Health is a priority of French development policy; support to multilateral organizations is strong
France is the fifth-largest donor to global health, following the US, the UK, Germany, and Canada; its contributions reached US$902 million in 2015, down from US$1.3 billion in 2014. A peak in 2014 was largely due to a US$300-million loan to Colombia, to support the country’s health system. The decrease in health ODA between 2014 and 2015 is thus largely within France’s bilateral cooperation: it went from US$565 million in 2014 down to US$199 million in 2015. In total, France allocated 7% of its ODA to health: this is below the average spent on health by the donors of the Development Assistance Committee (DAC) of the OECD, which stands at 9% in 2015. Health remains nonetheless a strategic priority of French development policy, as reiterated in the conclusion of the Interministerial Committee for International Development Cooperation (CICID) in November 2016.
Next to France’s traditional focus on the fight against AIDS, tuberculosis, and malaria, on maternal and child health, and on universal health coverage (UHC), the strategy for global health for 2017 to 2021 emphasizes four priorities for health interventions: 1) health systems strengthening, 2) global health security, 3) the promotion of health for the most vulnerable, and 4) the development of expertise, innovation and research in global health. The bilateral chapter of France’s health ODA policy is mainly carried out by the French Development Agency (AFD). AFD defines the main objectives of its policy in the sectoral intervention framework for 2015 to 2019: The focus is on the intersection of social protection and global health, particularly with regard to maternal and newborn health, and sexual and reproductive health and rights (SRHR). In 2016, the Ministry of Foreign Affairs (MAE) published its 2016-2019 strategy on SRHR; Within this sector, French ODA focuses on three areas: 1) HSS, 2) family planning and access to contraception, and 3) facilitating youth access to SRHR.
In March 2016, President Hollande announced that France will intensify its focus on strengthening countries’ capacities to respond to health crises, on improving global coordination for health security and surveillance, and on global health R&D, as part of its response to the Ebola crisis.
Priority countries for bilateral cooperation on health:
- 16 ‘Priority countries’ in sub-Saharan Africa: Benin, Burkina Faso, Burundi, Central African Republic, Chad, Comoros, Dem. Rep of the Congo, Djibouti, Guinea, Madagascar, Mali, Mauritania, Niger, Rwanda, Senegal, Togo
- Crisis and post-crisis areas, including Afghanistan, Palestine, Haiti, and Côte d'Ivoire
- Mediterranean region
In 2015, France channeled 78% of its health ODA multilaterally (US$703 million), which is a much higher share than average among DAC countries (55%). This share significantly increased between 2014 and 2015: This was due to the loan to Colombia, which accounted for the high level of bilateral cooperation in 2014. In absolute terms, funding to health multilaterals in 2015 slightly decreased, from US$712 million in 2014. In 2015, France delivered 44% of its total health ODA to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), making it the second-largest donor to the Global Fund after the US. France maintains its high level of contribution to the Global Fund for the 2017-2019 period, with a pledge of €1.1 billion (US$1.5 billion).
Other key multilateral recipients are the EU institutions, the World Bank’s International Development Association (IDA), and the International Finance Facility for Immunization (IFFIm). France is the second-largest donor to IFFIm, a financing entity that makes immediate funding available to Gavi, the Vaccine Alliance (Gavi) for immunization programs by issuing ‘vaccine bonds’ in the capital market. In 2006, France introduced an airline ticket tax to fund UNITAID, a global health initiative that aims to make prevention, diagnostics, and treatment of HIV/AIDS, tuberculosis and malaria affordable and widely available. France is the largest contributor to UNITAID with an annual contribution of €210 million, financed by France’s financial transaction tax (FTT).
In 2014, France spent 22% of its health ODA (US$199 million) bilaterally. This corresponds to only 2% of France’s bilateral ODA for all sectors, far below the DAC countries’ average (9%). Much of the 65% decrease in bilateral health ODA between 2014 and 2015 is due to a US$300 million loan to Colombia in 2014, for health system strengthening purposes.
In line with one of France’s strategic priorities, the largest sub-sector within bilateral health ODA in 2015 was infectious diseases control (20%), followed by reproductive health care and basic health care (each 13%). Geographic focus areas of France’s bilateral support for health are its 16 priority countries in sub-Saharan Africa (the ‘pays pauvres priotitaires’, or ‘PPPs’), the Mediterranean region, and crisis and post-crisis areas.
The MAE’s sub-directorate for human development leads on global health
The MAE drives the development of strategies for French development policy, including around global health. Within the MAE, global health is covered by the ‘Subdirectorate for Human Development’ (HUMA), within the Directorate-General for Globalization, Culture, Education and International Development (DGM). When it comes to the design of specific AFD programs related to global health, AFD’s ‘health and social protection’ department, a sub-section of the ‘Human development department’, plays the lead role.