Overall, it is reported that women constitute up to 70% of the health-care workforce, providing an essential contribution to fencing the frontline of the COVID-19 pandemic.
Yet the pandemic has taken an enormous psychological and physical toll on frontline health-care workers due to prolonged working hours, isolation from their families, social stigma, direct and prolonged exposure to the virus, and many other factors. Working under such extreme conditions has often exacerbated existing challenges within health systems, including gender inequality.
Commencing in August 2020, a 1-year research project aimed to examine how gender identity affects the work and life aspects of female frontline health-care workers amid the COVID-19 pandemic in Kazakhstan. The study revealed that women reported higher emotional exhaustion due to the double burden of household responsibilities and longer working hours per week, and that they experienced other social factors that impaired their quality of life.
Research objectives and methodology
The cross-sectional study was designed to understand how perceived safety, well-being and livelihood vary by gender and occupation among hospital health-care providers managing COVID-19 patients in Kazakhstan.
The study also assessed how the realities of the pandemic along with gender and occupational differences influenced the length of working hours, occupational safety (including the provision of personal protective equipment (PPE), training and availability of isolation facilities), work–life balance and the burden of unpaid care, self-reported COVID-19 infection and recovery, emotional exhaustion, and exposure to workplace and domestic violence.
The researchers used a quantitative electronic questionnaire to collect data. Then, they applied a proportional stratified random sampling strategy, with stratas over gender and occupation, to form a study population among the frontline health-care workers of different occupational levels within COVID-19-dedicated hospitals across Kazakhstan. A total of 433 questionnaire responses were used to form the results of the study.
The research project was designed and implemented through a collaboration between the WHO Country Office in Kazakhstan, Astana Medical University and Fjelltopp (a data-analysis social enterprise), with the agreement of the Ministry of Health of Kazakhstan. The study received funding from the Ministry of Foreign Affairs of the Netherlands.
Frontline health-care workers, especially medical doctors, experienced longer working hours during the pandemic with no differences by gender. There was a median increase of 8 hours per week with an additional increase of 5 hours per week during the peak of the epidemiological situation. There were no differences in access to PPE or training based on gender. However, women were significantly less likely to use isolated living facilities while working on the frontline due to their responsibilities for household care.
Both prior to and during the pandemic, women reported carrying greater household responsibilities than men, yet both genders mentioned shedding significant responsibilities to work on the frontline. Those who self-reported as testing positive for SARS-CoV-2 were more likely to work longer hours per week, rate PPE more poorly, and suffer from a higher level of emotional exhaustion; no differences were seen by gender.
Women reported higher emotional exhaustion than men. The factors included both household responsibilities and longer working hours per week. According to Dr Laura Vremis, the lead author of the report, “The difference of emotional exhaustion levels by gender could perhaps be explained by the fact that the weight of the frontline work has fallen on top of household responsibilities of female health-care providers. In turn, these household responsibilities have been further aggravated by the pandemic. In Kazakhstan, like in many other countries, this latter [responsibility] remains the disadvantageous prerogative of women.”
The study also showed that workplace violence remains a challenge. The most common cases of violence were inflicted by patients and their relatives. While the majority of responders stated that they had never experienced any form of violence, those who reported that they had been subjected to violence stressed a significant rise in occurrences of both psychological and physical violence during the pandemic.
“This study demonstrates the need to strengthen the systemic protective measures of health-care personnel during an exacerbation of the epidemiological situation,” said Dr Zhanar Kalmakova, Acting Board Chair of the National Center for Public Health.
Based on the study’s findings, a number of recommendations have been proposed to address gender-specific challenges, including but not limited to optimizing working hours for those with care responsibilities, strengthening and monitoring infection prevention and control programs, improving policies and protocols concerning workplace violence , monitoring and addressing emotional exhaustion, providing expanded support for mental health, and managing increased risk factors for violence during public health emergencies.