Mapping Women’s Leadership Impact in Yemen’s Conflict-Affected Health Systems: A Systematic Review to Inform Gender-Responsive Health Policy and Practice

Mapping Women’s Leadership Impact in Yemen’s Conflict-Affected Health Systems: A Systematic Review to Inform Gender-Responsive Health Policy and Practice | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Mapping Women’s Leadership Impact in Yemen’s Conflict-Affected Health Systems: A Systematic Review to Inform Gender-Responsive Health Policy and Practice Mamoon Alazazy This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8339711/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Yemen’s conflict-affected health system faces a profound humanitarian crisis. Women comprise over 70% of the health and social care workforce globally, yet hold only 25% of senior leadership positions. In Yemen, with 5.5 million women lacking access to reproductive healthcare and a maternal mortality ratio of 183.4 per 100,000 live births, understanding women’s leadership impact is critical for health system strengthening and improved health outcomes. Objectives This systematic review maps evidence on the impact of women’s leadership in Yemen’s conflict-affected health systems and comparable conflict settings, identifying how women leaders influence health outcomes, organizational performance, and policy responses in resource-constrained environments. Methods We conducted a comprehensive systematic review following PRISMA 2020 guidelines. Searches were conducted across PubMed, SCOPUS, CINAHL, EMBASE, and grey literature sources (2010–2024). We included studies examining women’s leadership in health systems, with particular attention to conflict-affected settings and low-resource contexts. Two independent reviewers screened citations, extracted data, and assessed quality using mixed methods appraisal tools. Data were synthesized thematically across six impact domains. Results We included 47 studies from diverse settings, including 8 studies with direct Yemen relevance. Women leaders demonstrated significant positive impacts across six domains: (1) financial performance and organizational stability (8 studies); (2) health outcomes and clinical quality (12 studies); (3) innovation and evidence-based practice adoption (7 studies); (4) engagement with ethical and sustainability initiatives (6 studies); (5) organizational culture, retention, and team cohesion (11 studies); and (6) influence on other women’s careers and leadership pipelines (9 studies). Yemen-specific barriers included security constraints, wage arrears affecting 50,000 health workers, cultural restrictions (mahram requirement), facility destruction (50% of health facilities non-functional), and absence of transparent leadership pathways. Enablers included community-based midwifery models, formal mentorship programs, and integration of gender-responsive policies into health system strengthening frameworks. Conclusions Despite severe conflict-related constraints, evidence demonstrates that investing in women’s leadership in Yemen’s health systems yields measurable improvements in financial sustainability, health outcomes, organizational culture, and system resilience. Policy priorities include: (1) establishing transparent leadership development pathways for women; (2) integrating gender-responsive practices into conflict recovery planning; (3) supporting women health workers’ safety and retention through security provisions and wage assurance; (4) creating mentorship and peer support networks; and (5) mainstreaming gender equity in health system strengthening programs. These investments are essential to achieve universal health coverage and gender equality in Yemen. Women’s leadership Health systems Conflict-affected settings Yemen Organizational performance Gender equity Health outcomes Policy Full Text Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Organizational performance, Gender equity, Health outcomes, Policy","lastPublishedDoi":"10.21203/rs.3.rs-8339711/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8339711/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eYemen\u0026rsquo;s conflict-affected health system faces a profound humanitarian crisis. Women comprise over 70% of the health and social care workforce globally, yet hold only 25% of senior leadership positions. In Yemen, with 5.5\u0026nbsp;million women lacking access to reproductive healthcare and a maternal mortality ratio of 183.4 per 100,000 live births, understanding women\u0026rsquo;s leadership impact is critical for health system strengthening and improved health outcomes.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis systematic review maps evidence on the impact of women\u0026rsquo;s leadership in Yemen\u0026rsquo;s conflict-affected health systems and comparable conflict settings, identifying how women leaders influence health outcomes, organizational performance, and policy responses in resource-constrained environments.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a comprehensive systematic review following PRISMA 2020 guidelines. Searches were conducted across PubMed, SCOPUS, CINAHL, EMBASE, and grey literature sources (2010\u0026ndash;2024). We included studies examining women\u0026rsquo;s leadership in health systems, with particular attention to conflict-affected settings and low-resource contexts. Two independent reviewers screened citations, extracted data, and assessed quality using mixed methods appraisal tools. Data were synthesized thematically across six impact domains.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe included 47 studies from diverse settings, including 8 studies with direct Yemen relevance. Women leaders demonstrated significant positive impacts across six domains: (1) \u003cb\u003efinancial performance and organizational stability\u003c/b\u003e (8 studies); (2) \u003cb\u003ehealth outcomes and clinical quality\u003c/b\u003e (12 studies); (3) \u003cb\u003einnovation and evidence-based practice adoption\u003c/b\u003e (7 studies); (4) \u003cb\u003eengagement with ethical and sustainability initiatives\u003c/b\u003e (6 studies); (5) \u003cb\u003eorganizational culture, retention, and team cohesion\u003c/b\u003e (11 studies); and (6) \u003cb\u003einfluence on other women\u0026rsquo;s careers and leadership pipelines\u003c/b\u003e (9 studies). Yemen-specific barriers included security constraints, wage arrears affecting 50,000 health workers, cultural restrictions (mahram requirement), facility destruction (50% of health facilities non-functional), and absence of transparent leadership pathways. Enablers included community-based midwifery models, formal mentorship programs, and integration of gender-responsive policies into health system strengthening frameworks.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eDespite severe conflict-related constraints, evidence demonstrates that investing in women\u0026rsquo;s leadership in Yemen\u0026rsquo;s health systems yields measurable improvements in financial sustainability, health outcomes, organizational culture, and system resilience. Policy priorities include: (1) establishing transparent leadership development pathways for women; (2) integrating gender-responsive practices into conflict recovery planning; (3) supporting women health workers\u0026rsquo; safety and retention through security provisions and wage assurance; (4) creating mentorship and peer support networks; and (5) mainstreaming gender equity in health system strengthening programs. These investments are essential to achieve universal health coverage and gender equality in Yemen.\u003c/p\u003e","manuscriptTitle":"Mapping Women’s Leadership Impact in Yemen’s Conflict-Affected Health Systems: A Systematic Review to Inform Gender-Responsive Health Policy and Practice","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-12 08:28:57","doi":"10.21203/rs.3.rs-8339711/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f5347a48-09a9-4b63-8ac6-b749d112a244","owner":[],"postedDate":"December 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-12T08:28:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-12 08:28:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8339711","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8339711","identity":"rs-8339711","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}