Health is one of Australia’s development priorities but overall health funding has recently declined

‘Health and education’ is one of the six priority areas of the government’s development strategy. In 2016, Australia invested US$347 million on health official development assistance (ODA), equivalent to 11% of total ODA. This is higher than the average health ODA spent by other members of the Organisation for Economic Co-Operation and Development’s (OECD) Development Assistance Committee (DAC; the average is 8%). This makes Australia the 10th-largest donor to health in absolute amounts.

Health ODA as a proportion of total ODA is expected to have increased to 13% in fiscal year (FY) 2016-17 and remain at this level in FY2017-18, according to the budgets for these years. This makes it Australia’s fifth-largest investment priority in FY2017-18.Health ODA in absolute terms, as with other components of the development portfolio, has suffered from budget cuts in recent years, decreasing by 22% between 2013 and 2016. However, the budget for FY2017-18 indicates this will not decrease further.

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Australia delivered almost half of its health ODA multilaterally (49%, or US$170 million in 2016), which is lower than the DAC average (56%). The Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) and Gavi, the Vaccine Alliance (Gavi) were the two main recipients of Australia’s multilateral health ODA, with respectively 40% and 26%.

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At the Global Fund’s 2016 replenishment conference, Australia increased its pledge by 10% (from A$200 million, US$149 million for 2014 to 2016), to A$220 million (US$164 million for 2017 to 2019). Australia’s commitment to Gavi, the Vaccine Alliance, is similar in size at A$250 million (US$186 million) over four years (2016 to 2019). In June 2017, Australia announced a contribution to the Global Polio Eradication Initiative (GPEI; US$13 million for FY2019-2020). This makes a total of A$104 million (US$77 million) that Australia has contributed to GPEI since 2011.   

Australia also pledged A$1.6 billion (US$1.2 billion) for 2011-2015 to the Global Strategy for Women’s and Children’s Health. Australia did not meet its aim of doubling annual family planning contributions that it set as part of this commitment, spending only A$17 million (US$13 million) in FY2015-16 compared to the promised A$53 million (US$39 million) annual spending by 2016.

In February 2017, Minister for Foreign Affairs Julie Bishop announced A$9.5 million (US$7 million) in financing to the International Planned Parenthood Federation to deliver the Sexual and Reproductive Health Program in Crisis and Post-Crisis Settings (SPRINT) in the Indo-Pacific region over three years. The investment aims at strengthening sexual and reproductive health, rights, and support during humanitarian crises.

At the family planning summit in July 2017, Australia also committed A$30 million (US$22 million) to family planning in the South Pacific, partnering with UNFPA. This is complemented by a further pledge of A$3.5 million (US$2.6 million) to support UNFPA Supplies.

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Priority countries for bilateral cooperation on health for FY2017-18:

  • Cambodia
  • Papua-New Guinea
  • Solomon Islands
  • Timor-Leste

Australia’s bilateral ODA to health amounted to 51% (US$178 million) of total health ODA in 2016. This corresponds to 8% of Australia’s total bilateral ODA (DAC average: 6%). Earmarked funding to multilaterals amounted to US$55 million of bilateral ODA to health. Australia’s bilateral development financing focuses on the Indo-Pacific region, with health specifically focused on Southeast Asia and the Pacific. The majority of bilateral health investments in 2016 were for infectious disease control (30%), followed by sexually transmitted disease (STD) control, including HIV/AIDS (23%), health policy and administrative management (14%), basic health care (11%), and reproductive health care (8%).

Australia’s five priority areas in health are: 1) health systems strengthening (HSS); including maternal, newborn and child health (MNCH), and family planning services; 2) cross-border health threats (including HIV, tuberculosis, and malaria); 3) effective global health response (including through engagement with global health funds); 4) access to water, sanitation, and hygiene (WASH) and nutrition; and 5) health innovation (including research and development (R&D)).

Despite being one of Australia’s strategic development priorities, the priority given to health in many bilateral programs has reduced in recent years, particularly for HIV and reproductive health care. Australia’s regional HIV initiative in East Asia has ended. HSS and HIV programs in Indonesia have not been extended beyond 2016.

In Papua New Guinea (PNG), the government has shifted its focus from direct health service delivery towards building the PNG government’s capacity to deliver its own health programs, which civil society fears may affect their HIV funding. Due to criticism, Australia reinstated some HIV funding for civil society. National financial problems in PNG have prompted Australia to increase tuberculosis program funding to respond to increasing multi-drug resistant tuberculosis problems in three provinces.

In October 2017 the government committed A$300 million (US$223 million) in ODA over five years for a regional health-security fund. This is aimed at tackling emerging health-security risks. The initiative will be the vehicle for continuing funding of PDPs, policy analysis on future emerging infectious disease programs, capacity building, and expert placements through a new Health Security Corps. An Indo-Pacific Centre for Health Security has been established within the Department of Foreign Affairs and Trade (DFAT) to manage this initiative.

The Development Policy Division in DFAT leads on policy development within global health

Australia’s development investments in health are guided by the ‘Health for Development Strategy 2015-2020’. Funding to meet the goals of the strategy comes from country, regional, and global programs, and are delivered through the regular budget process. Priorities and delivery strategies are set by the relevant program areas, taking into account partner countries’ priorities.

The Development Policy Division of DFAT is the driver of health development policy and provides operational guidance to assist with the implementation of the strategy, for example, on health systems reform, regional health security, private sector engagement, nutrition and health, and WASH. It works closely with the Indo-Pacific Centre for Health Security, other DFAT programs, and external partners, including the Therapeutic Goods Administration, to plan and adjust pipeline investments.