BOARDS FOR ALL? A review of power, policy and people on the boards of organisations active in global health - Global Health 50/50
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BOARDS FOR ALL? A review of power, policy and people on the boards of organisations active in global health 2022 Global Health 50/50 Report
2 Global Health 50/50® is an independent charitable initiative. Global Health 50/50 was co-founded by Professors Sarah Hawkes1 and Kent Buse.2 It is staffed by a dedicated collective of researchers, strategists and communications experts most of whom work in the global health sphere while also contributing to the work and aims of GH5050. Collective members who contributed to the 2022 Report include: Tiantian Chen, Mireille Evagora-Campbell, Fizza Fatima, Erick Freire, Thepan Ganesh, Sophie Gepp, Sophie Hampton, Lara Hollmann, Unsia Hussain, Victoria Olubunmi, Alex Parker, Ashley Sheffel, Treasure Udechukwu, Zahra Zeinali and David Zezai. Sonja Tanaka and Anna Purdie co-ordinate and manage the GH5050 collective. The initiative is guided by a diverse independent Advisory Council3 and charitable oversight is provided by a Board of Trustees.3 We are deeply grateful to the members of both of these bodies. GH5050 is grateful to the many people who shared their expertise, insights and experiences in the development of this report. Several of those people are featured in the PDF and online versions of this report. Global Health 50/50 is a registered charity, UK Charity Registration Number: 1194015. Suggested citation: Global Health 50/50, ‘Boards for all? A review of power, policy and people on the boards of organisations active in global health’, Cambridge, UK, 2022. Global Health 50/50 Report 2022 is published under a Creative Commons Attribution NonCommercial 4.0 International Licence. All care has been taken to ensure the accuracy of the data reported. However, if you believe that an error has been made, please contact: info@globalhealth5050.org. #GH5050 #BoardsforAll @GlobalHlth5050 www.globalhealth5050.org 1 Director, Centre for Gender, Health and Social Justice, Institute for Global Health, University College London. 2 Director, Healthier Societies Program, The George Institute for Global Health, Imperial College London. 3 https://globalhealth5050.org/meet-the-team/
WARMI JILAQATA Rita Suaña Coila and women from the Uros community collect waste that has washed downstream from the surrounding cities to be taken to the recycling centre. Captured in cinematic black
and white, Rita casts an imposing figure. Rita was the first woman mayor of the town of Uros, a community that has lived on the floating islands of Lake Titicaca since Incan times. Her election
sent shockwaves through her community - her own family doubted that she, as a woman, would be able to do the job. In this patriarchal society, her leadership is historic.
Puno, Peru, 2015
David Martín Huamaní Bedoya David Martín Huamaní Bedoya is a photographer from Lima, Peru, whose work exhibits nationally and internationally.
CONTENTS
4
Foreword PART 1. Annexes
Elhadj As Sy, Chair of the Board Power and privilege in global health 1. Organisational performance over the past
of the Kofi Annan Foundation 5 boards: a review of people and policy 11 three years: Consistently high performers,
Fast risers and Stagnators, 2020-2022 33
SECTION 1. Who gets to govern? 2. Poor performers by variable,
An analysis of more than 2,000 2018-2022 36
Word global health board seats 14
3. Organisational performance, 2022 39
From the Global Health 50/50
Collective 6 Featured voices: 4. Methods 42
Insights from the boardroom 20
Summary
What’s in Boards for All? 7 SECTION 2. Board policies: an underutilised
gateway to more equitable
global health governance 21
PART 2.
The Unfinished Agenda: Gender and
Health Index trends over five years 26
MOVING THE EQUALITY 5
AGENDA FORWARD
“ENSURING THE LEADERSHIP AND INFLUENCE OF
PEOPLE FROM LOW- AND MIDDLE-INCOME COUNTRIES, ELHADJ
AND ESPECIALLY WOMEN, IS NOT ONLY A QUESTION OF AS SY
Co-Chair of the Global
EQUITY – HOWEVER ESSENTIAL – BUT OF THE VERY Preparedness Monitoring
Board, Co-Chair of the
RELEVANCE, EFFECTIVENESS AND IMPACT OF THE Lancet Commission
on Gender and Global
GLOBAL HEALTH ENTERPRISE.” Health, Governor of the
Wellcome Trust, Member
of the Governing Board
of Interpeace, and Chair
of the Board of the Kofi
Annan Foundation
Global Health. The very name of our chosen field, our shared Across the variables on policy, practice and outcomes detailed influence, to critically examine whose interests are being
calling, is imbued with fundamental values of universality, in this report, GH5050 finds areas of progress, yet these are served by the status quo. Irrespective of our gender, we are
equity, and well-being for all. islands in a sea of stagnation. GH5050 reports no change in all responsible for ensuring equality. As a man, I am proud to
the availability of gender equality workplace policies in two be working towards equality for all genders, for all people.
When I read the findings of this report, however, I question years, despite the brutal impact of the pandemic on women’s
whether we are living up to our name and ideals. This critical working lives. Fifty-four organisations have neither had a The past two years have revealed many fault lines in our
report from Global Health 50/50 (GH5050) has shown the woman CEO nor a woman board chair in the five years that society. Untold lives have been lost and many more have
extent to which so much of global health is governed by the GH5050 has been assessing them. However, whenever we call been irrevocably changed. Widening economic, gender, and
Global North. Among more than 2,000 board seats, analysis for talents, women have come. So, what is going wrong? racial inequalities are doing harm to all of us.
reveals that 75% are held by nationals of high-income countries We have learned too. The past two years have spawned
(home to 16% of the global population). Shockingly and The rigorous and alarming findings of the 2022 GH5050 report remarkable innovations in the way we connect. We have
damningly, fewer than 1% – just 17 board seats – are held by must spur us into action. I have the privilege and opportunity worked side-by-side with colleagues and communities, without
women from low-income countries. to sit on several boards but, often and unfortunately, as the ever having been in the same room. This is an opportunity
first and only African, Black person or person from the Global to truly go global and transform the way global health is
The influence and responsibility vested in these governing South. I know from my own experience as a member of several governed, and to ensure increasingly diverse voices in positions
bodies is vast. Some control the distribution of billions of boards, that boards that are rich in diversity – social diversity of decision-making. I welcome the increase in formal policies
dollars each year, some engage in global discourse determining and idea diversity – are better problem solvers. But equally that set the vision, measures and accountability mechanisms to
priorities, norms and solutions. They collectively govern the important is an organisation that fosters an egalitarian board advance diverse representation on boards; these must become
careers of 4.5 million employees. Ensuring the leadership and culture – one that elevates different voices and perspectives, commonplace across all global health organisations.
