<p>Women comprise most of the global health and care workforce, yet they remain underrepresented in leadership across health systems, including in ministries of health, hospitals, academic institutions, humanitarian agencies, and health financing bodies. This imbalance is not only a matter of fairness; it shapes whose expertise is recognised, which priorities are funded, and how health systems respond to inequity, crisis, and exclusion. The problem is particularly acute in fragile and conflict-affected settings, where insecurity, displacement, interrupted education, shrinking civic space, and institutional breakdown further narrow women’s pathways into leadership. This viewpoint argues that strengthening women’s leadership should be treated as a core component of health systems strengthening rather than as a peripheral diversity agenda. It further argues that leadership initiatives must move beyond numerical inclusion to address how authority, legitimacy, and opportunity are distributed across institutions and communities. Drawing on an intersectional lens, the paper examines how gender interacts with ethnicity, caste, class, disability, age, geography, and displacement status to shape who is excluded from leadership pathways and why. It then outlines four practical and adaptable strategies for change: digital mentorship and leadership training platforms, community-based leadership incubators, policy and institutional reform fellowships, and participatory research and advocacy networks. The paper emphasises that leadership development will remain limited unless it is accompanied by reforms to workplace culture, sponsorship, promotion systems, safety, and institutional accountability. Strengthening women’s leadership in health systems is therefore essential not only for representation, but also for building more equitable, trusted, and resilient systems capable of advancing universal health coverage and responding effectively to diverse community needs.</p>