Reflection as Action: What Nearly 25 Years of Philanthropy Have Taught Me

Elizabeth supporting the C2C team at the opening of our first clinic in Northern Haiti, 2017

At a time when global health and development funding is under immense pressure amid the dismantling of USAID programs and a steep decline in official development assistance across the Global South, philanthropists are being called to act faster and do more. The criticism is often fair: too many donors hesitate, or rely on short-term fixes, while communities shoulder the risks of delay.

But I have learned that effective philanthropy requires more than speed. It demands persistence, humility, and the discipline to pause. Rarely do philanthropists take stock of their giving, their approach, and the deeper “why” behind their choices. Over the past year, I made space for that reflection, not as an excuse for inaction, but as a way to recommit to the values that have guided me for nearly two decades: long-term, flexible, community-based support grounded in evidence and trust.

I became a donor in my mid-40s, when our family business began to generate dividends. The amounts were modest, just enough to supplement my income as a Physicians’ Assistant and public health consultant. At the same time, my father asked me to establish a family foundation with proceeds from the company. My first lessons were humbling and instructive: go directly to the community, ask what is needed, and design with the long view in mind.

We intended to be long term funders and partners in the community where the company had done business for several decades but with great needs, we need to narrow the focus to improving access to early childhood education and quality after school programming and conserving land along watershed corridors in Massachusetts. Our lesson was about the approach: to be community-centered, long-term, flexible, and grounded in trust.

Over time, my giving became intertwined with my professional career in emergency medicine and international public health. As a Physicians’ Assistant, it felt natural to focus on primary care, especially women’s health. I saw how healthy women create the foundation for healthier families and stronger communities. Yet I often grew frustrated at the gap between lofty rhetoric and lived reality. Health systems in low-resource settings were too often fragmented and disease-specific, when what people needed was simple, integrated care.

That frustration sparked creativity. I began sketching clinics in shipping containers—compact but complete, with a pharmacy, lab, and dignified space for care. A prototype was ready when the earthquake struck Haiti in 2010, and soon it became the foundation for my nonprofit, Care2Communities.

The most rewarding moments were never the easy ones. What made my philanthropy effective wasn’t simply writing checks. For more than a decade I devoted over 40 hours a week, learning alongside my partners. I led with evidence and data, but I also trusted my instincts and knew when to pivot. Those instincts were sharpened not by ego, but by questions and humility.

The work was deeply meaningful, but the years were also heavy. I raised two children as a single parent. I managed chronic illness. I cared for aging parents. I navigated high school and college with my kids during COVID. Through it all, I kept giving, kept learning, kept joining donor networks and boards, convinced that I was following best practices—yet rarely pausing to connect the dots.

What stayed steady was my commitment: to women’s health equity, to primary care, to women’s leadership. But eventually, I realized I needed to create space for reflection, not just action. So I invited two trusted partners— a philanthropic advisor, Nicole Ippoliti, who knows the landscape I fund, and my co-founder at C2C, Allison Howard Berry—to sit with me for a few days.

Their reflections were clarifying. They reminded me that I had already been practicing long-term, unrestricted giving; that I had been listening deeply; that I had been both leading and learning. Most importantly, they gave me a mirror. They helped me see that my philanthropic focus on women’s health and climate resilience was not just emerging but had been there all along, shaped by my own lived experiences and professional path.

That conversation shifted something in me. It helped me celebrate what I had built and recommit with fresh clarity. It reminded me that sometimes the most transformative investment we can make as donors is not in a new project or initiative, but in ourselves—in creating the quiet space to reflect, realign, and rediscover the through-line of our work.

If I could offer lessons to other philanthropists, they would be simple but hard-earned:

• Short-term, one-off grants rarely create lasting change. Long-term, flexible, community-based funding does.

• Partners can’t plan with uncertainty. Philanthropy should reduce risk, not add to it.

• Stay in your lane and fund what you know.

• Think like an investor: build a portfolio where different programs need different types and stages of capital.

• Be engaged: learn constantly, join boards, speak on panels, show up for your partners.

• Above all, fund equitable systems change.

