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AbstractAfrica is the continent where the social and health situation is of greatest concern, and where progress on the Millennium Development Goals is the slowest. Access to global assistance for health is complex, as it is channeled through new funding mechanisms: global public-private partnerships or “innovative” financing. The aim of this paper is to demonstrate that the effectiveness of this aid, which is growing in volume, depends on a more equitable distribution between different countries on the same continent, or among patients with different pathologies, on financial resources as well as technical expertise, and on a evidence-based allocation of funding, using objective criteria such as epidemiological data, the efficacy of the chosen treatments, the population profile, the effectiveness and efficiency of selected interventions, etc. It is our opinion that food insecurity, including in urban areas, and unequal access to global health aid – combined with Africa’s unprecedented demographic growth and with the global financial and economic crisis effects– threaten the African continent political stability, particularly in the French-speaking Africa. To avoid the situation deteriorating still further, France and Europe, who have a historic responsibility towards this part of the world, must ensure that the human and financial resources allocated to global initiatives – channels these institutions favour to the detriment of bilateral aid – also benefit the most deprived populations living in French-speaking African countries.