France’s bilateral health ODA decreased from US$452 million in 2010 to US$211.3 million in 2011. The decrease was, however, mainly due to the fact that contributions to UNITAID — previously reported as bilateral ODA for basic health care (US$242 million in 2010) — were counted as multilateral contributions for the first time in 2011. French bilateral ODA prioritized basic health care (19.7%), health policy and administrative management (15.9%), and reproductive health care (12.2%) in 2011. 38% of France’s bilateral ODA to health is managed by AFD (the Ministry of Higher Education and Research and the MAE manage 22.8% and 29.3% of bilateral ODA to health respectively). Loans made up 11% of bilateral health ODA which is consistent with AFD’s desire to provide mostly grants to this sector.

AFD finances projects in the health sector that focus on three areas: maternal and child health, the fight against communicable diseases and pandemics, and health systems strengthening. Most AFD projects involve the financing of equipment, medication and the extension of health care coverage. These axes are consistent with the overall strategy set by the MAE. Sub-Saharan and Northern Africa were the main regional recipients of gross bilateral ODA for health in 2010 (49.7% and 11.8% respectively).

The key recipient of France’s multilateral investments in global health is the Global Fund (US$458 million or €330 million in 2011). France is the 2nd largest contributor to the Global Fund (after the United States), with accumulated total contributions of US$3.3 billion since the organization’s creation in 2002. This includes a recent pledge of €1.18 billion (US$1.4 billion) for the 2011—2013 replenishment period. France is also the leading contributor to UNITAID (US$144 million or €104 million in 2011). It levies a solidarity airline tax to raise funds for UNITAID and to meet part of its commitment to the Global Fund. In June 2011, France made a direct commitment of €100 million (US$146 million) to the GAVI Alliance for 2011—2015, adding new funding to its prior contributions over US$19 million (€13 million) in 2004—2006. With a total commitment of US$1.7 billion (€1.2 billion) for 2007—2026, France is also the 2nd largest contributor to IFFIm after the UK. In addition, between 2006—2009, France has contributed a cumulative total of US$15.5 million (€11 million) to the Global Polio Eradication Initiative (GPEI), but no additional pledges have been made since then.

Further contributions to multilateral health initiatives in 2010 include funding for the European Union institutions (US$103.7 million, or €78.3 million]), the World Bank (US$44.4 million, or €33.5 million), the WHO (US$29.9 million, or €12.6 million), and to other UN organizations (US$6.4 million, or €4.8 million). France’s preference for financing global health via multilateral channels is likely to continue given that the Global Fund received explicit and strong political support from former President Sarkozy and former First Lady Carla Bruni-Sarkozy (who is the Global Fund Ambassador for Protecting Women and Children against AIDS). This support was reaffirmed by the new President, François Hollande, in July 2012.

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