The Global Fund to Fight Aids, Tuberculosis, and Malaria is about to appoint a new director. Although this is still a top job in global health, it is no longer quite as enviable a role as it was a decade ago. After a glorious early period experimenting with a bold new model for distributing over $20bn in aid (£12.5bn; €16bn), the Global Fund hit a crisis over fraud a few years ago and its reputation was deeply damaged. The new leader, and a new funding model, to be announced on November 15, are supposed to get things back on track.

Despite an attempt to keep the names of shortlisted candidates secret, it has emerged that all four are from major donor countries. They are reported to be Mark Dybul, former head of the US President's Emergency Plan for AIDS Relief (PEPFAR), Canadian Robert Greenhill, head of the World Economic Forum, Monique Barbut, the French outgoing chief of the UN’s Global Environment Facility, and the UK’s Dame Barbara Stocking, outgoing head of Oxfam. Dybul, who is politically independent and openly gay, is known for favouring sexual abstinence programmes in the fight against AIDS.

A new funding model, expected to be announced along with the appointment, has been heavily influenced by Republican health experts in the US. If Dybul gets the job the US, the fund’s biggest donor, contributing $7bn (£12.5bn; €16bn), will be seen to be taking control.

The fund says a new strategy introduced this year has already restored faith and that the imminent changes will make the organisation work better for countries in need. But observers and non-govermental organisations fear that in a bid …