Health ODA has dropped since 2010
Spain’s funding to global health stood at US$97 million in 2015. This corresponds to 5% of its total ODA, which is below the OECD Development Assistance Committee (DAC) member average of 9%. Although health is underlined as a key strategic priority in the ‘Master Plan for Spanish Cooperation 2013-2016’, this did not prevent cuts to the health sector during and after the economic crisis. Within its health ODA, Spain takes a rights-based and equity approach: it focuses on strengthening universal health coverage by supporting public health systems, as well as on tackling infectious and non-communicable diseases in developing countries.
As for the rest of its ODA, Spain chooses to channel the majority of its funding to health through multilateral organizations: 61% in 2015 (US$59 million). Most of this funding is made up of assessed contributions, such as binding contributions to the European Union (EU) (37% of total health ODA; US$36 million) and funding for the International Finance Facility for Immunization (IFFIm; 11%; US$10 million) and WHO (11%; US$10 million).
Bilateral cooperation accounts for 39% of Spain’s ODA for health in 2015. Spain focuses over one-third (33%) of its bilateral health funding on health system strengthening (HSS), followed by basic nutrition (17%), reproductive health care (14%), and medical services (5%). This largely corresponds to the priorities outlined in the Master Plan, which focuses on HSS, universal health coverage, the fight against neglected diseases, and family planning. Spain outlines access to medicines and health research and development (see Deep Dive: ‘Global health R&D’ for more details) as priorities under its global public goods policy.
As for commitments to global health, the Spanish government pledged US$240 million to the IFFIm for 2006 to 2025. IFFIm is a long-term financing entity that makes immediate funding available to Gavi, the Vaccine Alliance (Gavi) for immunization programs by issuing ‘vaccine bonds’ in the capital market. Spain had not contributed to the Global Fund since 2010 as a result of budget constraints. At the Fifth Replenishment Conference of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) in September 2016, Spain announced that it would resume funding to the Global Fund as soon as a new government was formed. In November 2016, the Spanish Congress’ Development Committee approved an all-party resolution calling for an overall pledge of €100 million (with €30 million to be disbursed in 2017). At the Replenishment Conference, the Spanish government also announced a US$17 million contribution for the Global Fund’s Debt2Health initiative.
MAEC defines strategic orientations, AECID implements policy
Within the Ministry of Foreign Affairs and Cooperation (MAEC), the most relevant departments covering health issues are the General Directorate for Sustainable Development Policies (DGPDS) and its health division. With regards to implementation, the Spanish development agency AECID covers health-related programs through its Directorate for Multilateral and Sectoral Cooperation and its regional departments (i.e., the Directorates for Africa and for Latin America), which manage bilateral programs on the ground. In addition, the Ministry of Health provides advice to MAEC and AECID on key issues, and attends some global health forums such as the World Health Assembly.