02082nas a2200169   4500000000100000008004100001260001600042653002100058100001600079700002000095700001300115700001500128245007200143300000800215520167500223022001401898       2023                            d  bElsevier BV10aGeneral Medicine1 ae Silva MRC1 aOduro-Bonsrah P1 aWambui P1 aChakroun M00aStrengthening Africa's voice on boards of global health initiatives  a1-23 a<p>Achieving equitable global health outcomes means attaining the longest, healthiest life for all people. This ambitious goal implies effective, pro-equity global governance, meaningful representation, and effective implementation across initiatives and programmes to promote good health. Yet in the governance of global health initiatives and programmes there are not enough driving forces towards promoting equitable decision-making processes, representation, and balanced power dynamics. Decisions on strategy, policy, programming, and finance in global health are often deliberated and taken by governing boards. In a 2022 study, it was found that across more than 2000 positions on global health boards, about 75% were held by nationals of high-income countries (HICs), which are home to only 16% of the world's population. This constitutes a massive under-representation of low-income and middle-income countries (LMICs), with ensuing consequences for decision making. Boards have an influential role across major global health organisations and partnerships, including WHO, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Gavi, The Vaccine Alliance, and the Pandemic Fund. Among these leading global health institutions, the membership of boards is variable in terms of size, tenure, rotation, representation, gender balance, power dynamics, and procedures for nominating board members. It should also be noted that the imbalance in power dynamics is not always obvious, because even when there are equal numbers of members from HICs and LMICs, the asymmetries in access to information, support systems, and networks are substantial and impactful.</p>
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