influence of people from low- and middle-income countries, and welcomes conversations about diversity.
and especially women, in these bodies is not only a question If there is one sector that should lead in this space, it is global
of equity – however essential – but of the very relevance, I encourage my colleagues and peers who, like me, have health. Let us live up to our name.
effectiveness and impact of the global health enterprise. a responsibility because they occupy these positions of
WORD FROM THE 6
GH5050 COLLECTIVE
Governing boards represent the locus of power across contribute to the governance of global health, with women with our findings to take deliberate steps to embed gender
organisations active in global health, where decisions on particularly under-represented. Just 17 of the over 2,000 global equality and diversity into their structures, policies and
leadership, strategy, finance, and programming are made health board seats are occupied by women nationals of low- programme delivery.
that influence the health outcomes of people around the income countries. Meanwhile, a quarter of board members are
world. Our 2022 report provides a close-up view of these men from the United States. Despite these inequities, only 12% As part of GH5050’s methods, GH5050 invites each of the
bodies as epicentres of continued inequities as well as prime of boards in our sample have published affirmative measures 200 organisations to engage directly in the collection and
spaces for transformation. to promote women’s participation and only 6% have published interpretation of organisational findings at several points during
policies to address geographic imbalances. the data collection process in advance of publication. The data
Two years ago, we reported that power imbalances resulting in this report reflects the participation and contributions of over
from systemic patriarchal, colonial and imperial norms pervaded 90 organisations who took the time to submit documentation,
the global health system, with a crippling lack of gender equality LACK OF PROGRESS IN verify findings and engage with GH5050. We are deeply
and diversity in the highest positions of leadership. Our report DEMOCRATISING AND DIVERSIFYING appreciative of their participation which helps to bring about a
was written as the COVID-19 pandemic was advancing across GLOBAL HEALTH more transparent, gender-equal and gender-responsive global
the world, and in it we warned that the global health system health system.
was “broken” and neither “fair nor fit-for-purpose”. In 2021, we Despite decades of work to reveal the ingrained imprint of
uncovered how hard this inequitable system strikes the most historical injustices and decolonise development cooperation, We are grateful for the guidance of our Advisory Council and
vulnerable in times of crisis, finding for example that over 80% of the global health sector seems only to be waking up to its own the contributions of organisations in validating the data for this
COVID-19 health-programming activities did not recognise how complicity in patterns of colonialism, imperialism, racism and report. Without your support, none of this would be possible.
gender affects people’s health despite the clear role1 of gender abuse of power in the last few years.5 We are delighted and honoured that Elhadj As Sy has written
on people’s experiences during the pandemic. the Foreword to this report – we need many more men to step
We are alarmed by the lack of progress on democratising up for gender equality.
The COVID-19 pandemic has thrown into relief how structural and diversifying global health. The collective failure to deliver
forces shape individual opportunities and outcomes. Pandemic equality in global health is inextricably linked to a failure to
measures have hit the economically vulnerable hardest2 while ensure equality in voice, representation and inclusion at the A CALL TO CLAIM THE ROOM
the world’s ten richest men doubled their wealth during top. We cannot realise our collective mandate to deliver health
the crisis.3 Women have borne the greatest burden of the equity globally while those sitting in the spheres of influence This report is a call to the barricades. Or more specifically a call
pandemic at home and in the workplace, and as a result the do not reflect the people they serve. And hence, for the first to the boardroom – the Global Health Boardroom. It is high
clock of achieving gender parity has been set back to 135 time, we have taken the decision to highlight organisations that time that the room is claimed. We saw disability rights activists
years, from 99 years previously.4 have not improved their practices and policies over the past do it; we saw HIV activists do it; and we are seeing young
five years. We would encourage people working for or funding climate activists do it. The time is overdue for people with a
these organisations to use our data to demand change. stake in global health to assert ‘Nothing About Us Without
STARK FINDINGS OF POWER Us!’ and claim their rightful place in its boardrooms. We need
IMBALANCES ‘Boards for All’ if we are to achieve ‘Health for All.’
GROUNDS FOR OPTIMISM
This year, we find that in the corridors of power and the rules
determining who is given a platform to govern, considerations Despite the findings in this report, and the wider state of
of gender and diversity are all too often lacking. People from growing inequality, there are grounds for optimism. We are
low-income countries are largely denied the opportunity to inspired by the drive of numerous organisations who engaged
WHAT’S IN 7
BOARDS FOR ALL?
FIRST-EVER ASSESSMENT OF ANNUAL ANALYSIS OF CALLS FOR CHANGE FROM GLOBAL
GLOBAL HEALTH BOARD MEMBERS ORGANISATIONS’ GENDER-RELATED HEALTH BOARD MEMBERS
POLICIES AND PRACTICES
This report takes an in-depth look at power and privilege The report features insights from board members from low-
by examining who governs global health. For the first The 2022 report presents the findings on board and middle-income countries and from representatives of
time, this report assesses the demographics of every representation alongside its annual analysis of 200 organisations active in global health. These leaders reflect on
board member of the most influential organisations active organisations’ gender-related policies and practices. what makes for a diverse board in global health (and how they
in global health, which includes 1,946 individuals holding Every year, GH5050 shines a light on whether and come about), how individuals and organisations are challenging
2,014 board seats across 146 organisations. This is a how organisations are playing their part in addressing traditional power inequities to shape more diverse and inclusive
sub-sample of the 200 organisations annually assessed by two interlinked dimensions of inequality: inequality of boards, and what greater diversity in decision-making could
GH5050 (see page 8), and excludes those organisations opportunity in career pathways inside organisations and mean for delivering better and fairer health outcomes.
where board membership is mandated through member inequality in who benefits from the global health system.
state participation or where data could not be located.