All hands on deck..together. Reflections on SWF

Standing between Project Dandelion Foundesr, Pat Mitchell and Ronda Carneige. Embracing the moment with fierce determination and playfulness

It feels a little like the ground is shifting.  This may be because, for three days at the Skoll World Forum in Oxford, I was surrounded by the change makers and dreamers, artists and activists, who are committed to tackling climate change and the inequities of our world, and, increasingly, are recognizing the need to do this together. As former Irish president, UN High Commissioner for Human Rights, and now chair of The Elders, Mary Robinson said,, “it’s not enough to be doing it alone any more, and thinking, ‘I’m making my contribution’. No, we’ve got to connect. And we’ve got to know our power. And then we've got to shift the money.” Mary Robinson is a co-founder of Project Dandelion, which, if you have been following my posts here, you will know I am an active supporter of. Project Dandelion is inspired by the beautiful, resilient, undaunted weed whose seeds our children tell the time on. Project Dandelion is woman led and a call for women across the world, no matter where you are and who you are, to raise your voices for immediate and meaningful climate action. We know how counterproductive dispersed efforts are in tackling climate change. We need to see collaboration, cross pollination, and a climate movement that extends beyond the climate community.

At Skoll, the Dandelions were out, and their message was clear: The time for radical collaboration is now. This call to action was echoed throughout the forum and it was heartening to see. I am a long-time advocate for a collaborative approach. I was an early partner of Co-Impact, a global philanthropic collaborative focused on health, education and livelihood and gender equity, and recently joined the +1 Global Fund, a collaborative platform initiated by the Roddenberry Foundation, which seeks out and strengthens change makers in oft overlooked communities in the global south, and funds them.

The philanthropic community is finally waking up to the critical role indigenous communities play, in fighting climate change, and this was reflected in the programming at Skoll this year. Indigenous communities were front and center, and their philosophy was given the platform they deserve, for they  hold the wisdom we must all learn from and support in any way we can. Indigenous communities are the stewards of our world. Eighty-two percent of the world’s biodiversity is protected by just 5% of the world’s population, and they are under attack like never before. It was sobering to hear their accounts of activists murdered, maimed and terrorized, all because they are fighting to protect our shared planet’s most important ecosystems - for us.

None of this is new. We have known for a long time that we need to collaborate in order to address the challenges we face. We know too, that those who are on the ground, literally on the frontlines of the climate crisis, have the local knowledge that is invaluable in times like this. We need to stop talking and start acting. This is a pivotal moment for our planet. The urgency is clear and obvious. It is inherent on those of us who can, to do what we can to ensure that those on the frontlines have what they need to right this world. This is no time for egos. This is the time for collective and radical collaboration.

This is the time for all hands on deck. Together.

Swallows Taught Me Everything I Needed To Know About Donor Collaboratives

Meeting Siliva Bastante De Unverhau 7 years later

I was asked to speak about how I came to support donor collaboratives at the Skoll World Forum yesterday and many have asked me to share my reflections as it was a closed session. It was useful to tell a bit of my backstory to weave it all together.

Early in my career as an emergency medicine Physicians’ Assistant, I felt a profound sense of purpose. I saw myself as a troubleshooter, identifying what was broken and striving to fix it. One recurring patient—a young boy with severe asthma who lived in a car with his family—exposed me to the harsh realities of poverty in my hometown of Boston This experience illuminated the broader issue of social determinants of health, revealing how systemic challenges perpetuate illness, with the ER serving as a last resort.

Driven by a desire to comprehend these systemic flaws, I pursued further education and subsequently worked to fortify health delivery systems in Africa and Haiti. However, despite these efforts, the focus remained primarily on treating diseases, with scant resources allocated to health system strengthening (HSS) in the late 90s.

Over the next three decades, I witnessed transformative developments in global health, from initiatives like PEPFAR to the shift towards Universal Health Care and the remarkable expansion of Community Health Worker networks. Yet, it wasn't until later in life that I found myself unexpectedly embarking on entrepreneurship, propelled by a conviction that most household illnesses could be addressed affordably and effectively through basic healthcare education and access to low-cost medicines.

This conviction led me to co-found Care 2 Communities (C2C), a comprehensive primary care clinic network in Haiti staffed entirely by Haitians in partnership with the Ministry of Health. Despite the immense challenges in fundraising and navigating a broken system, C2C has flourished, serving as a beacon of hope in northern Haiti.

