Improving Outcomes for Women & Girls Through 100% Mission-Aligned Assets
Women and girls’ health and well-being in the U.S.
HOW IT STARTED
Long career as physician and health care executive at Kaiser Permanente. Founded Tara Health Foundation in 2014, with the mission to improve the health and well-being of U.S. women and girls using 100% of its assets including philanthropic and investment capita.
HOW IT’S GOING
Co-founded Rhia Ventures in 2018 to bring new types of capital and innovation to the US reproductive health field; recently co-authored “The XX Edge,” which shows that when women have autonomy to make financial decisions and apply their skills across capital markets, investors see higher returns and economies grow; encouraging other members to forge ahead, learn, and adapt.
Background and Evolution
My parents were role models; my father was a physician while my mother was a successful economist and consultant. As for me, I’m not just a problem solver, I’m a problem seeker. I have always been driven to fix things before something goes wrong. As a healthcare executive, I took care of populations of people and worked to create systems that would deliver evidence-based care. I was also exposed to finance, which informed my career in impact investing and philanthropy.
Women are central to their families’ health and also their communities’. Helping one woman control her family’s size also helps that family and the larger community. The ripple effects spread from there. I see reproductive health as an essential lever for every other major issue—climate, poverty alleviation, job creation. You can view them all through the lens of family planning. When women can’t control when they have children, everything else falls apart.
How did TPW influence your philanthropic practice?
When I start something new—whether it’s in medicine or philanthropy—I always want to learn and do. I liked that TPW gave me a project with a deliverable at the end, and I got to meet other people and there was a lot of peer learning. One of the most powerful parts was the exposure to different aspects of philanthropy. I still occasionally go back to my workbooks to refresh my memory.
For myy project I collaborated with the Center for High Impact Philanthropy (CHIP) at Penn to developa framework to outline the evidence for what is “good” for women and girls. Using existing published research, CHIP established that there are five domains—health, education, economic empowerment, personal safety and legal rights—that are directly linked to improved health and wellbeing for women and girls. WIthin each domain, there are multiple determinants. . Within health, for instance,clean water, nutrition, maternal health, mental health, and family planning all are linked to improved health outcomes. CHIP published The XX Factor: A Framework for Improving the Lives of Women and Girls in 2017. My newly formed Tara Health Foundation team found this report to be an essential tool to gauge what was in scope and what was out of scope for our grant making and investments.
In general, TPW encouraged me to be bold and creative in my problem-solving. The active nature of working on a project was really important to me and my path.
What aspects of your philanthropy do you consider to be most successful? What are you most proud of?
Tara Health recognized that it needed private capital to build out the pipeline for innovation and commercial products related to contraception and maternal health. Early on, we commissioned a landscape assessment that identified where the best places were for private capital in those fields. Tara Health Foundation was able to recruit other like-minded foundations to help fund this landscape assessment. From this report, it was clear that more venture capital was needed in the reproductive and maternal health space to fuel innovation. The Reproductive Health Investors Alliance (later Rhia Ventures) started in-house at Tara , and then we spun it out as a separate 501c3. We identified early stage companies, and then looked for co-investors to syndicate the investment deals. Eventually we had enough momentum to launch a fund.
I’m very proud of the structure we created at Rhia Ventures to support this new venture capital fund (now called RH Capital). RH Capital has a traditional for-profit structure brings in limited partners, but has managing directors instead of general partners. So the owner of the fund is actually the nonprofit, which means some of the carried interest that would normally go to the enterprise actually goes back to the nonprofit. In the early stages, the nonprofit subsidizes, through philanthropic money, the operating expenses of the for-profit. The fund team successfully closed their second fund $38 million. This means that through the philanthropic work of Tara Health and other donors, we’ve created the infrastructure to bring a lot more investment dollars into a sector that has been traditionally underfunded.. Rhia Ventures, the nonprofit, benefits if these companies are successful with the carried interest to repay the initial subsidization, and this allows Rhia Ventures to do better nonprofit work. And we have all these LPs in RH Capital who’ll hopefully make a lot of money.
I see mobilizing other capital as an important measure of success in philanthropy. Our most significant metric is, how many other funders did we get on board with us? I don’t think most philanthropists think of it that way. With Rhia Ventures, rather than having some other complicated system of evaluation, it’s letting the market, letting communities decide if something has value, rather than us.
Why did you decide to make Tara Health a spend-down foundation?
We have a sunset clause and expect to be fully spent down by 2030. Solutions need to endure beyond a single philanthropist’s lifetime. I have no interest in legacy or creating mandates for folks to follow. Money does its best work when it’s moving. Hoarding and maintaining an endowment just doesn’t fit with my philosophies about philanthropy. It would be inconsistent to have any kind of enduring corpus.
What problems in philanthropy keep you up at night?
I see three big problems. When I worked for a large U.S. foundation, there was a huge disconnect between the grant programs and the investment strategy. There was no communication and many missed opportunities to work together. Most egregiously, there was no mechanism to identify if the investment strategy was undermining the grant program strategy and causing damage. I also worry that a lot of philanthropy is driven by impulse, passion, or ego; the evidence base that helps identify where action is most effective often doesn’t exist. Finally, philanthropy can do harm by operating in or bolstering unsustainable systems that are destined to fail.
What’s an example of the kind of missed opportunity you just mentioned?
We need to match the right type of capital to the problem we’re trying to solve. Let’s say a women’s health clinic is a for-profit enterprise that intends to earn revenue and become sustainable, but needs consultants to help build out the profitable reimbursement strategy. That requires operating capital to pay for consultants, which could be structured as a grant. Once that’s in place, though, the clinic shouldn’t need more philanthropy. It may need investment dollars, which could look like a low-interest loan to help build and scale. If it’s a commercial enterprise, it should qualify for a business loan, but providing certain services (e.g. abortion) might make it difficult to qualify for a commercial loan in some geographies. Philanthropy can step in with a loan or provide collateral at a local bank to support the clinic.. That’s an example of using philanthropic dollars with a more integrated approach.
What have been your biggest lessons in this work?
It’s really important to be willing to fail. When Tara Health was at an early stage, before the days of Rhia Ventures, we had a spectacular investment failure that showed why I needed people to advise me what companies to invest in! If I had been more experienced, I would have seen the huge red flag—the founders and the lead investor in this company hated each other. I knew this was a problem, but thought I could fix it somehow. Instead, I should have just walked away from the deal.
What is the biggest challenge facing humanity, and what role can philanthropy play?
I am 100% confident that when women are in control of more capital, the world will be better. Right now, women control less than 3% of the world’s capital. Whatever problem you’re trying to fix, look at who’s controlling the money.