Liberia’s health workforce is maldistributed across professional cadres, levels of care and geographical regions. To enable it to deliver quality health services to all Liberians, the Liberian-German Health Programme is addressing these imbalances through a life cycle approach that includes the introduction of school girls from remote areas to careers they may never have heard of.
Grace Kreejardiah, a twelfth-grade student at St. Joseph Catholic High School in Greenville, Liberia, knows where she’s heading in life. For the past six months, Grace has spent several afternoons a week in the laboratory at the F.J. Grant Hospital. She’s learned how to test blood for malaria and typhoid, how to analyse urine samples, and how to use a microscope to search for bacteria on slide preparations. When she graduates later this year, Grace has her sights set on becoming a laboratory technician.
A year ago Grace was less certain about her future plans. But then she attended a Career Day organised by the Employment-oriented Support to Women in the Health Sector project, which is implemented by German development agency GIZ on behalf of Germany’s Ministry for Economic Cooperation and Development (BMZ). There, the laboratory technician from the hospital was one of several professionals who described their jobs and the training that’s required to do them. When he announced that he was willing to mentor up to four local girls, Grace jumped at the chance. The career counsellor at her school had been encouraging her to think about what she wanted to do after graduating, and here was an opportunity to try out something that had never even crossed her mind. “I didn’t know women can work in the lab,” Grace said, in an interview. “I didn’t know any women who did. It’s all men.”
Gender imbalances in the health workforce
Since the devastating Ebola outbreak of 2014 - 2016, the government of Liberia has been working to strengthen the health system to deliver quality health services to all Liberians and to protect them against disease outbreaks. A motivated, productive health workforce is essential to achieving this goal.
Although the number of health professionals has risen considerably over the past decade, health workers in Liberia are maldistributed across professional cadres, levels of care and geographical regions. Part of this is related to gender. While women accounted for 45 per cent of health workers in Liberia in 2016, they are heavily overrepresented in the ‘caring’ professions, such as nursing (69 percent) and midwifery (94 percent), and underrepresented among technical cadres, such as laboratory technicians (18 per cent), and higher-paid cadres, such as doctors (23 percent) and physician assistants (20 percent).
This imbalance is a reflection not only of educational outcomes, but also of social norms surrounding women’s roles and domestic obligations. More than one-third of Liberian women are married before they turn 18 and, once they have started families, are expected to stay with them. This makes it difficult for women to take up positions in remote areas of the country which would require them to live on their own. The result is a high rate of health worker attrition in areas such as southeastern Liberia, which is difficult to reach and expensive to live in.
County health authorities think they may see a solution to this challenge: growing the pool of qualified health workers coming from areas like the Southeast. The idea is that, following training, local residents may be more likely to return to, or stay in, postings in their own communities.
Helping girls make informed career choices
The Employment-oriented Support to Women in the Health Sector project, which is part of the Liberian-German Health Programme, has been working since 2017 to bring more women into the health workforce and, in particular, into roles traditionally dominated by men. The measures supported by the project aim to support women at different stages of their careers, from initial career choice through pre-service education and career development.
“The gender imbalance in the health workforce is a result of choices made quite early in life,” explains Viktor Siebert, who heads the project for GIZ. “Career guidance is therefore an important entry point, because it allows for gender norms to be addressed in a fundamental way among adolescents, their families and the community at large.”
Working in close cooperation with the Ministry of Education’s Division of Guidance and Counselling and the Ministry of Health at the national level, and with education and health authorities at the county level, the project supports a range of career guidance activities in southeast Liberia, a historically underserved part of the country. This includes career counselling services in selected secondary schools, annual Career Days, opportunities for girls to visit workplaces and learn about the world of work, and community outreach activities to foster a supportive environment for girls to make informed, independent career choices. GIZ implements these activities in partnership with the German organisation medica mondiale e.V. and with medica Liberia, a local women’s rights NGO which has worked for years to empower Liberian girls in the area of sexual and reproductive health and rights.
