Africa: Global Health Decision-Makers Must Mirror Humanity’s Diversity

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New research reveals the gulf between the aims of organisations shaping health outcomes around the world and their governance structures and practices

We have learned over the past two years that the health sector is vital to our collective wellbeing – and to our economies and sustainable livelihoods. Health workers around the world are local heroes, toiling tirelessly in their communities to battle the pandemic, while also endeavouring to ensure that basic medical care is maintained.

Yet new research reveals that organisations making global health policies and dispensing resources affecting the health of billions of people worldwide have a grave leadership problem. They do not reflect the makeup of those they are meant to serve.

The 2022 report by Global Health 50/50 (GH 50/50) documents that leadership positions of global health organisations are dominated by men from high-income countries. A full 44 percent of board seats are occupied by men from high-income countries, while less than one percent of seats are held by women from low-income countries.

Fewer than one percent of board seats of global health organizations are held by women from low-income countries.

Despite the enormous power these organisations wield to establish priorities, guide billions of dollars of investment, and respond to health needs in the short- and long-term, a comprehensive and rigorous analysis of the sector paints a picture of glacial progress in increasing the diversity of leadership. What this means in practice is that approaches and solutions to the health challenges we all face are determined by a very narrow sub-set of humanity.

GH 50/50 has been assessing representation among the leadership of 200 organisations active in global health since 2018. Since its first report, 58 percent of organisations active in global health have never had a woman CEO – and 51 percent have never had a woman board chair. A staggering 39 percent have never had either.

In this, its fifth report, GH 50/50 has named organisations that have consistently performed poorly on gender-related policies and practices and lag on gender and geographic diversity of their leadership and boards. The decision to name organisations whose performance it aggregates is an inflection point for Global Health 50/50 – borne of sheer frustration.

‘Naming and shaming’ reflects frustration at so little progress towards representational leadership.

Some 32 organisations are showing clear signs of stagnation. Since the declaration of the COVID-19 pandemic in March 2020, many of these organisations have shifted priorities to focus on the crises brought about by the virus. They may argue that prioritising diversity isn’t important while a global pandemic is raging.

This would be a short-sighted perspective to adopt. The pandemic has highlighted the problems that arise when decision-making bodies fail to include the voices of those who are affected and could bring the strength of differing experiences and perspectives.

One consequential example of this myopia is how personal protective equipment PPE) designed for male bodies  has persistently put the lives of women healthcare workers at risk. It is worth asking, as well, whether more people from low-income countries on global health boards would have reduced the vaccine inequalities that we see globally.

Organisations active in global health generally have noble and worthy missions. I am achampion of many of them: they aim to prevent and treat disease, ensure greater access to vaccines and life-saving drugs, improve nutrition and hygiene, protect the vulnerable, and empower people to demand resources for health for all.

But there is a gulf between what some of these organisations are striving to achieve and the ways in which they are operating. In order to bridge this divide, we must start by questioning what is happening at the top.

We will all suffer without more inclusive leadership

Over the last two years, the differential impact of the Sars-CoV-2 pandemic has been well documented. Yet, at a time when organisations should have made special efforts to include poorly represented populations in both the workplace and the board rooms, the GH 50/50 research reveals that only 10 percent of the organisations studied have published affirmative measures to promote more women on boards, and only 5 percent have publicly available policies to address geographic imbalances.

Three-quarters of assessed organisations do not publish board diversity policies. There is very little hope for change if diversity is not on the agenda and is not open to public scrutiny.

I have had the privilege of serving on a number of boards and recently co-chairing the Independent Panel for Pandemic Preparedness and Response. The Panel’s report demonstrated that some of the best leadership in response to the crisis emerged in the governments and communities in countries beyond the global club of the high-income sphere.

For me, this reinforces the central message of the Global Health 50/50 report: how crucial it is to ensure diverse perspectives in global health governance and policy-making.

Throughout my career, I have despaired over inequities of gender, race, and geography in the leadership of global health. And the report shows that rather than addressing these failings, the sector responsible for addressing health inequities is, in fact, stagnating on the diversity front.

This comprehensive analysis must be a catalyst for change.

The research done by Global Health 50/50 is the single-most comprehensive analysis of its kind, providing invaluable evidence of the obstacles that many women and minorities experience on a regular basis. Nyovani Madise, Director of Development Policy at the African Institute for Development Policy – and one of a handful of women from low-income countries who sits on one of the boards reviewed, shared the following rationale with us for diverse leadership: “The biggest obstacle in my career has been often being the lone voice – having other people to affirm the things you’re saying. Because [when] you hear something so far removed from what you’re used to, it’s easy to dismiss. But when you hear two or three voices articulating the same thing, you start paying attention and saying, ‘Okay, maybe there’s merit in this argument or in this idea?'”