It is time to increase Africa’s governmental representation on the governing board of the global fund to fight AIDS, tuberculosis and malaria

The response to COVID-19 exposed a lack of African capacity to influence global health decision-making and policy. A more general recognition of limited African voice has also been reflected in reform debates within Global Health Initiatives (GHIs) as well as in more traditional sites of geopolitical power, such as the United Nations Security Council. Yet, whereas the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) was once heralded as the innovative partnerships for health, its governance structure has not kept pace with emerging global norms that advocate for greater African representation, national ownership, sustainable development and greater aid effectiveness.

Drawing on insights from a larger GFATM research report,1 we focus on only one reform pathway of many to address this shortfall. Namely, we argue that the GFATM should add at least one additional voting seat for African governments on its Governing Board. This would not only bring the GFATM in line with global norms and institutions that advocate for increased African representation, but also, by doing so, increase the performance and aid effectiveness of the GFATM, helping address longstanding challenges in how we finance and promote global health.