Abstract This study presents an empirically based analysis of legitimacy aspects of polylateral governance across three global health funds: Gavi, the Vaccine Alliance; Global Fund to Fight Against AIDS, Tuberculosis and Malaria; and the Global Financing Facility for Women, Children and Adolescents. Adopting a normative approach to legitimacy, we ask how these global health funds fare against key legitimacy principles in global governance, as expressed in the 2011 Busan Partnership Agreement and the earlier Paris Declaration on Aid Effectiveness (2005). The findings show that, while global health funds exhibit high levels of alignment with the set standards of technocratic legitimacy, they fail to meet the principles of democratic legitimacy and fairness. This shortfall is largely due to the structure and operations of the funds’ boards that accord significant sway to financiers and partners from the Global North.
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