However, after a decade of relentless dedication, I found myself burnt out and disillusioned by the cutthroat nature of fundraising. During this bleak period, I encountered Olivia Leland and Silvia Bastante de Unverhau at Skoll, where Co-Impact was taking shape. Recognizing the limitations of individual efforts and the complex issues facing vulnerable populations, I decided to join Co-Impact, witnessing firsthand its transformative impact in building just and inclusive systems to support health education and livelihood opportunities across 17 countries, with 57 partners, reaching 600 million people in about 5 years.

The success of Co-Impact underscored the potential of collaborative funding models, yet it remains an underutilized approach. Of the $1 Trillion in grants made last year only .2% went to collaboratives. We---donors, doers, DAF holders, and foundations need to do better.

So when I learned of the +I Health Fund launched by the Roddenberry Foundation I was curious again. My involvement in this collaborative endeavor complements rather than competes with C2C and Co-Impact, embodying a belief in the power of collective action to drive meaningful change.

Reflecting on my journey, I draw inspiration from the harmonious collaboration observed in nature—how plants breathe out the oxygen we need and we breathe out the CO2 that they need. Similarly, I envision a future where philanthropic efforts align harmoniously, guided not by competition but by a shared commitment to collective well-being.

By embracing innovative, collaborative models, we can navigate the complexities of our world with grace and coherence, much like the murmuration of starlings or the interconnectedness of fungal networks. By prioritizing cooperation over competition and embracing a collective vision for a better future, we can pave the way for lasting and impactful change.

Why Funding Collaboratives Can Create A Gender Equal World

Treating patients in Nepal

Why funding collaboratives can catalyze the change needed for a gender equal world.

I am a woman and a collaborator with creativity and optimism. I am convinced: when we collaborate with our money, our values, our vision, and our imagination, we can start to imagine a gender equal world. I’ve been supporting Co-Impact since inception and rejoined to support the Gender Fund launched this week. Watching the model grow over 5 years, I'm convinced this model has what it takes to catalyze global improvements in basic human rights: being able to live a healthy life, get a good education and a chance to work and thrive.

I was initially attracted to Co-Impact because supporting people and communities through strengthening healthcare systems has been the through-line of my life. As a clinician, a founder and a funder, I’ve sought out the pathways that challenge the status quo. The reality of global health inequity cannot be addressed one patient, one grant, or one intervention at a time. Entrenched systems need to be wholly reimagined, and this can only be achieved through bold, broad collaborations in philanthropy that now center gender.

Over four decades, I’ve learned one thing over and over again: health is intersectional.  I spent the first decade of my career as a Physician’s Assistant working in US emergency rooms. I saw how often the drivers of poor health were social, economic, and gendered. The second decade transferred my clinical skills to the global south, working as a PA in Cambodia and Mozambique, where the health challenges were staggering. Lack of access to basic and preventive care made good health impossible. Frustrated by my inability to disrupt the cycles of disease and illness, I was most enraged by the suffering of women. I knew this above all else: in every country, women were disproportionately impacted by broken health systems. I saw what happened to a family when the mother fell ill or died; the ripple effect was devastating. I needed to understand the wider systems, how aid distribution models were structured, and why that funding failed to strengthen the clinics and hospitals that were at the center of healthy communities. I studied international health policy in London and put my degree to work with USAID and with other NGOs in East Africa, but my calling in my third decade was clear: I was a builder. I couldn’t challenge the status quo from within the architecture of foreign aid because it was clear that the flow of money – fragmented, siloed, short-term – was the problem.

My third decade was devoted to building. I co-founded Care2Communities, a non-profit social enterprise model delivering high-quality primary healthcare in Haiti. Through iteration, learning, and long-term relationships, we built a community-based clinic model that centered patients and families. We replicated the model with communities across northern Haiti and, today, the network of clinics serves over 250,000 people.