Publicly-available information was collected on the While numerous organisations have continually performed
gender and nationality of board members, their place of well in the Gender and Health Index, and dozens
employment, the sector in which they work, and where the more have made measurable progress, the report FEATURED VOICES:
organisation they work for is headquartered. finds growing polarisation between high- and low-
CATHERINE BERTINI, Chair of the board of the Global Alliance for
performing organisations. The performance and progress •
Improved Nutrition; Distinguished Fellow at the Chicago Council on
As the world continues to suffer from the impacts of a of organisations that have been assessed since 2020 is Global Affairs
devastating pandemic, including unprecedented levels of presented in Annex 1. Organisations are listed in three
• MINAKSHI DAHAL, Research Officer at the Center for Research on
inequality, this report presents rigorous evidence on the categories: consistently high performers, fast risers and Environment Health and Population Activities, Nepal
inequitable gender composition of boards governing global stagnators. For the first time, organisations that have
health and the outsized presence of a small number of performed poorly in 2018 and have not shown improvement • KATE GILMORE, Chairperson of International Planned Parenthood
Federation
nationalities in these decision-making spaces. in 2022 for each core variable is presented (Annex 2). The
2022 performance of all 200 organisations is presented in • ANURADHA GUPTA, Deputy Chief Executive Officer of Gavi, the
Vaccine Alliance; Board member of Partnership for Maternal, Newborn
This data is presented to contribute to growing Annex 3. and Child Health
interrogations of power in global health: Who dictates
global health priorities and solutions? What interests, Full details of the methods GH5050 employed to analyse • ANUJ KAPILASHRAMI, Professor in Global Health Policy & Equity at
University of Essex; Board of trustees for Health Poverty Action
worldviews and precepts are these decisions based on, and board membership and board policy, as well as the methods
thus who actually benefits and how? What does it mean for for data collection on the core variables, can be found in • CATHERINE KYOBUTUNGI, Executive Director of the African
priority-setting, knowledge-generation and effective and Annex 4. Population and Health Research Center; Board member of Partnership
for Maternal, Newborn and Child Health
equitable responses in global health when, as this report
finds, 44% of board members are from a single country – the As the many voices in this report attest, however, fostering • DEVAKI NAMBIAR, Program Head of Health Systems and Equity at the
George Institute for Global Health; Board member of Health Systems
United States? The report further questions whether more diverse and inclusive governance spaces is possible through Global
representative and equitable global health governance is a committed leadership, deliberate policy, and sustained
question of men from high-income countries relinquishing action and accountability. • NYOVANI MADISE, Director of Development Policy and Head of the
Malawi office of the African Institute for Development Policy; Board
power, or whether it will rely on an increasingly diverse set member of Population Council and Trustee of Liverpool School of
of actors seizing power and ‘claiming the room’. Tropical Medicine
THE GLOBAL HEALTH 50/50 REPORT 8
AND ORGANISATIONAL SAMPLE
Through its annual report and the Gender and Health Index, GH5050 has taken a deliberative approach to identifying
GH5050 assesses the gender-related policies and practices of a broad and representative sample of organisations active
global organisations (operational in a minimum of three countries) in global health, including organisations based in low- and
that aim to promote health and/or influence global health middle-income countries, for inclusion in its annual reports.
agendas and policy. The GH5050 report and Index continue to The sample currently contains 200 organisations from 10
provide the single-most comprehensive analysis on gender equality ‘sectors’, headquartered in 37 countries which, together,
and the distribution of power and privilege in global health. employ over 4.5 million people.
146 200
ORGANISATIONS INCLUDED
ORGANISATIONS IN ANNUAL REPORT ON
INCLUDED IN 2022 BOARD GENDER-RELATED POLICIES,
MEMBER ANALYSIS PRACTICES AND OUTCOMES
Non-governmental and
non-profit organisations
11 14
Private for-profit companies
42
6 Public-private partnerships
Non-governmental and
non-profit organisations 10 10 Funders and philanthropies
Private for-profit companies,
including 7 consulting firms
8 Multilateral and bilaterals
62 36 Public-private partnerships Research and surveillance
organisations
Philanthropic funders
17 United Nations bodies
Faith-based organisations
63 Consulting firms
16 8 Consulting firms
7 Faith-based organisations
11 Research and surveillance
organisations
14 11
Regional political bodies
SNAPSHOT 9
OF 2,014 BOARD SEATS ACROSS 146 ORGANISATIONS...
Global health a fraction of Women from low-income While some
governing boards organisations have countries are nearly progress has been
are not globally transparent policies absent made, there are
representative for board diversity signs of stagnation
75% 12% Across the
sector, 40%
of board seats
(814/2014).
After 5 years
tracking 138
(23/198) women hold organisations...
are held by nationals have published targets to address
gendered power distribution by
58%
of high-income
countries. promoting women’s participation
on their boards.
(80/138)
have not had a
Women from women CEO
82% low- and
middle-income 9% of board seats.
51%
This rises to 82% countries hold
among the 123 board
(70/138)
6%
have not had a woman
seats of funding
board chair in the five
bodies.
(11/179) years GH5050 has been
have published targets to address tracking them.
geographic imbalances. Just 1% of are held by
51% 1%
1,438 board women
of all seats are held
by nationals of the
two most dominant
seats in the
non-profit
nationals of
low-income Almost 1/3
organisations have made little
sector countries.
countries: the to no progress across our index.
United States (44%)
and the United
Kingdom (7%). 3% (45/123) of seats
(5/198) on funding bodies.
have dedicated seats or quotas in the Women hold 37% In the past 2 years, we've
2.5% just 50 seats are held
public domain to promote diversity in
the identity characteristics of board
Just 1 seat is held
by a woman from a
seen no progress in the
number of organisations
members, including age and ethnicity. low-income country. publishing gender
by nationals of low- workplace policies,
income countries. despite inequitable
There are no women from low-income impacts of the pandemic
countries on for-profit boards. on women's working lives.
Hen - Stephen, Stockport, 2019 Stephen Whittle, OBE is a British legal scholar and co-founder of the trans-activist group Press for Change. Since 2007, he has been Professor of Equalities Law in the School of Law at Manchester
Metropolitan University. After the Gender Recognition Act 2004 came into force in April 2005, he achieved legal recognition as a man and was able to marry his partner, Sarah. The series Hen is an
anthropological study on the fluidity of gender, and an exploration into the lasting impact of societal restrictions concerning gender identiy and sexual orientation on people’s lives.
