The Global Fund to Fight AIDS, Tuberculosis and Malaria has proven highly effective at fighting the world’s major killers. Strong governance and development institutions, however, are necessary for improving health long-term. While some suggest international aid can strengthen institutions, others worry “dead” aid undermines governance. The Fund is a unique aid institution with mechanisms designed to improve transparency and accountability. We constructed a unique dataset to explore whether Global Fund financing has a significant effect on governance and development.