Disadvantages of the current systemDespite these advantages, the current level of control that funding agencies and donors have over priorities limits the contribution of health needs global decision-making. algorithm. Although there are a multitude of actors in global health, when calculating resource allocation, a small number of wealthy donors set the majority of global health priorities (31), reducing the possibility that the need for an empirically determined program is taken into account in the discussion. The major disparity between priorities set by global health stakeholders and needs is illustrated in Rwanda, where the local government highlighted disproportionate funding for the fight against HIV/AIDS even though the country had only one infection rate of 3% (2, 32). Under such guidance, long-term priority setting, particularly for issues whose outcomes are difficult to measure, is rare. Long-term financing is demonstrated here by examining the problem, policy, and political trends that have drawn attention to health systems strengthening efforts in recent years, but have not generated a commitment to large scale on this issue. In fact, engagement with HSS has been largely limited to the specific disease interests of major donors. Additionally, the recent global financial recession has put economic concerns ahead of strengthening health systems. It is argued here that funding-driven priorities, as they stand, promote inefficiency and inequality when resources are not allocated where they are most needed. A superior system would be one in which the power of major donors is limited or their interests are modified in ways that ensure that global health needs form the basis of policy.