Stockport, 2019
Bex Day Bex Day is a photographer and director from London.PART 1
11
POWER AND
PRIVILEGE
IN GLOBAL
HEALTH
BOARDS:
A REVIEW
OF PEOPLE
AND POLICY12 Boards are some of the most influential decision-makers in global
health. They often nominate an organisation’s leadership, set
strategic direction and funding priorities, and provide oversight and
accountability for financial, management and programmatic decision-
making. Globally, demands for gender equality and broader diversity
in decision-making and influence are loud and growing, bolstered by
global social justice movements and evidence that diverse and inclusive
boards are more innovative and effective.6
Positions of power in global health continue and within countries, on the degree to which rights and participation for affected
to be dominated by men from high-income people have suffered or been protected from communities have often been won through
countries. This is but one manifestation the immediate and longer-lasting effects of demands for their voices to be heard and
of a broken system where governance is the pandemic have been starkly apparent. experiences recognised in decision-making
not inclusive of multiple forms of diversity, spheres. (See page 13).
be it gender, geography, disability, sexual Our analysis reveals that the makeup of
orientation, race, class or education, therefore global health boards does not reflect the Our findings also show that change is possible:
excluding those whose perspectives and populations they serve.8 A recent survey from organisations are publishing more board
expertise can challenge the status quo and the non-profit sector in the United States of representation and diversity policies – GH5050
lead to better and fairer health oucomes for America found that when selecting board has reported an 11% increase over two years.
all. Representative participation in the boards members, board chairs and executives tended There is additional evidence from the private
governing public-health policy and practice is to prioritise characteristics such as reputation, sector that some boards are becoming more
a vital component of building trust in public networks and certain skills over membership responsive10 – for example, gender diversity on
health systems.7 As COVID-19 has once again or knowledge of the community affected or boards is gradually increasing in some regions.11
highlighted, public trust is essential for the served when selecting board members.9 Such
delivery and success of public health goals. a disconnect may perpetuate perceptions It is time for all global health organisations to
of patronage, reduce levels of trust, and correct historical disadvantage and inequality
The COVID-19 pandemic and response have contribute to a group-think mentality, which in the boardroom – to meet their obligation
laid bare the broken system in action, and the can lead to making poor strategic decisions. of contributing to a more equitable world and
resulting inequitable health outcomes. The to shape more diverse, inclusive and effective
impact of structural inequalities in race, class, History has taught us that representation governing bodies for better health for all.
PART 1 gender, geography and more, both between matters. Breakthroughs in progress towards13
“NOTHING ABOUT US WITHOUT US!” STAKING 13
CLAIM TO THE GLOBAL HEALTH BOARD ROOM
The success of many social justice movements has been underpinned by the drive of
hitherto excluded or marginalised groups to unite and claim space from power-holders
within arenas of influence.12 By gaining access to and transforming decision-making
spaces traditionally closed to them, communities have sought to ensure that their
interests were better met and their perspectives and lived experiences acknowledged
and included in governance and policy. The ultimate aims of such movements have
been recognition, self-determination and accountability to ensure due process and to
democratise and legitimise decisions and thereby promote trust in institutions.
THE FIGHT FOR DISABILITY The result of people living with decision-making bodies in which HIV- Global Fund’s Country Coordinating
RIGHTS, INCLUDING THE RIGHT disabilities claiming a seat at the related issues were being discussed. Mechanisms similarly stipulate that
table was the adoption of the Protest and legal action by coalitions people living with and affected by HIV
TO REPRESENTATION first international human rights of people living with and affected are to have full membership.17
treaty explicitly requiring states to by HIV, such as Act Up and Youth
Among the trailblazers of the fight involve the people it protects in Force, led to the conclusion that
for inclusive and participatory the development, implementation “AIDS changed everything”. 16The
decision-making were the leaders and monitoring of their rights.14In demands institutionalised lasting
of the disability rights movement.
Their defining motto, “Nothing
the health space, it led, among
other things, to WHO’s policy 15on
shifts in the global response. Among
other achievements, in 1994, 42
“POWER
About Us Without Us!” was at
once unequivocal, self-explanatory
disability. The policy commits the
organisation to “establish systematic
countries formally committed to the
GIPA principle (greater involvement
CONCEDES
and powerful. The central role
played by people with disabilities
process for consultations and active
engagement of people with disability
of people living with HIV/AIDS)
at the Paris AIDS Summit. This
NOTHING
in drafting the United Nations
Convention on the Rights of Persons
and organisations of persons with
disabilities in WHO’s business
principle, based on the right to
self-determination and participation
WITHOUT
with Disabilities in the early 2000s
marked a milestone in the path
operations and programmatic areas.” in decision-making processes that
affect the lives of people living with
A DEMAND.
towards inclusive decision-making.
Among other things, the Convention MEANINGFUL PARTICIPATION and affected by HIV, was enshrined in
subsequent UN Political Declarations
IT NEVER
guarantees the right to participation
in political and public life, including
OF PEOPLE LIVING WITH AND
AFFECTED BY HIV
and became a norm adopted in
most if not all countries. Later, when
DID AND IT
through equal participation in
“non-governmental organisations The HIV movement built on
UNAIDS and the Global Fund to
Fight TB, AIDS and Malaria were
NEVER WILL.”
