Terms of Reference

The promise of digital health has not been fully realized and efforts to scale programs and technologies have largely been unsuccessful. The three core barriers to maximizing the potential of digital technologies to improve health outcomes are: lack of coordinated funding aligned to government priorities; lack of support for, and use of, existing open-source technologies (“global goods”) that could be reused or adapted; and lack of regional leadership and capacity.

Digital Square is a new way to do development. Our approach is to tackle the barriers that prevent digital technologies and systems from scaling. Digital Square's aim is that countries are empowered to develop sustainable national digital infrastructures, supported by coordinated investments, so that governments and decision- makers can access the information they need, when they need it, to ensure better health data and health outcomes for all. In order to achieve this vision, Digital Square will conduct activities to: • Improve coordination of investors. • Increase alignment and coordination in the digital health community. • Increase adoption and reuse of digital health global goods. • Enhance leadership capacity in low- and middle-income countries for managing regional and country digital health systems.

The following are the Terms of Reference for the Digital Square Governing Board.

Purpose of the Governing Board

The purpose of the Governing Board (the “Board”) is to:

• Make final decisions about Opal investments based on the Opal management team’s

recommendations.

• Guide and advise the Opal management team in managing Opal’s work.
• Seek and help secure additional resources for Opal.

Responsibilities

The responsibilities of the Board are to:

• Establish and carry out an effective system of governance at the board level.
• Advocate and promote Opal’s work with other global initiatives at regional and national levels,

including within their own organizations.

• Support fundraising by actively prioritizing and lobbying for strategic awards to ensure operational

viability and strategic growth.

• Make decisions about the investments of Opal based on recommendations from the Technical

Advisory Group (TAG) and Opal management team.

• Provide oversight to the strategic direction of Opal, as well as advise on and approve major strategic changes.
• Support Opal in acquiring the necessary resources to accomplish its objectives.
• Provide oversight of the TAG.
• Individual Board Members may be called upon for their expertise in specific issues.

Expectations of Board Members

In addition to the above responsibilities, Opal envisions that the Board Members will engage in the realization of Opal’s strategy through the following two venues:

• Ambassadors of Opal: Alignment within the donor and digital health communities—as well as key

leaders in non-health sectors—is crucial to the success of Opal. Board Members should actively advocate with the organizations, networks, and industries of which they are members in order to align with the mission and activities of Opal. This can include financial and in-kind contributions, partnerships on events and awareness-raising efforts, and ensuring that Opal’s work, including the global goods, is on global agendas for the next era in digital health and development.

• Fundraising: Board Members have a responsibility to ensure that Opal stays on its financial trajectory. Board Members should support the financial sustainability of Opal by proactively engaging in fundraising efforts and using connections with their various networks to garner additional financial support for Opal.

Benefits of Board membership

By virtue of the Board’s leadership role in shaping the future of digital health, Opal Board Members will benefit from:

• A voice in identifying and prioritizing Opal’s global strategic investment.
• A vote in Board investment decisions.
• Access to a new network of thought leaders in digital health. 5.0. Composition

The Board is the governing body of Opal and is dedicated to advancing the mission, goals, and priorities of Opal. The Board will consist of 13 Members plus a non-voting Chair. Seats will be filled by both individuals and organizations. Organizations will assign one Representative and may assign one Alternate to each seat. In the event that a Board Member (or Representative) is unable to fulfill his/her role, a new Board Member will be selected as a replacement. Although the final composition of the Board will be based on the quality and diversity of potential Members, it is planned to comprise:

• Three to four investing donor representatives.
• Three to four implementing organizations.
• Three to four technical experts from the digital health product development field.
• One to two globally recognized leaders who are considered to have a key role in contributing to the

longer-term vision for Opal.

PATH will act as Chair of the Board. Each Member will be allotted one vote, except for the Chair, whose role is ex officio and does not include voting rights. A Board Member who does not fulfill his/her responsibilities or misses two meetings without reasonable explanation will be asked by the Chair to resign. If the Board Member refuses to resign, a vote will be taken on the removal of the Member from the Board.

Meetings

There will be three Board meetings each year. Following the first formal meeting of the Board, subsequent meetings will be convened every four months. Two meetings will be virtual (phone) with optional in-person attendance. There will be one in-person meeting each year, likely to be in Washington, DC; London; Seattle; or New York. Board Members are expected to participate in all meetings. In addition to the three annual Board meetings, three reading days are anticipated. Ad hoc conference calls and/or meetings may also be called by the Chair of the Board if necessary to discuss specific issues.

Term

Board membership term will be two years, with recruitment taking place over the course of the first year, in order to stagger Board Member elections and to balance this with the need for continuity in leadership. Seats held by organizations may change their individual Representative at midterm at their own discretion; however, the organization is required to notify the Chair of any such change at least four weeks in advance of the next Board meeting.

Chair

PATH will act as Chair of the Board. Each Member will be allotted one vote, except for the Chair, whose role is ex officio and does not include voting rights. The Chair will:

• Convene and preside over each Board meeting, including approving the agenda and decision points

that Board members make.

• Foster and guide consensus-based decision-making by the Board.
• Provide due diligence on the Board membership, including ensuring that the overall composition of

the Board remains balanced and effective and that Members remain appropriately engaged and are reviewing notifications on breaches of conflict of interest.

• Serve as one of the principal spokespersons for Opal, along with Opal’s Director.
• Provide guidance to the Director of Opal on an as-needed basis, including guidance on bringing

issues to the attention of the Board for input or decision.

Voting

Quorum will be two-thirds of the Board. All Board Members, except for the nonvoting Chair, have one vote, and all votes are weighted equally. Decisions not reached through consensus will be approved with a majority of present members. Board Members may vote by proxy via their Alternate. For votes on investments, the Opal management team will compile recommendations from Opal’s Peer Review Committee and submit these recommendations to the Board. This investment decision-making process will be vetted and approved by the Board in year 1.

Committees

Board committees will be established as required and if approved by a majority of the Board members. The Opal management team will be responsible for coordinating such committees and providing reports on committee activities back to the Board.

Conflict of interest

Regarding potential conflicts of interest, a Conflict of Interest and strong recusal and transparent Recusal Policy is in place to maintain the objectivity of the Board and all of its Members, including the Chair.

Contact

Lesley-Anne Long Director, Digital Square, PATH llong@path.org