At least one more governmental seat for Africa on the governing board of the Global Fund to Fight AIDS, Tuberculosis, and Malaria could significantly enhance the continent’s influence in global health decisions. This call for increased representation, published on September 15, 2025, in the BMJ Global Health journal, argues that greater African involvement would lead to better health outcomes and more effective use of international funding.
Currently, Africa receives 71% of the Global Fund’s resources but holds only 10% of the voting power on its board. This imbalance highlights a critical need for reform, especially as the Global Fund faces a $1.43 billion cut in its current funding cycle, following reduced contributions from major donors like the United States and Germany.
Africa’s Disproportionate Burden and Limited Influence
Africa’s health challenges are immense, yet its voice in global health governance remains limited. Robyn Hayes-Badenhorst, Founder and Co-Executive Director of Supporting Health Initiatives at Wits University, emphasizes the need for structural change. “Funding decisions largely affect Africans, and yet their voices are systematically minimized,” she says, advocating for a shift in the global health institutional architecture.
The proposed additional seat would not only align with international norms but also bolster African health policy and accountability. It would enable more effective participation in decision-making processes that directly impact African health systems.
Implications of Funding Cuts and the Need for Reform
The recent funding cuts have created a crisis moment, opening the door for potential reforms. Professor Garrett Wallace Brown from the University of Leeds, who led the SHI research, sees this as an opportunity for radical change. “If we start by adding at least one governmental voting seat on the GFATM board, we can push for better strategic investments that promote self-reliance,” he argues.
Magda Robalo, supporting the Africa Health Sovereignty agenda, stresses the importance of sustainable domestic financing. She notes that Africa’s commitment to increasing domestic health budgets is crucial, yet only three countries currently meet their targets. This domestic investment is essential for unlocking co-financing incentives with international donors.
The Call for Incremental Change in Governance
While one additional seat may seem minor, it represents a critical step towards building Africa’s self-reliance in healthcare. Dr. Lieve Fransen, former GFATM chair, highlights the importance of incremental change in governance bodies. “These changes matter,” she asserts, noting that Africa’s two existing seats cover 47 countries with diverse health challenges.
The BMJ Global Health article is part of a larger report by SHI at Wits University, which provides empirical evidence that better representation enhances ownership and sustainability. This is crucial for aid effectiveness and aligns with past commitments like the Paris Declaration on Aid Effectiveness and the Accra Declaration on Universal Health Coverage.
Looking Ahead: A Strategic Moment for Advocacy
The publication of the BMJGH article comes at a strategic time, just before the G20 meeting in South Africa. Global leaders will discuss commitments to inclusive governance and resilient health systems. Hayes-Badenhorst emphasizes the need for a strong African voice at such gatherings, advocating for an additional governmental seat to foster equitable and sustainable health systems.
Enhanced representation would empower African governments to share health policies that reflect local realities, improve program sustainability, and reduce reliance on external actors. As the global health landscape evolves, Africa’s increased participation could drive meaningful reforms that benefit not only the continent but the world at large.