and associations concerned the demands of the disability established, people living with and
with the public and political life rights movement for meaningful affected by HIV were able to claim Frederick Douglass,
PART 1 of the country.”13 representation and engagement in seats on their governing bodies. The 19th Century African-American social reformer
Image: Treatment Action Campaign in South Africa, 2020. The Democracy Works Foundation, Link14
WHO GETS TO GOVERN?: AN ANALYSIS OF WHO
FILLS 2,000+ GLOBAL HEALTH BOARD SEATS
146
For the first time, the GH5050 report presents an
THE
in-depth analysis of who holds power and privilege in
SAMPLE
the governing boards of organisations active in global INCLUDES ORGANISATIONS:
health. From July through October 2021, GH5050
gathered publicly-available demographic information on
1,946 individuals holding 2,014 board seats across 146
8 6
organisations.18
11
Among the sample of 200 organisations which GH5050 annually
assesses, this board review excluded organisations whose board
compositions are determined by national governments (e.g. bilateral 62
agencies) and/or member states (e.g. UN agencies). This allowed the 16
review to focus on diversity outcomes in the absence of formal policies
that dictate geographically-balanced representation (i.e. distribution
of seats by region) and/or that mandate single-sector and/or single-
country representation (i.e. boards with seats reserved for government
representatives only). These exclusion criteria removed all United
Nations organisations (11), all bilateral and multilateral organisations
(14), and all regional bodies (8), as well as one (1) research and
surveillance organisation and two (2) multilateral funding bodies from 36
the larger sample. An additional 17 organisations were excluded given
that information on their board members was not publicly available, or Non-governmental and non-profit organisations Funders and philanthropies
the existence of a board could not be determined. Private for-profit companies, including 7 consulting firms Faith-based organisations
Public-private partnerships Research and surveillance organisations
Data collected on each board member includes the gender and
nationality of board members, their place of employment, the sector
in which they work, and where the organisation they work for is
headquartered. Data was drawn primarily from individuals’ online Further information on the methods used in this analysis can be found
PART 1 biosketches and LinkedIn profiles. in Annex 4.15 BOARD MEMBERS OF THE FOLLOWING ORGANISATIONS INCLUDED IN BOARD ANALYSIS:
CONSULTANCY Faith-Based Organisations PRIVATE SECTOR • International Federation of Pharmaceutical
• Accenture • Africa Christian Health Association Platform • AB InBev Wholesalers Foundation (IFPW)
• Deloitte (ACHAP) • AbbVie • Johnson & Johnson
• KPMG • American Jewish World Service (AJWS) • Abt Associates • Kuehne + Nagel
• McKinsey & Company • Catholic Medical Mission Board (CMMB) • Becton, Dickinson and Company • Medtronic
• Palladium Group • Catholic Relief Services (CRS) • BP • Merck
• PwC • Islamic Relief Worldwide • Bristol-Myers Squibb • Nestle
• Rabin Martin • Muslim Aid • Coca-Cola • Novartis
• World Council of Churches (WCC) • Consumer Brands Association • Novo Nordisk
• World Vision • DSM • Pfizer
• Eli Lilly and Company • Philips
• ExxonMobil • Reckitt Benckiser Group (RB)
• General Electric • Safaricom
NGOs & NON-PROFITS • International Union Against Tuberculosis and • Gilead • Sumitomo Chemical
• ACTION Global Health Advocacy Partnership Lung Disease • Teck Resources
• GlaxoSmithKline (GSK)
• Action on Smoking and Health (ASH) • International Women’s Health Coalition (IWHC) • Unilever
• GSMA
• Advocates for Youth • Ipas • US Council for International Business (USCIB)
• Heineken
• Africa Centre for Global Health and Social • Jhpiego • Vestergaard Frandsen
• Intel
Transformation (ACHEST) • Magna • Viatris
• International Federation of Pharmaceutical
• Alight • Management Sciences for Health (MSH) Manufacturers and Associations (IFPMA)
• amfAR, Foundation for AIDS Research • Médecins Sans Frontières (MSF)
• Amref Health Africa • Medicines Patent Pool (MPP)
• AVERT • Medico International
• BRAC • Memisa PUBLIC-PRIVATE PARTNERSHIPS PHILANTHROPIC AND FUNDERS
• CARE International • Mercy Corps • Clean Cooking Alliance • Aga Khan Foundation (AKF)
• China Foundation for Poverty Alleviation (CFPA) • Movendi International • Drugs for Neglected Diseases Initiative (DNDi) • Bill & Melinda Gates Foundation
• Clinton Health Access Initiative (CHAI) • MSI Reproductive Choices • FIND, the global alliance for diagnostics • Bloomberg Philanthropies
• Cordaid • NCD Alliance • Gavi, the Vaccine Alliance • Caterpillar Foundation
• Elizabeth Glaser Pediatric AIDS Foundation • Oxfam International • Global Alliance for Improved Nutrition (GAIN) • Ford Foundation
(EGPAF) • Partners In Health • Global Fund to Fight AIDS, Tuberculosis & • Imam Khomeini Relief Foundation
• EngenderHealth • PATH Malaria • Open Society Foundations
• FHI 360 • Pathfinder International • Global Handwashing Partnership (GHP) • Qatar Foundation (QF)
• Framework Convention Alliance (FCA) • Plan International • Global Health Innovative Technology Fund • Rockefeller Foundation
• GBC Health (GHIT Fund)
• Population Action International • Sanofi Espoir Foundation
• Global Health Council • International Vaccine Institute (IVI)
• Population Council • Wellcome Trust
• Health Action International • Medicines for Malaria Venture
• Population Reference Bureau (PRB)
• Health Poverty Action • Nutrition International
• Population Services International (PSI)
• i+solutions • Partnership for Maternal, Newborn and Child
• Promundo Health (The Partnership, PMNCH)
• International AIDS Society (IAS) • Reproductive Health Supplies Coalition • RBM Partnership to End Malaria RESEARCH AND SURVEILLANCE
• International Center for Research on Women • Save the Children
(ICRW) • Scaling Up Nutrition • Africa CDC
• Sonke Gender Justice • Stop TB Partnership • Africa Population and Health Research Centre
• International Diabetes Federation (IDF)
• SRHR Africa Trust • TB Alliance (APHRC)
• International Federation of Medical Students
(IFMSA) • Union for International Cancer Control (UICC) • Alliance for Health Policy and Systems Research
• Vital Strategies (AHPSR)
• International Federation of Red Cross and Red
Crescent Societies (IFRC) • World Economic Forum • Health Systems Global
• International Planned Parenthood Federation • World Heart Federation • icddr,b
(IPPF) • Institut Pasteur
• World Obesity Federation
PART 1 • International Rescue Committee (IRC)FINDINGS Gender and geography of board
membership
This analysis reveals the inequitable gender composition of the 2,000-plus board seats and the outsized presence of a small number of
16
nationalities. The starkest inequalities are found in the disproportionately low representation of women from low- and middle-income countries
in the governance of global health.
