Stronger African voice needed on global health bodies, research finds

Worldwide efforts to fight AIDS, malaria and TB need drastic reform if they are to be effective, with more decision-making power for African nations, new research led by Leeds academic has shown.

Funders would see a better return on investment and programmes would be less reliant on outside investment over time if African voices were better represented on global health bodies, according to research led by a School of Politics and International Studies academic.

Working with experts from the UK, South Africa and Kenya, Professor Garrett Wallace Brown found that African national constituencies represent 71 per cent of the Global Fund to Fight AIDS, Tuberculosis and Malaria’s (GFATM) allocations and have largest disease burden, but the continent is “woefully under-represented” on its governing board.

Our findings were dramatic and signal the need for reform

The researchers are now calling for African governments to be given at least one additional voting seat on the GFATM board, and their calls have been published in the journal BMJ Global Health.

Professor Brown said: “Our findings were dramatic and signal the need for reform. Our research shows that increasing African governments’ representation on the GFATM board will lead to more meaningful, integrated and sustainable GFATM programmes, and will move us towards effectively addressing longstanding challenges in how we finance and promote global health.”

He added: “If we start by adding at least one governmental voting seat on the GFATM board, we can begin to push for better strategic investments for the promotion of self-reliance, which would meaningfully enhance long-term health and well-being for the most vulnerable.”

Funding decisions largely affect Africans, and yet their voices are systematically minimised

The work comes amid a global health funding crisis as the USA dismantles the US Agency for International Development (USAID), and Germany announces plans to reduce its funding for global health aid. GFATM will receive US$117 million less over the coming years. World leaders are expected to discuss inclusive governance and resilient health systems at November’s G20 meeting in South Africa.

Robyn Hayes-Badenhorst is founder and co-executive director of Supporting Health Initiatives (SHI) at the University of the Witwatersrand, and co-authored the report. She added: “Funding decisions largely affect Africans, and yet their voices are systematically minimised. Beyond having greater representation on the GTAFM Board, we are advocating for a complete shift in the global health institutional architecture.

“Enhanced representation will empower African governments to share health policies that reflect local realities, improve programme sustainability and reduce reliance on external actors.”

The BMJGH commentary accompanies a full report, commissioned by SHI and led by Professor Brown, which examines African government membership on the GFATM board.

Further information

• For further information or to arrange interviews, contact University of Leeds media officer Victoria Prest via email on pressoffice@leeds.ac.uk
• It is time to increase Africa’s governmental representation on the governing board of the global fund to fight AIDS, tuberculosis and malaria was published in BMJ Global Health, on Monday, September 15 2025. DOI: 10.1136/bmjgh-2024-018252
• The full report “Increasing African government membership on the board of the Global Fund to Fight AIDs, Tuberculosis and Malaria (GFATM)”, which on the University of Witwatersrand website
• The research was funded by Supporting Health Initiatives, part of the University of Witwatersrand
• Main image: Adobe stock 475189988.