While many project activities are also open to boys, the overarching emphasis on girls is not by accident: “Career guidance makes girls more aware of their personal strengths and introduces them to all kinds of opportunities they might otherwise not know about,” explains Felecia Nyan, the director of the Division of Counselling and Guidance at the Ministry of Education. “Girls tend to be left behind in Liberia. They think that only men can do certain things, like becoming an electrician or a scientist. Career guidance is important because it sends the message that girls can go into fields that they think are closed to them.”
Girls Clubs: Building self-confidence in a safe space
The project works closely with 17 secondary schools in Grand Gedeh and Sinoe counties to test out approaches to career guidance which can eventually inform a national strategy. The schools enroll a total of 4,835 pupils, including 2,100 girls who are reached by project activities. At each school medica Liberia has trained a teacher in the basics of career counselling (which is made available to both boys and girls) and has supported the establishment a Girls Club. Each Girls Club brings together 20 girls, between the ages of 15 and 25, who have been recommended for participation by their school leadership.
The members of the Girls Clubs meet on a monthly basis with one of two career guidance counsellors, hired by the project, who rotate through the participating schools. The meetings provide a chance for girls to talk about both personal and academic challenges, to develop a deeper awareness of their strengths and interests, and to build their self-esteem as they think about their futures.
“Girls all across Liberia need safe spaces, but this is especially true in the Southeast,” says Massa Mamey, an adviser with the Employment-oriented Support to Women in the Health Sector project. “The Clubs give the girls something to look forward to, and the chance to interact and express themselves in a way they normally don’t.”
Positive role models inspire girls to reach higher
In many parts of the world, and even in the Liberian capital, Monrovia, Career Days are a familiar concept – a way of introducing young people to potential careers and employers. But in the counties of southeastern Liberia, Career Days are so unusual that organising one can cause a small sensation.
In 2018 Career Days in Grand Gedeh and Sinoe counties attracted more than 850 participants, including male and female secondary school students, teachers, education officials, parents and representatives of local government. The Career Days were true community events, with dozens of curious children and local residents following the sounds of a marching band which led a colorful parade of students in their uniforms to the Career Day venues.
Caroline Bowah, the head of medica Liberia, explains that the idea behind the Career Days was to bring in a wide range of professionals – not only from the health field – to speak about careers where women are underrepresented. Geologists, engineers, lawyers, lab technicians and physicians – many of them female – addressed overflow crowds. Young people could ask questions about what the different jobs entail, what they require in terms of further education and training, and how one can get practical experience in the field.
According to Bowah, the magic of the Career Day lies in a simple formula: the presence of young, inspiring female graduates who can talk about their professions and relate to the social and educational challenges facing young girls. “The reaction from the local girls was, 'Oh, wow! This is possible?' The Career Days give the girls and the whole community a glimpse of something beyond what they know.”
A small intervention generates an enthusiastic Response
While the Career Days help to spark interest, the project also offers girls short-term experiences at local workplaces to increase their understanding of the world of work. More than 225 girls from Grand Gedeh and Sinoe have taken part in Girls’ Days, visiting referral hospitals, community colleges, commercial farms and courts to see firsthand what it means to work as a doctor, a magistrate, a professor or an engineer.
It is also supporting girls, like Grace Kreejardiah, to study to become lab technicians. In April 2018, 30 girls from Grand Gedeh participated in an information day about jobs in the field of laboratory and medical technology, organised by GIZ and Africabio as part of Medical Laboratory Professionals Week. Twenty-two young women are being sponsored by the project to study laboratory technology, including 16 from the Southeast – more than the total number of lab technicians currently working in the region.
The response to all of these activities has been overwhelmingly positive: there is a great desire on the part of girls, their parents and their schools to become better informed about career choices and the world of work – both within the health sector and beyond. Career guidance is both empowering for individual students and motivating for communities, because it sends a positive message about the value of education. At the same time, career guidance services on their own will not be enough to rectify gender imbalances in the workforce; the generally low quality of public education, particularly in remote areas, and the limited number of job openings remain significant factors affecting girls’ career opportunities.
It is the intention of the Ministry of Education to make guidance and counselling assistance available to secondary students across Liberia, and this makes the approaches being tested in the Southeast particularly relevant. When the project draws to a close in late 2019, the lessons from the experience will help to inform a national policy on career guidance which the Ministry’s Division of Counselling and Guidance has already begun developing with German support.