Organisations in the sample Most board seats are occupied Women from low-income
are primarily headquartered by nationals of high-income countries are nearly absent
in high-income countries countries from governing bodies
Among 2004 board seats, where the nationality of board members
could be determined: Across all 2,014 boards seats,
94% 40%
3/4 are held by women.
1
(75%; 1,506/2,004) are held by nationals of high-income countries.
of organisations
44%
are headquartered Just board member
in high-income identified as non-binary.
countries.
(882/2,004) are occupied by Americans. 100
73%
23%
(488/2,004) are held by nationals of Europe including the UK.
80
60
(106/146) are headquartered in just
10x
40 42% 38% 34%
3 countries
20
40% 20% Americans and British nationals hold ten times the seats held by Chinese
United States Switzerland and Indian nationals - together they hold 5% (110/2,004) of board seats.
0
2.5% HICs mics lics
Women make up 42% (625) of board members from high-
13% (50/2,004) are held by nationals of low-income countries.
income countries, 38% (170) of members from middle-income
United Kingdom19 countries, and 34% (17) of members from low-income countries.
27%
Other countries
47% Fewer than 1% 17 board seats – are occupied by
The boards of 69/146 (47%) organisations are composed entirely of
members from high-income countries. women from low-income countries.TOP 15 NATIONALITIES REPRESENTED 17
AMONG BOARD MEMBERS
42
149
Canada
United
882
United States
Kingdom
51
Netherlands
33
Switzerland 33 40
59
Germany Japan
France 44
China
66
India
27
36
Nigeria
22
Kenya
Brazil
31
South Africa
33
Australia
Seats held by nationals of
Nationality of 2004 high-income countries
board members of 146 Seats held by nationals of
middle-income countries
organisations active
in global health 75% 1506 22% 448 2.5% 50 Seats held by nationals of
low-income countries
(where nationality could be determined)FINDINGS board inequalities by sector
18
Different types of organisations wield different types of power – such as political, normative or financial. An analysis of the board members of
private for-profit companies, a sector which wields considerable financial power, reveals even deeper imbalances than the sample overall.
Stark gender inequalities on private sector boards board inequalities differ by sector
Non-profit sector
For-profit Overall NGOs, FBOs Public-private Funders
sector (103 orgs & research partnerships (11 orgs
30% Women are
overwhelmingly from 2% (43 orgs
576 seats)
1,438 seats) (76 orgs
1,037 seats)
(16 orgs
278 seats)
123 seats)
high-income 39%
countries – just 11
Board seats held by 30% 29%
Among 43
12% 18%
private seats (2%) are
companies, occupied by women Nationals of LMICs
women hold from middle-income
30% (173/576) countries (compared
28% 28% 33%
of board seats. with 53 seats (9%) 21%
occupied by men Individuals working for
7%
from middle-income organisations
headquartered in LMICs
countries). 46%
45% 44%
37%
30%
0% Not a single national (male or female) from a low-income
country is represented across 576 seats in the private sector.
Women
12% 12% 18%
2% 7%
Women LMIC nationals
More women sit on non-profit boards than
for-profit boards
0% 1% 1% 2% < 1%
Women LIC nationals
inequalities in representation widen on funding
45%
Women occupy 45% (641/1438) of board seats of non-profit
organisations (n=103). These include NGOs, faith-based boards
organisations, research organisations, public-private The 11 philanthropic funders4
641/1438
37%
Women hold 37% (45/123) of all seats.
partnerships, and global health funders. in the sample, which together
Of 123 board seats, 82% are held by
distribute more than US$16 billion
nationals of high-income countries.
each year for global health and
development, appear to have
1% 17 out of 1438 seats are occupied by women from
low-income countries (1%). Four women from low-income
countries occupy two seats each, bringing the actual number
some of the least diverse
governing bodies among the
non-profit sample, in terms of 3%
Just four board seats (3%) are held by
nationals of low-income countries, with
one occupied by a woman from a
17/1438 of women board members down to 13. gender and geography. low-income country.
4 Aga Khan Foundation; Bill & Melinda Gates Foundation; Bloomberg Philanthropies; Caterpillar Foundation; Ford Foundation; Imam Khomeini Relief Foundation; Open Society Foundations; Qatar Foundation; Rockefeller Foundation; Sanofi Espoir Foundation; Wellcome Trust.FINDINGS Gender and geography of board chairs
19
GH5050 has been collecting and reporting on the gender of board chairs in global health for five consecutive years.
More women are represented than ever before, Little progress made in increasing other measures
but still far from parity of diversity among board chairs
Among Among the
2018 2022
180
board chairs whose nationality could be found,
49
newly-appointed Board Chairs in 2021/2022
whose nationality could be found:
100
80
60
20% 32% 40
Among the 138 organisations consistently reviewed since 2018, 32%
(41/130) of board chairs are women – a notable change since 2018,
when 20% of board chairs in the same sample were women.
69% 22%
20
2020/21 2021/22 are nationals of are nationals of middle-
0 high-income countries income countries
Among board chairs newly
appointed since 2021, 43% (22/51) 18% (33) 17%
in 2021 and
are women, an increase from 34% are nationals of low-
the previous year. and middle-income
countries, compared to
15%
34% 43% in 2020.
Just three new appointees (3/51) are
under the age of 45. Appointment of
70
Among the original sample of
8% 10%
138
older board chairs may privilege those
(51%) who have historically held positions of
have not had a woman board chair in the five power. There are just nine board chairs are nationals of are women from low- and
organisations that GH5050 tracks, years that GH5050 has been assessing them. overall under the age of 45. low-income countries middle-income countriesFEATURED VOICES: INSIGHTS FROM THE BOARDROOM 20
1 2 3 4
“Board invitations usually only come once “The few women leaders from lower-income “In Nepal, women are expected to be the “The young people on our board are
you assume leadership positions in your countries who are on global health governing sole caregivers at home. But one of the impatient with the self-satisfaction of
own organisation. But there are not enough boards exude exemplary confidence and provisions for promotion in the civil service the aged. If we appoint only CEOs to
senior women and the demand on their capabilities. Seeing them in action can be is service in a remote area for a certain boards, we will replicate organisations
time is high - when you approach them, hugely inspirational for staff, setting off a time, which is difficult for a lot of women as they are. It is a shocking assumption
they think “Oh, I’m already on five boards, virtuous cycle of women inspiring women. to complete sooner resulting in inequities that the same thinking, skills and world
and I cannot take on any more.” So if we I have seen how women leaders sitting on in promotion between women and men. views will transform this world. Youth is
want more women board members, we these boards have the domino effect of Young women are also held back by the a competency, not just an identity, and
need to support women throughout their dismantling gender stereotypes.” lack of women mentors to guide us, hear boards without it are ill-suited for the
careers so they can reach the top.” our concerns and act as a role model. I challenges we face.”
think this really limits opportunities for
Anuradha Gupta,
young Nepalese women trying to succeed
Catherine Kyobutungi, Deputy Chief Executive Officer of Gavi, the Vaccine Kate Gilmore,
in national and international health spaces.”
