Challenges in Multi-Level Health Governance: Corruption in the Global Fund’s Operations in Uganda and Zambia

Abstract

There has been a marked rise in new organisations such as public private partnerships (PPPs) within the global health sector, of which The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is perhaps one the most well-known. From its conception, it was hailed as a new breed of international institution which would be less bureaucratic, more transparent and more accountable to its stakeholders. However, the GFATM has unfortunately been plagued by corruption in its operations in several developing countries. In this note, we draw on case studies of GFATM experiences of corruption in Uganda and Zambia to argue that we should be cautious in welcoming this new form of global governance in regard to its ability to ensure transparency and accountability. This is because one of the key strengths of the PPP structure, is that it creates autonomy at the national level, which constitutes a weakness when there is corruption. Indeed, despite evidence of widespread corruption in the GFATM in both of our case study countries, the GFATM has been unable to effect successful prosecution of the culprits and recover money that has been siphoned off, as both the Ugandan and the Zambian governments have exhibited a lack of political will.