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This paper examines how international public health has been transformed over two decades through the increasing use of tools combining medical and financial appraisal. The argument is that the neoliberalism behind what is now called “global health” is less about the maximum downsizing of State involvement than a redefinition of their role in health matters, dominated by the issue of investment performance and the rollout of an “audit culture.” To discuss this perspective, the article examines the path and effects of two new government instruments: international public-private partnerships and the calculation of DALYs, a specific method for assessing disease incidence and the performance of health actions, which has been promoted by the World Bank and WHO since the early 1990s.