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


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.

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  1. 1.

    Public private initiatives within international health often have a mix of both state and non-state parties all working together to achieve a common goal and to share resources and responsibilities. See UNGA (2005) Enhanced Cooperation between the United Nations and all Relevant Partners, in Particular the Private Sector, Report of the Secretary-General, UN Doc. A/60/214, at p. 4.

  2. 2.

    Other PPPs that have been institutionalised include the Global Alliance for Vaccines and Immunisations (GAVI), UNITAID, The Stop TB Partnership and The Medicines for Malaria Venture.

  3. 3.

    Uganda’s suspension from the Global Fund is not an isolated example. The GFATM has at some point suspended grants in numerous developing countries: Ukraine, Myanmar, Indonesia, Chad, Mali, Nigeria and South Africa.

  4. 4.

    Brugha and Walt (2001).

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    Brugha et al. (2004, pp. 95–100).

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    Kapilashrami and McPake (2013).

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    Taylor and Harper (2014).

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    Kapilashrami and McPake (2013).

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    Young Nicola Man et al. (2014).

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    Wild and Domingo (2012).

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    For more on endemic corruption in Uganda, see Persson et al. (2010), Von Soest (2013), Amundsen (2006), Mwenda (2007) and Mwenda and Tangri (2005). For Zambia, see Taylor (2006) and Szeftel (2000).

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    CCMs typically include representatives of health professionals, NGOs and the private sector. As well as government, representatives of development international organisations sometimes participate. CCMs nominate principal recipients to carry out fund-supported programmes, and these nominees may be public or private entities. Business firms further participate in co-investment schemes expanding prevention and treatment for employees and their dependants, while fund-supported programmes assist surrounding communities.

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  23. 23.

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    The Global Fund, ‘Office of the Inspector General’.

  25. 25.

    See for example, the 2013 acquittal of former GFATM Uganda officials in the Anti-Corruption Court judgement in Uganda v. Kabagambe and 3 others [2013] UGHCACD 5 (unreported).

  26. 26.

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  27. 27.

    Grants have a life-time budget for their entire duration but are usually divided into phases comprising of two years.

  28. 28.

    The government and the GFATM signed a memorandum of understanding which described interim arrangements and structures under the leading of the Ministry of Finance Planning and Economic Development as the Principal Recipient.

  29. 29.

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    The Ministers for Health were nonetheless prosecuted for the disappearance of funds under a separate project, the Global Alliance for Vaccines and Immunisation (GAVI). This was a separate investigation carried out by the Inspectorate of Government that was not within the ambit of the Global Fund commission of inquiry. For more on this separate trial, see Priscilla Muhairwe, Political Sins, Legal Penalties. The Independent. 22 February 2013. Accessed 7 June 2014.

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Correspondence to Sharifah Rahma Sekalala.

Additional information

S. R. Sekalala: Research Fellow.

M. T. Kirya: Independent Researcher and Consultant on Corruption.

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Sekalala, S.R., Kirya, M.T. Challenges in Multi-Level Health Governance: Corruption in the Global Fund’s Operations in Uganda and Zambia. Hague J Rule Law 7, 141–151 (2015).

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  • Corruption
  • Global governance
  • Public private partnerships (PPPs)
  • The Global Fund