Jun 20, 2009 Volume 373 Number 9681 Pages 2083 – 2170
Who runs global health?
The past two decades have seen dramatic shifts in power among those who share responsibility for leading global health. In 1990, development assistance for health—a crude, but still valid measure of influence—was dominated by the UN system (WHO, UNICEF, and UNFPA) and bilateral development agencies in donor countries. Today, while donor nations have maintained their relative importance, the UN system has been severely diluted. This marginalisation, combined with serious anxieties about the unanticipated adverse effects of new entrants into global health, should signal concern about the current and future stewardship of health policies and services for the least advantaged peoples of the world.