Table 1 Evidence of systemic structural gender discrimination and inequality and negative HRH effects and consequences from country and global gender analyses

Senegal (2021): Deployment, family separation, work–life conflict, absenteeism and sexual violence [50]; Supporting Evidence File

Constellation of discrimination: vertical and horizontal and task segregation, reproductive role/status discrimination; multi-source violence and sex-based harassment; victim-blaming and silencing; men share selected family/domestic tasks, but are women responsible, valued for domesticity; non-recognition/devaluation of women’s paid health work and economic contribution to household; full- and (unpaid) overtime work; night duty; no childcare; marital/familial conflict; non-respect of maternity leave and breastfeeding; non-hiring and promotion of pregnant workers; male preference and delegitimization of women’s leadership competence/men’s refusal to be supervised or treated by women; category bias in access to scholarships, housing, safe and secure work, strategic leadership positions; maternal wall and glass ceiling practices around recruitment and promotion. Non-application of existing labor protections. “Ideal worker” and gender-blind HRM

Conflict and stress and absenteeism; lack of safety; unequal opportunity for jobs and career; under-representation of women in strategic leadership. Social closure and resignation/exit. Female health workers absorbed back into unpaid care/domestic labor. Workforce shortages, disruption in continuity of services

Global (2019) Nursing Now Gender Analysis of occupational segregation in nursing leadership [13]

Intense gender stereotyping (Gender essentialism and male primacy) and devaluation of nursing that maintains doctor/nurse hierarchy; constellation of discriminations, etc.; inflexible hours and the second shift after work, time poverty lack of childcare; glass escalator for male nurses in promotion, glass ceiling for female nurses; under-resourced jobs

Strain, burnout; nurses defer leadership responsibility until children are grown; social closure, workforce exit

Mali (2018): General gender discrimination and inequality analysis in education and employment systems [43]

Pregnancy and family responsibilities-based exclusion/discrimination in both education and employment systems; sexual coercion and sex-based grades; lack of safety; women responsible for almost all household labor as well as 100% employment in the labor market, yet underestimation of women’s work and financial contribution to household. No childcare

Conflict, strain, burnout from competing demands; drop out/reduced health worker pipeline

Uganda (2017): Sexual Harassment Formative Assessment [18]

Sex-based harassment (e.g., gender harassment, unwanted sexual attention and sexual coercion): unwanted sexual attention and body-shaming by colleagues; sexual coercion by managers/supervisors including bullying, gaslighting, victim-blaming and silencing dynamics; punitive transfers; mutually reinforcing intersections of sex-based harassment and vertical occupational segregation as related obstacles experienced by women seeking professional advancement; sextortion/exploitation of health workers and patients

Corruption of HRM/supervision; hostile work climate; anxiety, depression and fear; lack of safety; absenteeism; unequal opportunity for advancement; punitive transfers, turnover or exit; damage to organizational reputation; disruptions in continuity and use of services

Ethiopia (2017): Occupational segregation in supply chain management [44]

Gender stereotyping of the supply-chain management (SCM) job, male-targeted recruitment; Pregnancy and family-based exclusions; vertical and horizontal segregation, etc.; and the second shift preclude taking on leadership roles; fear of community violence. Non-application of existing labor protections

Women not recruited for SCM field work or management, remain in office jobs. Supply chain inefficiencies

Kenya (2016): General gender discrimination and inequality analysis in medical education systems [45, 46]

Pregnancy and family responsibilities discrimination; women responsible for almost all household labor as well as employment in the labor market; time poverty; familial conflict; sex-based grades. Vertical, horizontal and task segregation for students and faculty

Lack of safety; fear; lack of opportunity to advance; social closure and drop out; reduced health worker pipeline

Zambia (2013) and Uganda (2012) General gender discrimination and inequality analyses in small private/large public employment systems [47, 48]

Vertical and horizontal segregation; maternal wall and glass ceiling practices; “ideal worker” norm; denigration of women’s/leadership competency; sexual coercion by supervisors; intrusion of cultural patterns into HR processes; stigmatization of affirmative action. Non-application of existing labor protections

Unequal opportunity for employment; under-representation of women in leadership

Lesotho (2009): Occupational segregation in community-based HIV/AIDs care [12]

Gender essentialist and male primacy stereotyping keep women in caregiving jobs and men out of them; fear of men’s sexual predation against female PLWHA; men refuse volunteer/unpaid work

Unsuccessful recruitment of men; workforce shortages

Rwanda (2008): Workplace violence [49]

Constellation of discriminations and violence: verbal abuse, physical assault, bullying, sexual harassment; denigration of women’s/leadership competency; “hostile animus” towards female health workers; pregnancy discrimination; maternal wall and glass ceiling practices

Strain; lack of safety; “indecent” work