I didn't call myself a philanthropist until my mid 30's when a family business event allowed me to have more than I needed. Since then, I have committed myself to exploring how philanthropy can catalyze meaningful, measurable impact for the health of women and communities. I joined Women Moving Millions by committing to support women and girls at the level of $1 million over 10 years–my first bold donation for sure! I learn from serving on nonprofit boards including Network of Engaged International Donors Global and membership to TPW. I took on a mentor role for other social entrepreneurs. I pursued an honest learning journey to address power and privilege, and how the lack of diverse voices in the circles of wealth and influence, perpetuate inequality in our work. Inheriting wealth challenged me to consider, continuously, how I live each day and how my core values are represented in all of my choices. That includes everything from how I spend my time, to where I direct my philanthropy, to how I ensure that my investment portfolio reflects my values and embrace the truth that our individual choices can create the world we want where everyone thrives.

I joined Co-Impact in my fourth decade because it spoke to everything that I had hoped would happen in Haiti. I saw a well-constructed systems approach, where communities led, and women were centered. Where many of the solutions existed but needed philanthropic jet fuel, not scattered infusions of funding in disconnected pockets. Co-Impact’s first grants put millions of paid healthcare workers into rural communities across Africa through Last Mile Health and the Liberian Government. We invested in technologies that catalyzed new education opportunities for millions of students through Teaching at the Right Level - Africa. We also invested in the graduation approach to economic opportunity through a global multi-stakeholder effort involving Jeevika, Fundación Capital, and the Partnership for Economic Inclusion (PEI), as a pathway to lift millions of people out of extreme poverty. Scale meant depth and breadth.

The Co-Impact model required relinquishing some measure of control of my donation,, but it was the kind of trade-off that was necessary for large, unrestricted, long-term, and flexible funding. I had to commit to trusting the collective, the experts and innovators who vetted the models for systems transformation – but in so doing, I could leverage my giving commitment ten-fold. The Co-Impact Gender Fund invites philanthropists and stakeholders to an equal table. Donor input and participation isn’t dependent on dollar commitments. We fund as a group – no competition between funders; we just link arms in our shared commitment.

COVID has laid bare the realities of health inequity across the globe. Our planet is on fire, and it is women in the global south – arguably those least responsible for the pillaging of planetary resources – who will be the ones most immediately and perilously impacted. I invite you to join collaborative funding networks to shift the balance of power to the lives and the voices most affected by funding their work, their solutions, their wellness, and their future. Because theirs is ours.

One Word: Haiti

C2C's staff providing high-quality health care closer to home

When funders gather, they talk about bold and game-changing ideas. That’s what makes funding communities such exciting spaces: like-minded people coming together with shared goals, the financial capacity to make an impact, and a burning desire to see change happen. The best communities are tenacious and think big. As a philanthropist myself, I’ve gained wisdom, grounding, and inspiration from these groups.

But, in recent years, I’ve wondered: Are we intimidated by the thorniest challenges? Are we bandwagon-ing too much? I know what the term “donor darling” says about an organization, but what does it say about us?

For over two decades, I’ve been a member of the Threshold Foundation, a group of philanthropists who pool resources, passions, and expertise to engage in transformative grant-making. Threshold was a precursor to the collaborative philanthropy models that are exploding today and it’s gratifying to see those small, early efforts translated into a large-scale movement. In more recent years, I’ve become a member of Women Moving Millions and a founding community member of Co-Impact and I’m thrilled to see collaboration expected of grantors as much as it is of grantees.

But despite the philanthropic renaissance and re-thinking we are seeing in the world today, I’m continuously dismayed by the reaction I get with one provocative word:

Haiti.

I’ve been funding in Haiti since 2009 and – without a doubt – there are endless lessons and learning that come from a decade of close engagement with Haiti as the nation has struggled to find a path towards health and economic prosperity. I started out making traditional philanthropic gifts to the areas that are personal priorities for me, namely, the health of women and girls. But I quickly pivoted my focus to social business models because, like so many, I saw the pitfalls of traditional aid which – compounded by the influx of earthquake relief money – struggled to deliver real outcomes for people.

In more robust emerging markets, like East Africa, India, and South America, social enterprises are transforming how we think about social impact and how philanthropy can be harnessed to achieve sustainable aims. Big money is pouring into market-based approaches. But in Haiti? Support for social business is anemic.

I’ve had one too many funders tell me that they “just don’t think {insert idea} can work in Haiti”. Largely, these impressions are not based on any facts, experience, economic data, or knowledge of consumer behavior in Haiti.

On the eve of the Skoll World Forum, I am challenging funders and impact investors: look again.

