Australia - Global health
At a glance
Health is one of Australia’s development priorities, but funding has recently declined
According to data from the Organisation for Economic Co-operation and Development (OECD), Australia’s total ODA to health in 2016 (the latest year for which multilateral and bilateral data is available) was US$366. This represented 11% of total ODA in that year. 49% was channeled to multilaterals and 51% of funds were provided bilaterally.
Between 2017 and 2018, Australia’s bilateral health ODA grew for the first time since 2012, from US$188 million to US$298 million (or 12% of Australia’s total bilateral ODA in 2018). Despite being one of Australia’s strategic development priorities, the emphasis on health in many bilateral programs has reduced in recent years, particularly for HIV/AIDS and reproductive health care.
In addition to bilateral funding to health, Australia channels some of its ODA to multilateral organizations. Australia will likely continue to support health multilaterals, which the government has recognized as key to the global COVID-19 response. Australia pledged to contribute US$10 million to the Global Polio Eradication Initiative (GPEI) for 2021-2023. This follows a larger contribution of A$18 million (US$13 million) to GPEI for 2019 to 2020. Other key multilateral partners include the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund; US$163 million contributed for 2017-2019 and US$164 million pledged for 2020-2022) and Gavi, the Vaccine Alliance (Gavi; US$156 million pledged in direct funding and US$78 million to the International Finance Facility for Immunization for 2016-2020). At the June 4 Global Vaccine Summit 2020, Australia pledged A$300 million (US$224 million) to Gavi for 2021-2025. This is the largest contribution made by Australia in recent years and marks a return to funding levels seen under the previous Labor Party (center-left) government; however, while the country's funding for Gavi has returned to pre-2013 levels, Australia's overall development budget remains far lower than under the previous government (A$4.8 billion or US$3.6 billion at the time of the comparable Gavi pledge). Given the A$4.0 billion (US$3.0 billion) cap on ODA (which remains in place, despite the exacerbated development needs caused by COVID-19), the government’s pledge to increase funding to health multilaterals has raised concern among experts and civil society groups about the likelihood of cuts to other programming, which will be necessary to cover the costs of Australia’s growing multilateral contributions.
Overall, health ODA, as with other components of the development portfolio, has suffered from budget cuts in recent years, decreasing by more than 25% since its peak in 2012. The FY2019/20 budget reflected an increase in funding to health due to the creation of, and subsequent redirection of funding to, the Indo-Pacific Centre for Health Security. This investment is part of the government’s increasing interest in regional health security (see also, Sector: ‘Global health R&D’). It also included a larger than usual disbursement to the Global Fund, in line with its multi-year replenishment cycle. The FY2019/20 budget allocates a total of A$546 million (US$408 million) to health (including both bilateral and multilateral funds), which amounts to 14% of the overall ODA budget. Given the more limited scope of the FY2020/21 budget document (see section: Budget structure), it is difficult to determine the exact volume of funding allocated to this sector for the coming year. However, the budget does reveal that within global health programs, funding for ‘Health, Water and Sanitation’ increased by 64% compared to FY2019/20 to reach A$168 million (US$126 million). According to a recent DFAT briefing, health sector spending overall could rise to around 18% in FY2020/21 due to the COVID-19 response.
Australia’s latest development policy, ‘Partnerships for Recovery: Australia’s COVID-19 Development Response’, launched in May 2020, is oriented toward COVID-19 response and recovery efforts, and therefore includes health — in particular health security in the Indo-Pacific — as a key pillar. The policy names emergency health and humanitarian assistance as the foremost immediate concern. This is also reflected in the latest budget (FY2020/21) which outlines a 6% increase in funding for ‘Humanitarian, Refugees and COVID-19 Response’, which now sits at A$476 million (US$355 million). The increase is mainly due to a rise in funding for the Emergency Response Fund. Longer-term health system strengthening is also a priority, in particular, immunization, maternal healthcare, family planning, and efforts to prevent future pandemics. Through their development assistance, the government plans to help partner countries “contain the spread of the virus, conduct public health awareness campaigns, support local health systems with equipment and training, and facilitate the supply of essential goods”. Australia’s policy also commits to investing in water, sanitation, and hygiene (WASH) projects and to supporting organizations combatting gender-based violence and ensuring adequate provision of sexual and reproductive health services during the pandemic. Australia will also fund global research and development (including multilateral initiatives) for COVID-19 vaccines, diagnostics, and therapeutics (see sector: ‘Global health R&D’).
