Who pays for cooperation in global health?

A comparative analysis of WHO, the World Bank, the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, and Gavi, the Vaccine Alliance

In this report we assess who pays for cooperation in global health through an analysis of the  nancial  ows of WHO, the World Bank, the Global Fund to Fight HIV/AIDS, TB and Malaria, and Gavi, the Vaccine Alliance. The past few decades have seen the consolidation of in uence in the disproportionate roles the USA, UK, and the Bill & Melinda Gates Foundation have had in  nancing three of these four institutions. Current  nancing  ows in all four case study institutions allow donors to  nance and deliver assistance in ways that they can more closely control and monitor at every stage. We highlight three major trends in global health governance more broadly that relate to this development: towards more discretionary funding and away from core or longer-term funding; towards de ned multi-stakeholder governance and away from traditional government-centred representation and decision-making; and towards narrower mandates or problem-focused vertical initiatives and away from broader systemic goals.