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.
BT - The Lancet DO - 10.1016/s0140-6736(23)01574-x LA - Eng M3 - Comment N2 -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.
PB - Elsevier BV PY - 2023 SP - 1 EP - 2 T2 - The Lancet TI - Strengthening Africa's voice on boards of global health initiatives SN - 0140-6736 ER -