Even before the release of this new policy, in the first half of 2020, Australia was supporting the global community and its neighbors in the Pacific in particular with their response to the COVID-19 crisis. In FY2019/20, A$280 million (US$209 million) in ODA was redirected from the humanitarian emergency budget and bilateral country programs toward the COVID-19 response. This included A$205 million (US$153 million) to the Pacific, particularly in the areas of technical assistance and supplies, laboratory diagnosis, managing personnel shortages, surveillance, and response budgeting; A$25 million (US$19 million) to the Australian Humanitarian Partnership; A$80 million (US$60 million) to the Gavi-COVAX Advance Market Commitment, a global effort to ensure any newly developed COVID-19 vaccine will be equitably distributed to low-income countries; and A$83 million (US$62 million) to the Association of Southeast Asian Nations (ASEAN) including A$60 million (US$45 million) under the Partnerships for Recovery Strategy. The FY2020/21 budget announces further funding to support the Pacific and Timor-Leste with their recovery from the crisis, however, these funds will likely be used to mitigate the economic rather than health costs of the pandemic.
Australia’s bilateral development financing focuses on the Indo-Pacific region, with health specifically focused on Southeast Asia and the Pacific. The largest share of bilateral health investments in 2018 was in health policy and administrative management (21%). Funding to this subsector increased by 72% compared to 2017. Infectious disease control (19% of bilateral funding to health in 2018) saw an even larger spike in funding of 243%. This increase includes Australia’s efforts to tackle outbreaks of tuberculosis and polio in the Indo-Pacific. The epidemic of drug-resistant tuberculosis in Papua New Guinea was of particular concern to Australia because of the high rates of customary travel by indigenous groups between the two countries. Assistance in funding to basic health care remained steady, receiving 13% of Australia’s bilateral ODA to health.
In October 2017, the Department of Foreign Affairs and Trade (DFAT) launched the Indo-Pacific Health Security Initiative and committed A$300 million (US$224 million) in ODA over five years for tackling emerging health-security risks. The initiative is the vehicle for continuing funding of Product Development Partnerships (PDPs), policy analysis on future emerging infectious disease programs, capacity building, and expert placements through a new Health Security Corps. In May and June 2020, under the Indo-Pacific Health Security Initiative, the Australian government committed funds to the Coalition for Epidemic Preparedness Innovations (CEPI) and The Foundation for Innovative New Diagnostics (FIND) for COVID-19 vaccine and diagnostic research and development (see sector: ‘Global health R&D’).
Australia is committed to promoting gender equality across its development program (see Sector: ‘Gender equality’). In the field of health, Australia supports sexual and reproductive health rights (SRHR), family planning, and maternal health, with a strong focus on the Indo-Pacific region (as will all the country’s ODA). In August of 2018, Australia’s DFAT entered into a partnership with the United Nations Population Fund (UNFPA) and six Pacific governments, investing A$30 million (US$22 million) in a four-year ‘Transformative Agenda for Women, Youth and Adolescents’ program. The program works to improve access to sexual and reproductive health and rights (SRHR) with a focus on family planning. This was complemented by additional contributions to the UNFPA in 2018 of US$7 million in core contributions and US$8 million to support UNFPA Supplies. Specific areas of collaboration include population data and family planning.
The Human Development and Governance Division (HGD) in DFAT leads on policy development related to global health issues
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 while considering partner countries’ priorities.
The Human Development and Governance Division (HGD) 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 other government partners (including the Health Department and Therapeutic Goods Administration), to plan and adjust pipeline investments.