TB, and malaria (Caines 2005). The most prominent GPPP that exists today is the Global Fund, which was established in 2002 as a new type of financing mechanism for the prevention and treatment of HIV/AIDS, TB, and malaria. As the leading funder of malaria and TB programs and the second largest funder of HIV/AIDS programs, the Global Fund is a unique joint endeavor between governments, civil society, and the private sector that has established itself as one of the most prominent GPPPs today (Bartsch 2007, Bernstein and Sessions 2008). The model of the Global Fund is also unique in the sense that it possesses no in-country or technical assistance expertise because it strictly operates as a financing mechanism without involvement in implementation activities (Bernstein and Sessions 2008). This creates an interesting dynamic between the Global Fund and the broader network of other global health actors that provide technical assistance to developing countries, as discussed later.

The Global Fund’s new prominent role has created several tensions for the governance of global health. Firstly, as a GPPP, the Global Fund is expected to engage all of its partners. Yet, there have been concerns over the lack of engagement of CSOs and private industry in the Global Fund. For example, it has been noted that Southern governments have been reluctant to grant CSOs greater involvement at the global and national levels due to a fear of “losing influence and policy options” if authority is shared with CSOs (Bartsch 2007). Also, as a PPP, the Global Fund should attempt to leverage the benefits offered by its different partners—including private industry. The Global Fund’s requirement of financial donations and its obstinate refusal to allow the pharmaceutical industry’s proposal of gifts in kind (e.g., medicines), or other collaborative mechanisms, has been an area of debate (Bartsch 2007).

Secondly, the Global Fund’s lack of harmonization with other global health initiatives has been a significant concern. The Global Fund’s support of narrow vertical (i.e., disease-focused) initiatives varies from other global health efforts that support broad, horizontal (i.e., health systems) development. It is feared that the Global Fund’s approach, on top of existing health initiatives, would “contribute to a further fragmentation of health policies at the national level” (Bartsch 2007). Interestingly, the Global Fund has taken note of how basic health systems factors, such as infrastructure and capacity building, are critical to the achievement of its objectives. This led to a later decision to accept proposals for “health systems strengthening,” but only “where it is directly related to AIDS, tuberculosis or malaria” and not health systems strengthening more broadly (Global Fund b).

Thirdly, the Global Fund’s Country Coordinating Mechanism (CCM) has introduced a number of problems at the national and global level in terms of its lack of coordination with extant systems of governance. Under Global Fund procedures, CCMs function in the capacity of developing and submitting grant proposals as well as overseeing implementation (Global Fund a). The establishment of CCMs, however, has been “in addition” to extant national coordinating