New and old global health actors: effectiveness vs. legitimacy?

The most effective global health actors appear the least representative and accountable. In an increasingly crowded global health landscape a debate has emerged on who does what, how and financed by whom. While the WHO is criticized for lacking effectiveness, transparency, accountability, and authority, new arrangements of transnational governance are not considered representative.

This paper discusses the legitimacy of the Global Fund, the GAVI Alliance and The Bill and Melinda Gates Foundation. It concludes that the norm-setting capacity of the WHO deserves strengthening. The legitimacy of global health is likely to benefit from a more interventionist perspective on global health, rather than a neoliberal perspective in which market forces will provide global health. Nevertheless, to date, the effectiveness of the delivery of global health benefits a lot from the newer forms of transnational governance and new funding that has emerged in this field.

This paper is part of a project on the legitimacy of transnational governance, jointly carried out by Clingendael and The Hague Institute for Global Justice in 2012-2014.