The implementation of the Global Fund tuberculosis project in Somalia provides a compelling example of national participation and international donor coordination to provide lifesaving health services in a country riddled with conflict and a debilitated infrastructure. The success of the negotiations was largely attributable to a flexible and participatory based framework, cooperation between the national governments, civil society and international actors, all of whom were unified by a commitment to public health. The negotiation process reveals that only through an adaptable and inclusive course of action, guided by the principles of accountability and transparency, was any progress made in providing health services in a fragile state.