How global are global health boards?
I recently read the Global Health 50/50 report 2022 which was released in March this year and what a damning report it is. The demographics of over 2,000 board seats across 146 organisations active in global health were examined. If you haven’t read the report here are some highlights.
Geography
75% of the board seats are held by nationals of high-income countries
2.5% are held by nationals of low-income countries.
Less than 1% are held by women in low income countries.
Overall, 51% of all seats are held by nationals of two countries: the United States (44%) and the United Kingdom (7%).
Gender
40% of board seats are held by women
Women from low- and middle-income countries hold 9% of board seats.
Funders
82% of board seats of philanthropic funders are held by nationals of high-income countries.
3% are held by nationals of low-income countries
These findings are embarrassing and clearly show that the global health sector really isn’t global. All our talk about “leaving no one behind” is obsolete if the people steering the global health ship are so far removed from the realities in Low- and Middle-Income Countries that they don’t even know who they’re leaving behind.
I published an article recently about why I left my global health career and statistics like these are some of the reasons why. Boards hold immense power and influence, shaping the strategic direction of global health organisations. They often nominate organisation CEOs and make key decisions that affect health programming and ultimately impact the health status of people living in Low- and Middle-Income Countries.
A recent survey found that board chairs and executives are more likely to select board members based on their reputation and network rather than their membership or knowledge of the community affected or served. Now, if 75% of board seats are occupied by nationals - most likely white- from High Income Countries, who are they likely to nominate as the incoming CEO when the current CEO moves on? One would hope it would be a fair, transparent process but it’s a known fact that we gravitate towards people who look like, act like and think like us. It’s called affinity bias. There’s no mistaking the glaring lack of black and brown led INGOs. Only 3% of charity CEOs in the UK are from a Black or Minority Ethnic group. You read that correctly- 3%.
One of the findings that shocked me most from the report was the fact that only 9% of seats are occupied by women from Low- and Middle-Income Countries and 1% from women in Low Income Countries. Ironically, the vast majority of global health programmes target women in Low- and Middle-Income Countries. Women are the gateway to their families and communities and the success of many global health programmes hinge on women’s participation. Again I question: if only 1% of boards are composed of women from Low Income Countries how are we capturing their expertise to design responsive health programmes? How do we hear from women in Low Income Countries outside of the project beneficiary feedback form? How are we ensuring programmes are culturally appropriate and will be accepted in communities where we intend to work? Do we really believe the nationals of the 51% (the United States- 44% and the United Kingdom -7%) have the contextual understanding to make decisions for a woman and her family living in rural Senegal for example? Black and brown women are more than mere beneficiaries of global health programmes and have so much more to offer if only we’d consult them and tap into their expertise.
When I see organisations having all white or majority male boards and senior leadership teams, I feel they are doing a huge disservice to the populations they purport to serve as they are ill placed to make decisions that affect the lives of millions of people in Low- and Middle-Income Countries. We need greater accountability in global health organisations. The time is ripe for organisations to rectify the composition of their board and senior leadership teams. Worryingly the report found only 6% of organisations have published targets to address geographic imbalances in their boards. Are the other 94% comfortable with the status quo?
Representation matters. Board representation matters. Senior leadership representation matters. If we want to truly be a global community, we need to start creating space for Low- and Middle-Income Countries nationals to occupy key leadership positions so that they can steer the ship because as it currently stands, we’re lost at sea and millions of lives are at stake.