Executive Director of the African Population and Health Alliance; Board member of Partnership for Maternal, Chairperson of International Planned Parenthood
Research Center; Board member of Partnership for Newborn and Child Health Federation
Maternal, Newborn and Child Health Minakshi Dahal,
Research Officer at the Center for Research on
Environment Health and Population Activities, Nepal
1 2 3 4 5 6 7 8
5 6 7 8
“In tackling the issue of poor representation, “People talk about the issue of listening “I don’t think there’s a single point where “When organisations don’t embrace
a lot of focus is on the disadvantages and to women, of listening to diverse voices boards become representative, inclusive, diversity, I say it’s their loss. If we are going
challenges that women experience due like it is novel. I still worry that it’s all talk and so on. It’s a direction in which we have to have people making decisions about
to their gender, and occasionally their because I don’t believe that organisations to travel. It means being open to unlearning, issues in low- and middle-income countries,
intersectional position. But we also need to truly understand why diversity matters. to discomfort, to being at the back, and, for we must listen to the people who see the
better understand the privileges amongst But if we don’t listen to these voices then people who are new on the block, claiming reality on the ground. Sometimes the things
those that wield power and how they do we can never be as effective as we should the room and claiming that space.” that matter are very basic. And we need to
so, the resources and capital they have be in health.” have that voice in board meetings.”
access to. We then need to ask how those
Devaki Nambiar,
resources and spaces be democratised.”
Catherine Bertini, Program Head of Health Systems and Equity at the Nyovani Madise,
Chair of the board of the Global Alliance for Improved George Institute for Global Health; Board member of Director of Development Policy and Head of the Malawi
Anuj Kapilashrami, Nutrition; Distinguished Fellow at the Chicago Council Health Systems Global office of the African Institute for Development Policy;
Professor in Global Health Policy & Equity at University of on Global Affairs Board member of Population Council and Trustee of
Essex; Board of trustees for Health Poverty Action Liverpool School of Tropical Medicine21
BOARD POLICIES: AN UNDERUTILISED GATEWAY TO
MORE EQUITABLE GLOBAL HEALTH GOVERNANCE
Board policies are critical tools for realising diverse
Box. Reaching beyond traditional networks:
and effective governance. They represent the diversifying the candidate cohort
institutional value placed in the experiences and
insights necessary in guiding its direction and
purpose. Publicly-available board policies are essential The process of identifying potential board candidates often
relies heavily on the networks of board members and chief
for cultivating transparency around organisations’
executives. Diversifying board membership will require
commitments to diverse, inclusive and equitable
challenging this paradigm and using non-traditional recruitment
working environments – and enabling accountability methods. The BoardSource 2021 Leading with Intent Report
for delivering on these commitments. found that alternative networks that have been tapped within
charity sector include:
Each year, GH5050 assesses whether the 200 organisations it tracks
have board diversity and inclusion policies in the public domain. • Leaders from the communities the organisation serves
The 2022 report deepens this assessment by analysing the content • Referrals from leaders in the communities the
of all publicly-available policies to examine which constituencies, organisation services
populations and characteristics are named. Each policy was assessed
• Programme participants or former participants
for the presence of affirmative measures to improve gender equity
or diversity among board members, and specifically whether • Leaders from peer or partner organisations
policies included targets or dedicated seats for underrepresented • Publicly posted or advertised board openings
population groups.
• External headhunter, agency, or board matching services
GH5050 has repeatedly demonstrated the level of underrepresentation
of women in global health governing boards. Despite this eviden- Source: Board Source Report 202120
ce, only a fraction of organisations have publicly published specific
measures to advance women’s representation on boards. An even
smaller proportion of policies have targets or dedicated seats to
promote regional diversity, representation of civil society or affected
communities, or diversity in other characteristics of board members,
PART 1 including age and ethnicity.FINDINGS
Board diversity policies
22
Just one in four Increase in availability of board policies Organisations with available
organisations publish with STRATEGIES AND measures to promote board policies with measures to
strategies on diversity and inclusion, 2020-2022 promote diversity and inclusion
advancing board
diversity 65%
59% Public-private
partnerships
54%
Bilaterals and
49%
29% global multilaterals
1 in 4
organisations (48/19821) publish policies with
24% NGOs & non-profits
specific measures to advance gender equality,
24%
diversity and inclusion on their boards – an
Private sector
improvement from roughly 1 in 6 in 2020.
25%
20%
18%
Research and
surveillance
15% 17%
18%
14%
10% 18% UN system
6% 9%
14%
Philanthropic and
funders
17%
2020 2021 2022
No policy on diversity and inclusion Board policy with specific measures
13% Regional
organisations
on the board found. (e.g. targets, dedicated seats,
monitoring) to promote diversity,
Commitment to diversity and/or
representation of affected
inclusion and representation
Representation determined by
10% Consultancy
(32/198) of organisations publicly publish a
communities found, but no specific country affiliation - “Member
commitment to diversity and representation in measures to advance diversity and States"; no other policy to promote
their boards, but do not publish strategies and
measures to reach those commitments.
