The research assesses the notions of accountability and country ownership in Global Health using the Global Fund (GF) as a case study. We evaluate the power asymmetries that exist at various levels of the GF and take insight from beneficiaries and engaged stakeholders to understand how to solutionize through a decolonial framework, the structural barriers to centering the key populations most impacted in decision-making and program development for better outcomes. We explore the critical question of how the GF impacts the axis of accountability between governments and their people.