Why global health leadership must look more like the world it serves

Over the past two decades, global health has delivered extraordinary progress. Vaccines have reached millions more children, disease surveillance systems are stronger, and digital technologies are transforming how health systems operate. These gains are the result of remarkable collaboration across governments, foundations, NGOs, researchers, and communities.

But beneath this progress lies a conversation that many of us working in the field have long recognised.

“And perhaps most importantly, it requires leaders, both men and women, to actively support environments where leadership potential is recognised early and nurtured intentionally.”

Global health leadership still does not fully reflect the world it is trying to serve.

Women make up the majority of the global health and care workforce. Yet when decisions are made at the highest levels, whether in international agencies, funding bodies, or global commissions, women remain significantly under-represented. The imbalance is not always overt. Often it is structural, subtle, and embedded in longstanding systems of influence and access.

This is not simply a question of fairness. It is a question of effectiveness.

Leadership shapes priorities. It shapes how problems are understood and which solutions are pursued. When leadership spaces lack diversity, whether in terms of gender, geography, or experience, the range of ideas and perspectives available to solve complex health challenges becomes narrower.

In a field as complex and interconnected as global health, that is a risk we cannot afford.

I have spent much of my career working at the intersection of partnerships, programmes, and systems strengthening across Africa and beyond. In that work, I have seen the extraordinary contributions women make every day, leading programmes, managing crises, building partnerships, and holding fragile systems together under immense pressure.

Many of these women are not only capable leaders; they are already doing the work of leadership.

Yet too often, the structures that shape formal leadership opportunities move more slowly than the reality on the ground.

Recent conversations across the sector have highlighted this tension. The experiences shared by respected leaders such as Dr Magda Robalo, Co-Chair of UHC2030 and President of the Institute for Global Health and Development, and Precious Matsoso, Co-Chair of the WHO Intergovernmental Negotiating Body for the Pandemic Accord and former Director-General of South Africa’s National Department of Health, remind us that even highly qualified women can find themselves navigating opaque systems and decision-making processes that do not always operate with full transparency or inclusion.

At the same time, there are encouraging signs of progress.

Across Africa and around the world, more women are stepping into influential roles, leading ministries of health, global initiatives, research institutions, and major programmes. In many international negotiations and diplomatic health forums, women are increasingly present and shaping the conversation.

These shifts matter. They signal that change is possible.

But progress in global health leadership has often been uneven. In some areas, we move forward; in others, we appear to pause or even step back.

The question we must ask ourselves is not only how to correct the imbalance when it becomes visible. The deeper question is how we build leadership systems that consistently recognise talent, capability, and contribution, regardless of gender.

This requires more than individual resilience, though resilience remains essential.

It requires institutions to examine how leadership pipelines are formed, how decisions are made, and how opportunity is distributed. It requires transparency in recruitment and selection processes. It requires deliberate mentorship and sponsorship structures that help emerging leaders navigate complex professional ecosystems.

And perhaps most importantly, it requires leaders, both men and women, to actively support environments where leadership potential is recognised early and nurtured intentionally.

In my own experience leading teams and partnerships, one lesson has become increasingly clear: sustainable impact does not depend only on strong individuals. It depends on strong systems that allow capable people to thrive.

When organisations build environments where talent is genuinely recognised and supported, leadership begins to expand naturally. New voices emerge. Diverse perspectives inform decisions. And institutions become stronger and more resilient as a result.

Global health today faces a new generation of challenges.

Health financing is under pressure. Climate change is reshaping disease patterns. Technology is transforming how health services are delivered. And geopolitical shifts are redefining how development partnerships function.

Meeting these challenges will require leadership that is both technically strong and broadly representative of the communities and systems we serve.

It will require leaders who understand local realities as deeply as global frameworks. Leaders who can bridge sectors, navigate complexity, and build coalitions across governments, civil society, academia, and the private sector.

Most importantly, it will require leadership cultures that recognise excellence wherever it appears.

The future of global health will not be built by one group alone. It will be built by diverse teams of leaders who bring different experiences, perspectives, and strengths to the table.

Encouragingly, many institutions are already moving in this direction. Networks such as Women in Global Health have helped shine a light on both the progress made and the work still ahead. Their advocacy has created space for conversations that once remained largely unspoken.

But the real transformation will come when inclusion is no longer seen as a special initiative. It will come when it becomes a natural feature of how institutions identify and elevate leadership.

Global health has always been, at its best, a collaborative endeavour.

The next phase of progress will depend on whether we can ensure that the leadership shaping that collaboration truly reflects the richness of talent across the field.

Because when leadership becomes more inclusive, the benefits extend far beyond representation.

They strengthen the quality of decisions we make, the partnerships we build, and ultimately the impact we achieve.

And in a world where health challenges continue to grow in complexity, that broader, stronger leadership may be one of the most important investments the sector can make.

Ota Akhigbe is the Director of Partnerships & Programmes at eHealth Africa, where she leads strategic partnerships, programme delivery, and health systems initiatives across multiple countries. She works at the intersection of global health, technology, and cross-sector collaboration, advancing scalable solutions that strengthen health systems and improve outcomes across Africa.