The Global Fund to Fight AIDS, Tuberculosis and Malaria is one of the most important international institutions in the field of global public health, approving over US$ 21 billion in grants since its inception in 2002. One of the Global Fund''s institutional innovations is the extent of non-state actor participation in its main decision-making body: five of the 20 seats with voting rights on the Fund''s Foundation Board are allocated to non-state actors. This institutional arrangement gives NGOs like the Zambia National AIDS Network and major donors such as the United States or France the same weight in the decision-making process, providing a unique opportunity to examine non-state influence actors in international institutions. The paper explains variation in the distribution of financial grants with independent variables that capture non-state actors'' preferences. Just like states, non-state actors are assumed to have strategic goals and, as a result, to have preferences about where and how an institution spends its money. If non-state actors can influence institutional decision-making, there should be at least a modest positive relationship between these actors'' preferences and the actual distribution of Global Fund grants. More concretely, when a non-state actor represented on the Foundation Board unilaterally assigns more resources of its own to a specific country, and publicly identifies it as a perferred target for aid, then this country should see higher approved grants during the Board tenure of this actor than at other times. Using an original database of over 900 successful and unsuccessful grant applications from 2002 to 2010, the paper shows that non-state actors'' preferences appear to have little effect on the distribution of aid, even where they are granted a strong role in institutional processes. The findings raises broader questions about the evolving norm of non-state participation in international institutions.
