Background The importance of strong and transformative leadership is recognised as
essential to the building of resilient and responsive health systems. In this regard,
Sustainable Development Goals (SDG) 5 prioritises a current gap, by calling for women's full
and effective participation and equal opportunities for leadership, including in the health
system. In South Africa, pre-democracy repressive race-based policies, coupled with strong
patriarchy, led to women and especially black women, being 'left behind'in terms of career …

… experiences and career pathways of black female managers and in part for some black
male managers. Professional hierarchy further compounded the influence of gender and
race for black women managers, as doctors, who were frequently male, advanced more
rapidly into management and senior management positions, than their female …