16.4 14.5 40.9 15.5
% 4.7 7.0 41.9 25.6 20.9 work hours
Fewer working # 5 8 6 16 8 Lack of equity in # 9 9 11 44 37
hours including % 11.6 18.6 14.0 37.2 18.6 pay % 8.2 8.2 10.0 40.0 33.6
weekends Lack of equity in # 8 11 13 35 43
Family # 0 6 4 21 5 training % 7.3 10.0 11.8 31.8 39.1
commitments % 0.0 14.0 9.3 48.8 11.6 Sexual harassment # 11 4 11 32 52
Occupational stress # 6 7 2 14 14 % 10.0 3.6 10.0 29.1 47.3
% 14.0 16.3 4.7 32.6 32.6 Lack of # 4 13 8 53 32
Sexual harassment # 14 2 1 17 9 mentoring/ % 3.6 11.8 7.3 48.2 29.1
in workplace % 32.6 4.7 2.3 39.5 20.9 coaching
Lack of promotional # 7 2 7 18 9 Lack of support # 1 11 12 40 46
opportunities % 16.3 4.7 16.3 41.9 20.9 systems at work % 0.9 10.0 10.9 36.4 41.8
INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 5
organizational support and absence of mentors and role rules, and behaviours. The relation of the workplace
models, as men who prefer to mentor other males with their homes and personal lives are set with an
occupy most of the senior management positions. assumption that work is separate from the rest of life
and the organization has its first claim on their employ-
ees. On the one hand, the ideal workers are those who
Conclusion and recommendations fulfil these prescribed demands of an organization
This study was conducted to understand the gender dis- which are generally masculine in nature and on other
parities against working women in healthcare and was hand women are more responsible for family, children,
majorly focused on three key factors: organization, indi- and reproductive activities. This type of phenomena
vidual, and societal factors. Findings from the study increases workload of female employees and they may
show that evident problems and difficulties of women or may not be able to work as an ideal employee. So,
are multi-dimensional; therefore, they require further by providing various facilities such as day care centres,
probing. Women who had experienced some kind of sex- parental leaves, and flexible work hours can be an effec-
ual harassment in their workplace were bound to change tive tool to attract and retain more competitive female
their employment. It can be concluded that the gender healthcare employees which may require additional
difference in healthcare organizations directly impeded investment.
women’s career progression.
Disclosure statement
Recommendation for practice No potential conflict of interest was reported by the authors.
It is vital to understand that human capital forms the
most important part of every organization; therefore, Notes on contributors
it is encouraged to ensure the following actions are
Soniya Rijal holds a Masters in Healthcare Management and
taken into account: has worked in the field of organization management (NGO,
hospitals/healthcare), research over 5 years.
1) Working women themselves should create a culture, Sharada P. Wasti holds PhD in Public Health from UK and
to change the embedded traditions that dictate has worked in the field of public health research over 14
unnecessary rumours, which harass other employees. years in Nepal.
2) A gender-friendly mechanism should be estab-
lished to address gender imbalances which guaran-
tees equal treatment for both women and men. ORCID
3) Provide adequate leaves for childbirth and mater- Soniya Rijal http://orcid.org/0000-0003-0571-2878
nity-related issues and adopt work, life, and gen-
der-friendly policies.
4) Abolish the traditional view such as ‘male and References
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