You aren’t going to find easy answers in Haiti. The economy isn’t going to function like the emerging markets that feel safer and more familiar. But the possibility and potential that is burgeoning in Haiti deserves your attention. Social enterprise models are showing results that should make you question the prevailing wisdom that free public services – across the board – are the only future for Haiti. Setting aside the fact that that approach is logistically impracticable, who would pay for that in the years and decades ahead?

Take a look at SOIL’s EkoLakay toilet model that provides an affordable household sanitation solution while employing a cadre of micro-entrepreneurs (bonus: it’s great for the environment). Take a look at how D’Lo Haiti leverages technology and a last-mile distribution model to ensure affordable clean water to tens of thousands. Take a look at C2C’s public-private partnership with the Ministry of Health to get every public clinic in northern Haiti delivering high-quality care at price-points that are lower than current public-sector pricing.

These social business models are leveraging every dollar in new, catalytic ways and – crucially – they’re showing us what the future could look like, where the private and public sectors meaningfully collaborate, and the financial models are dynamic and don’t rely on a one-way flow of funding from the US.

The time is long overdue to look again at Haiti. Join me. Let’s talk.

A Clinician at Davos: Reflections on the Role & Responsibility of Philanthropy in Collective Impact

The opportunity to attend the World Economic Forum in late January was both an honor and an eye-opener. In Davos, 3,000 delegates representing leadership in global business, government and civil society – including over 70 heads of state – convened for the annual meeting to explore and consider the state of our rapidly changing world and the opportunities and threats we face as globalization thunders forward at a breakneck pace. 

I have been reflecting on my time in Davos – which was a whirlwind of lofty rhetoric, ambitious proposals, and high ideals. With good reason, the World Economic Forum is often criticized as a convening of the world’s economic and social elite; a place of all talk, no action; an exclusive gathering of the privilged ‘deciders,’ whose policies and priorities impact hundreds of millions of global citizens – but without those citizen voices adequately represented.

So I attended with a healthy degree of skepticism about the composition of the delegate pool and the aims of the meeting. But I was pleasantly surprised to find so much more representation of those crucial voices than expected. More women, more young people, a profound urgency about the existential threats to our world – from technology to climate change – and a heartening level of attention to the pervasive inequality within nations and globally. 

The release of the Oxfam report, Public Good or Private Wealth?, just days before the opening plenary was a clarion call for civil society delegates. The report presented stark statistics on the depth and breadth of income inequality across the globe – and its calamtious consequences for the poor. Oxfam researchers reported that the world’s26 richest people own as much as the poorest 50% (that’s 3.8 billion people). It is not news that wealth is unfairly concentrated. But to consider, in stark detail, how acutely wealth inequality impacts poor families in developing economies – and the disproportionate burden on women and children – is devastating. And a moral imperative that we cannot turn away from. 

The findings of the report re-calibrated how I heard and engaged with conversations big and small at Davos – from keynote addresses to side-conversations over coffee. What is the responsibility of the private sector and of governments to decisively address inequality? What does a fundamental structural shift look like and how do we build the political will to take action? And, of course, how does philanthropy fit in? 

As a representative of Co-Impact, a newly-launched collaborative philanthropy model that pools resources for deep, strategic investments in programs that are effecting true systems-change level results, I was in Davos to lift up this new approach to collective philanthropic impact. As a philanthropist and a organization founder, I want to do even more than just “shine a light” on a new effort; I want to push the philanthropy sector forward, to embrace more collaboration, to take bolder chances, and to prioritize public-private partnerships (PPPs) and models that hold the potential for transformational change. 

I believe firmly that governments have a deep responsibility to drive the development agenda of the nation; the government must “hold the center” for all other actors – private sector, civil society, and philanthropy alike. Co-Impact’s first round of funding is backing exciting and impactful public-private partnerships models, like Last Mile Health and the national Community Health Assistant program in Liberia and TaRL Africa which supports African governments to develop strategies to help all children read and do basic arithmetic. As a social entrepreneur in Haiti, my organization Care 2 Communitieshas developed a public-private partnership with the Ministry of Health to transform community health clinics across the country. In a country whose development agenda has been dictated by traditional foreign aid and uncoordinated charity, we are doing something different because the ‘business as usual’ approach hasn’t worked. Governments are central and they must be engaged as the powerful partners they are, not window-dressing on an entirely private mobilization of funding.

