Inside the sprawling philanthropy founded by former President Bill Clinton, its health initiative, run by a longtime friend and policy adviser to the Clintons, holds a vaunted place, with the largest budget of any program in the foundation and a distinguished record of fighting diseases like AIDS and tuberculosis in underdeveloped countries.

Its chief executive, Ira C. Magaziner, who is admired as a brilliant, farsighted leader, has long alienated co-workers at the Clinton Foundation. But a harsh new set of complaints about Mr. Magaziner were captured this year in a performance review, with most of the grievances coming from the board of the Clinton Health Access Initiative, or CHAI, of which Chelsea Clinton is a member.

The review said Mr. Magaziner had shown “disdain” for the health initiative’s board, exhibited “duplicitousness with management” and displayed a “lack of transparency” and “dismissive behavior” toward Clinton family members.

Board members also accused Mr. Magaziner of “paranoia,” according to the review.