If you walk into almost any hospital or health centre in Kenya, chances are the majority of the faces caring for patients will be women. They are the nurses, clinical officers, pharmacists, administrators and public health professionals who keep the country’s health system running every day.

Yet when the time comes to make the biggest decisions, including setting policy, allocating resources or leading institutions, the boardrooms often tell a different story and a few questions linger. Why does this leadership gap persist? More importantly, how can it be changed?

A new study by researchers at the Centre for Social Behaviour Change and Strategic Foresight, a research lab within the Institute of Healthcare Management at Strathmore University Business School, moves the conversation beyond identifying barriers to proposing practical, context-specific solutions. Published in SSM–Health Systems, a peer-reviewed journal published by Elsevier and available on the ScienceDirect platform, the study exemplifies the Centre’s mission of generating evidence that bridges research and policy to strengthen health systems.

Dr. Jackline Oluoch Aridi, Dr. Dorcas Mbuvi and Prof. Joseph Odhiambo Onyango’s findings offer an evidence-based roadmap for creating more inclusive leadership within Kenya’s devolved primary healthcare system.

The research, dubbed Navigating the labyrinth: Exploring organisational strategies to overcome barriers to women’s leadership within Kenya’s sub-national primary healthcare networks: Experiences from ten counties,’ comes at a critical moment.

While women constitute the majority of Kenya’ health workforce, they remain significantly underrepresented in senior leadership positions. That imbalance is not merely an issue of fairness. It has profound implications for the quality, responsiveness and resilience of healthcare systems.

‘Healthcare is delivered by women but often led by men,’ has become a familiar refrain in global health discussions. The Strathmore-led research asks an even more important question. What would it take to change that reality?

To answer it, the researchers conducted an exploratory gender analysis involving 29 healthcare professionals drawn from ten counties across Kenya. Participants were enrolled in a Leadership, Management and Governance programme under an international Global Health Workforce Project designed to strengthen primary healthcare systems. Through in-depth qualitative interviews, the researchers explored the experiences of both women and men navigating leadership pathways within Kenya’s Primary Care Networks.

One of the study’s most compelling contributions is its rejection of the traditional ‘glass ceiling’ metaphor. Instead, the researchers describe women’s leadership journeys as navigating a ‘leadership labyrinth.’

Unlike a glass ceiling, which suggests a single invisible barrier, a labyrinth reflects the reality of multiple interconnected obstacles. Women often navigate complex pathways shaped by workplace cultures, caregiving responsibilities, societal expectations, recruitment practices, mentorship gaps and deeply rooted gender norms. Leadership, the study argues, is rarely blocked by a single obstacle but by an accumulation of structural and cultural challenges.

Rather than stopping at diagnosis, the research identifies four interconnected strategies capable of transforming leadership opportunities for women.

First, it calls for gender-responsive organisational policies. Participants advocated for transparent recruitment and promotion processes, family-friendly workplaces, flexible work arrangements, structured mentorship programmes, safeguards against workplace harassment and intentional efforts to ensure women are encouraged to pursue leadership opportunities. These are not special favours but practical reforms that recognise the distinct realities women often face when balancing professional responsibilities with caregiving roles.

The second recommendation reaches beyond hospital walls. The researchers found that many workplace inequalities are rooted in community beliefs and cultural expectations. They therefore recommend sustained Gender Equity and Social Inclusion (GESI) education and community engagement to challenge stereotypes that continue to portray leadership as a predominantly male responsibility. Participants highlighted the importance of involving local leaders, religious institutions, public forums and schools in reshaping perceptions about women’s leadership potential.

The third strategy focuses on strengthening government action. Kenya already possesses progressive constitutional provisions, including the two-thirds gender rule. Yet participants observed that implementation remains inconsistent. The study therefore urges stronger enforcement of existing legislation, improved collection of sex-disaggregated leadership data and increased political commitment to gender-responsive governance within the health sector.

Finally, the research emphasises accountability. Policies alone, the authors note, cannot transform institutions unless leaders are held responsible for implementing them. Transparent monitoring systems, measurable gender targets and institutional commitment are essential to ensuring that promises translate into meaningful change.

What makes the study particularly significant is its grounding in lived experience. Participants spoke candidly about workplace politics, career interruptions associated with parenthood, limited mentorship opportunities, cultural expectations and the subtle ways organisational structures can discourage women’s advancement.

At the same time, they also shared stories of hope in counties where intentional leadership, supportive supervisors and gender-sensitive practices are already making a measurable difference. Some participants described workplaces where male leaders actively identified, mentored and encouraged qualified women to take up leadership positions, demonstrating that meaningful change is both possible and already underway.

For Strathmore University, the publication reflects its broader commitment to producing research that addresses real societal challenges with practical, evidence-based solutions. Through the Institute of Healthcare Management, the University continues to generate scholarship that informs policy while strengthening leadership across Africa’s health systems.

As Kenya accelerates implementation of Primary Care Networks and pursues Universal Health Coverage, leadership diversity is increasingly recognised as a strategic necessity for stronger institutions, better decision-making and more equitable healthcare delivery.

The study ultimately reminds us that dismantling the leadership labyrinth will demand organisations willing to redesign systems, governments prepared to enforce equity, communities ready to challenge outdated norms and leaders committed to opening doors that have remained closed for far too long.

By translating rigorous research into actionable recommendations, the study demonstrates how evidence generated at Strathmore University can help shape healthier institutions, more inclusive leadership and stronger public policy for Kenya’s health sector.

Article written by Stephen Wakhu.