inclusion. diversity & inclusion
10% Faith basedFINDINGS
Targets and seats to advance diversity on boards
23
In its review of 198 organisations, GH5050 found publicly available information on the principles and rules that guide board composition for
111 organisations
This includes the 25% of organisations (48 total) for which strategies to advance board diversity were found, 17% of organisations (32 total) where information on an organisation's
commitment to board diversity was found, but no specific measures to reach those commitments, and 10% of organisations (19 total) whose boards are composed of member
states. This also includes 10 organisations for which governance policies on board selection based on skills were found, but no other characteristics were mentioned. GH5050
assessed which policies or board information contained targets and/or dedicated seats to ensure the representation of certain groups in their board policies.22
In this information on 111 boards, we found mention of targets and/or dedicated seats for
21% 13% 12% 3% 2% 0%
Gender equality: Civil society or affected Regional diversity: Young people: Race and ethnic People with
23/111 organisations communities: 11/92 (excluding 19 3/111 organisations diversity: disabilities or
14/111 organisations Member State-only 2/111 organisations members of the
multilateral and regional LGBTQ+ community:
bodies23) no policies found
138%
The odds that an higher for organisations with gender parity
organisation has a on their board than organisations that do
board diversity not have gender parity on their board
policy in place is (and this is statistically significant).FROM POLICY TO PRACTICE: 24
ORGANISATIONAL STRATEGIES TO ADVANCE BOARD DIVERSITY,
INCLUSION AND REPRESENTATION
“GAIN has developed a set of targets for “The UNAIDS board has a unique set up “CARE is committed to ensuring gender
its board - at least half of our voting board that includes civil society delegates selected balance on its board. The board also
members have to have grown up in and by civil society itself as members of the established a commitment to achieving
worked significantly in a lower-income board. When you have networks of people a 40% ratio of Black, Indigenous, and
country and at least half must be women. living with HIV, and those most vulnerable People of Color among its directors. To
The ambition for diversity has always been to and affected by HIV in the boardroom, it ensure accountability, we embedded the
there, but these targets are important shifts the dialogue. Other board members commitments into our Board Responsibilities,
to make us more disciplined and more have a constant reality check with a human created lines of communication with staff,
accountable to these aspirations.” face before them, who will say what works established systems to monitor progress and
for people in strategies, policies and hold an annual board training on gender,
Lawrence Haddad, implementation – and importantly also what equity, and diversity.”
Executive Director, Global Alliance for Improved Nutrition (GAIN) does not work. The discussion becomes more
focused on doing the right things in the AIDS CARE USA
response, those that have impact for people,
those where there is evidence behind – a
politically palatable compromise without
impact is not an option.”
According to IPPF Regulations, the Board must
comprise at least 50% women and at least 20% youth Morten Ussing,
under 25 years of age who meet specific profiles on “Since 2010, Gavi has had guiding principles
Director, Governance and Multilateral Affairs, UNAIDS
expertise, skills and experience. in relation to the gender balance of its
Board, Board committees and Board advisory
“Organisations have the power to improve committees. The gender balance is deemed
their board diversity. Be deliberate. Ask to be within the acceptable range if there
yourselves what is fair, what is just, how is no more than 60% of any one gender
inclusive can you be. Otherwise, we keep represented in each of the separate groups
running headlong without knowing what impact and as an aggregate. As individuals and as an
we’re making, and what the people we work institution, we are committed to building and
with want. We end up speaking at - instead of nurturing a culture in which inclusiveness is a
- with the people whose voices matter most.” reflex, not an initiative or afterthought.”
Seri Wendoh, Gavi, The Vaccine Alliance
Global Lead, Gender and Inclusion, International Planned Parenthood FederationThe Day of the Dead, a traditional Mexican celebration of life and death, is sustained amid the COVID-19 pandemic thanks to domestic and care work by women in their communities.
Tradition keepers The harvest of flowers, the purchase of candles, incense and the preparation of food belie a heavy workload that is rarely recognised. Here, Rosalia holds a photograph of her mother, who died
barely a week before the celebration of the Day of the Dead. This colourful image honours the keepers of traditions - the women who sustain festivities and families.
Oaxaca, Mexico. 2020 Greta Rico is a documentary photographer, journalist, and educator focused on issues of gender and human rights. Her work focuses on exploring social boundaries and rehistorizing the
Greta Rico body in a situated way.PART 2
26
THE
UNFINISHED
AGENDA:
GENDER AND
HEALTH INDEX
TRENDS OVER
FIVE YEARS27 Five years of robust evidence summarised in the Gender and Health
Index provides an increasingly clear picture of where progress is being
made and where it is not, and whether and how organisations are
using the findings of the Index to drive change. The sample assessed
each year by GH5050 is composed of 200 highly heterogeneous
organisations, each with their own unique purpose, system of
governance and organisational arrangements. Staff numbers range from
four to half a million employees. What binds them, however, is a stated
interest in influencing health outcomes and/or global health policy.24
A seemingly shared interest in influencing health, however, does not
translate into similar levels of interest in or commitment to equity.
STRIVING AND STAGNATING: A and strengthen gender-responsive policies, invested in gender, diversity and inclusion
SECTOR DIVIDED (2020-2022) where GH5050 had previously reported measures by the organisation.
them lacking or unavailable. Over the period
GH5050 has collected data on 199 of 2020-22 these organisations have improved We are concerned that progress reported
the current sample of 200 organisations their overall score, and the majority of them by GH5050 in recent years represents a
since 2020. Around a fifth of organisations have engaged regularly with GH5050 to sector divided into those organisations that
(39/199) have continuously performed request advice and resources. Further, many are striving to achieve gender equality and
well across the variables collected. (See of these organisations have demonstrated those that are stagnating. While dozens
Annex 1 for the list of organisations). a willingness to positively and actively of organisations have bolstered their
These organisations have transparent respond to the findings of the Gender and commitment to gender equality, set and
policies and measures in place to advance Health Index. published workplace policies to advance
gender equality and gender-responsive equity, cultivated more gender-equitable
programmatic approaches. These By contrast, we find that the scores of 32 leadership bodies and designed gender-
organisations are also often the most likely organisations have been consistently low transformative programmatic approaches, it
to engage regularly with GH5050 during its and little to no progress has been made. appears that a relatively large swathe of the
validation process, which may be further Only a few of these organisations have sample has done little of this essential work.
indication of their interest in and support for engaged with GH5050 in any meaningful
transparency and public accountability. way, including to validate and contribute to
the findings reported in the Index, which
Another subset of 55 organisations has may also be an indication of the relatively
PART 2 demonstrated increasing commitment to set lower level of interest and resourcesYou can also read