My experience at Davos underscored a truth that we already know: there is enough wealth in the world to ensure that people get a decent shot at life. But we need to work towards a structural shift in international aid and collective action at all levels – not just the world’s economic elite. Governments need to be at the heart of this transformation. 

A Clinician at Davos: Prioritizing Health Systems Transformation As An Economic Imperative

Looking for new solutions

I’m a Physician’s Assistant by training and I’ve always gravitated towards the direct, patient-level interventions that I know save lives: detecting pre-eclampsia in a pregnant woman; diagnosing and treating an acute respiratory infection in a young child; teaching a family how and why to treat their water, thereby ensuring a new trajectory of good health for the household.

But after 25 years working in international health, I have learned (and despaired) that these types of interventions, nested within profoundly broken systems, are wasted – or, at best, temporary – efforts. Despite billions of aid dollars, women still died from pre-eclampsia and children from pneumonia at alarming, stubbornly high rates. I put down my clinical tools and put on an implementer’s hat: studying health economics and health financing, working in Africa and Asia on health system-strengthening initiatives and, eventually, founding an organization in Haiti that builds a network of community-based primary care clinics.

As a clinician first, I believe passionately that access to healthcare is the foundation of economic freedom and mobility – particularly for women who, across the globe, suffer disproportionately from the myriad impacts of poverty. There is no shortage of challenges across the world, where 770 million people are living below the poverty line. But without good health – and accessible, affordable, high-quality health services – people cannot participate in a burgeoning economy; they cannot seek or attain an education; they cannot care for themselves, their households and children; they cannot participate meaningfully in civic life. Poor health undermines nearly everything else.

As a philanthropist, I feel impatient with the typical churn of grant-seeking and grant-making across sectors. Incremental grants aren’t changing the game and, too often, they aren’t even generating incremental progress. I worry that this kind of cautious, defensive posture in the grant-making community – an attempt to insulate against perceived risk or waste – is actually wasting more money (and time and creativity and talent) than if we were less fearful of failure. It would free us to experiment – to ask and answer bold questions about which strategies work, and which don’t.

This fuels my passion for Co-Impact. This bold new approach to collaborative philanthropy is seeking a ‘fulcrum effect,’ eschewing the funding models that simply haven’t produced the results we urgently need. Co-Impact embraces a ‘big bet’ approach and invests in initiatives that are at the forefront of true systems-change. This week, Co-Impact announced its first round of grants, totaling $80 million to 5 recipient organizations and in a few days Co-Impact will bring its urgent and compelling message to the World Economic Forum in Davos, where we will ensure that the dialogue about role of philanthropy in systems-change is not an afterthought but, rather, a central theme of economic transformation and inclusion.

As a Co-Impact community member, I am honored to be headed to Davos with this important message at this pivotal time: through collaborative, coordinated efforts – as funders and as implementers – we can achieve the ‘fulcrum effect’ we have been seeking for decades and the kind of systems-level change in global health that ensures that clinical efforts at the micro-level save lives and transform the future for tens of millions of people.

C2C Celebrates 20,000 Patients Served!

This past month, our 20,000th patient walked through the doors of a C2C clinic. From the entire C2C team, we want to say: THANK YOU!

We believe that poor families in Haiti deserve access to the highest quality medical care and health education to live healthy and productive lives. C2C was founded on a simple premise that access to healthcare is the foundation of all efforts to lift poor people out of poverty. 

Today, C2C clinics are “one-stop-shop” community clinics that offer consultation with a physician, a fully-stocked pharmacy, and a diagnostic lab on-site. The C2C network of community clinics is expanding rapidly across northern Haiti: each clinic functioning as a community business, managed by local staff and clinicians, working within the larger healthcare ecosystem to demonstrate that access to basic care, prevention education, and community support can be transformative and can save lives.

We celebrate this important milestone with you and extend our renewed gratitude for all of our supporters and friends who make C2C’s vision for a healthier Haiti possible.

Elizabeth Sheehan is the co-founder and President of Care 2 Communities (C2C). Learn more about what C2C is doing in Haiti!