New forms of aid, including “philanthrocapitalism” such as The Bill and Melinda Gates Foundation, are rapidly altering the international aid architecture for health. These organisations have financial power, actively shape agendas and influence policy. The rise of non-traditional donor organisations creates opportunities and has implications for Australia as it scales-up its aid program. AusAID could collaborate, complement, compete with, or copy these organisations. Arguably the biggest strategic implication is that they expand AusAID’s programming choices. This increased flexibility could be used to leverage and accelerate further reforms in the UN and elsewhere. But choice is a two way street. Developing countries may prefer large, grant financing from non-traditional aid organisations and choose to bypass traditional multilateral and bilateral development agencies.