Strong focus on SRHR; Sweden channels a vast share of its health ODA multilaterally

Sweden’s funding to global health stood at US$508 million in 2015, or 7% of its total ODA. This is below the average among members of the Development Assistance Committee of the OECD (DAC; 9%). ODA to health has remained rather stable since 2013 in absolute amounts. Health features prominently in the priorities set in Sweden’s 2016 Aid Policy Framework. Gender equality has been a key element of Sweden’s interventions in global health, especially since Sweden’s adoption of the ‘feminist foreign policy’ for 2015 to 2018.

Sexual and reproductive health and rights (SRHR) is one of six objectives of the policy; funding to this area is expected to increase under the strategy. In the first three months of 2017, in response to the US decision to cut funding to organization providing abortion-related services, the Swedish Government announced increased support to the area: this includes increased support to the UN Family and Population Fund (UNFPA), a €20 million pledge to the ‘She Decides’ initiative (a fund established by the Netherlands to counter the anticipated impact of cuts in US funding), and strengthened involvement towards organizations working around abortion.

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According to the government’s 2015-2019 strategy for SRHR in sub-Saharan Africa, Sweden will allocate US$42 million per year in this region specifically. Funding will focus on four main issues: 1) women’s and children’s health, 2) access to education about SRHR to young women and men, and LGBT, 3) health systems strengthening (HSS) to enable greater access to healthcare, and 4) strengthening of democracy and gender equality based on a human-rights approach. HIV/AIDS interventions are integrated within the first two objectives of the strategy. Other priorities within global health include HSS and healthcare, and non-communicable diseases. Sweden is committed to showing leadership in tackling antimicrobial resistance (AMR), with the Uppsala-based organization ReAct leading a global effort against AMR.

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The Swedish Government chooses to channel most of its health ODA through core contributions to multilateral organizations: US$328 million in 2015, or 65% of Sweden’s total health ODA. This is more than the average share of 55% via multilaterals amongst DAC members. Moreover, almost half of Sweden’s bilateral ODA to health is actually channeled as earmarked funding to multilaterals (US$81 million in 2015). In total, 81% of Swedish health ODA went to or through multilateral organizations. The largest recipient of Swedish core contributions to health multilaterals is the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund): it receives around 20% (US$100 million in 2015) of Sweden’s total contributions to the health sector. For the Global Fund’s 2017-2019 replenishment period, Sweden pledged US$347 million to the organization. In line with its overall multilateral funding, the Swedish Government is also a strong supporter of UN agencies: altogether they receive about one-quarter of Sweden’s total health ODA. In addition, Sweden is the third-largest funder per capita to Gavi, the Vaccine Alliance (Gavi). Sweden’s total pledge to Gavi for 2016 to 2020 amounts to US$211 million.

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Sweden provided US$180 million as bilateral ODA for health in 2015, or 4% of Sweden’s total bilateral ODA (this includes the US$81 million in earmarked funding to multilaterals mentioned above, which are reported as bilateral ODA). Bilateral funding focused heavily on reproductive health (40% of bilateral health ODA). Sexually transmittable diseases, including HIV/AIDS control, is the second-largest sector of bilateral health ODA (16%). In addition, Sweden allocated US$29 million to social mitigation of HIV/AIDS in 2015, which is not accounted for as health ODA. Medical research and basic health care follow, with 16% and 10% respectively. Health is currently a priority sector in nine country strategies, 1 seven of which belong to the largest recipients of Sweden’s bilateral health ODA (see box).

The largest recipients of Sweden’s bilateral health cooperation are nine countries, all low-incomes or lower-middle income economies:

  • Bangladesh
  • Democratic Republic of the Congo
  • Ethiopia
  • Mozambique
  • Myanmar
  • Somalia
  • Tanzania
  • Uganda
  • Zambia

The MFA leads on strategy; Sida manages the implementation of bilateral cooperation

Within the Ministry of Foreign Affairs (MFA), the main departments that focus on global health are the UN Policy Department, in charge of relations with global health funds and the Department for International Development Cooperation that coordinates thematic and strategy development for Sida. With regards to global health, the most important division within Sida is the Social Development Unit in the Department for International Organizations and Policy Support. Sida’s investments in global health are guided by Sida’s strategy for ‘Sustainable Social Development’, which includes both health and education. For country-specific programming, the respective regional departments take the lead.