Is more money for global health always good news? No, I am arguing in this lead essay in Ethics & International Affairs (Carnegie Council). Many of the problems that plague decision-making in global health assistance lie not in the global South but in the North, where the monetary flows originate and where most policies are conceived.

If we want to avoid the same strategic backlash that hit us after pouring billions into foreign aid without knowing much, if anything, about its effectiveness, we need to ask critical questions about how financial resources for global health are being spent and whether or not these patterns are the most effective.

It turns out that common depictions of ‘limited capacities’ in developing regions are only one factor in explaining suboptimal allocation. Conversely, organizational incentives, interorganizational dynamics and the sweet talk of global partnerships account have been looked at much less. I contend that they are the key aspects in need of investigation if we seek to understand the political economy of global health today.