France - Global health

Health is a priority of French development policy

Health is a strategic priority of French development policy, as reiterated in the conclusions of the Interministerial Committee for International Development Cooperation (CICID) in 2018 and the 2021 development law. Health is a key area of France’s multilateral engagement, and France successfully hosted the sixth replenishment conference of the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) for the 2020-2022 period in 2019.

The 2021 development law names health as a strategic sectoral priority of French development policy, in line with the 2018 conclusions of the Interministerial Committee for International Development Cooperation (CICID). France’s health strategy, promoted by a thematic Global Health Ambassador, has traditionally included the fight against HIV/AIDS and tuberculosis (TB), and the promotion of universal health coverage (UHC). The strategy for global health for 2017-2021, which, after a review, will be renewed in 2022, emphasizes four additional priorities for health interventions:

  1. Health systems strengthening (HSS);
  2. Global health security;
  3. Promotion of health for the most vulnerable; and
  4. Development of expertise, innovation, and research in global health.

In 2020, France was the fifth-largest donor to health. Its total official development assistance (ODA) to the sector stood at US$1 billion, a 7% increase from 2019, and accounted for 6% of its total ODA, below the Organisation for Economic Co-operation and Development (OECD) Development Assistance Committee (DAC) average of 10%. In 2020, 48% of funding to health was channeled bilaterally and 52% as core funding to multilaterals. While still above the DAC average of 44%, France’s multilateral health ODA has decreased compared to 2019, both in absolute (from US$654 million in 2019 to US$546 million in 2020) and relative terms (from 67% to 52%).

France’s bilateral ODA to health increased by 54% from 2019 to reach US$496 million or 48% of France’s health ODA in 2020, including 4% as earmarked funding to multilaterals. The largest share of this funding was allocated to ‘basic health infrastructure’ (24%), ‘basic health care’ (17%), and ‘infectious disease control’ (15%).

France’s bilateral 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 - 2019. France focuses on the intersection of social protection and global health, particularly emphasizing maternal and newborn health and sexual and reproductive health and rights (SRHR). In 2016, the Ministry of Foreign Affairs (MAE) published its 2016-2020 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. France is reviewing its SRHR strategy, with a new strategy planned for the second half of 2022.

France is a pioneer in supporting innovative financing mechanisms for health. It is the second-largest donor to the International Finance Facility for Immunisation (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 also introduced an airline ticket tax to fund Unitaid, a global health initiative that aims to make the prevention, diagnostics, and treatment of HIV/AIDS, tuberculosis, and malaria affordable and widely available. France is the largest contributor to Unitaid and allocates €85 million (US$95 million) annually to the organization, drawn from innovative finance mechanisms such as its financial transaction tax (FTT) and air ticket levy. In 2020, France pledged an additional US$11 million to the Unitaid COVID-19 response as part of France’s support to the Access to COVID-19 Tools – Accelerator (ACT-A), a global collaboration to accelerate development, production, and equitable access to COVID-19 tests, treatments, and vaccines. Beyond IFFIm, France is a strong supporter of Gavi overall. During the Vaccine Global Summit in June 2020, France pledged €250 million (US$285 million) for Gavi’s 2021-2025 period and €100 million (US$114 million) for the COVID-19 Advance Market Commitment (COVAX AMC), topped up by an additional €100 million (US$114 million) to COVAX AMC in June 2021. During the Second Global COVID-19 Summit in May 2022, France pledged an additional €100 million (US$114 million) to COVAX AMC, bringing France’s total pledge to Gavi to US$783 million for the 2021-2025 period including existing pledges.

As host of the Global Fund’s sixth replenishment, France pledged €1.3 billion (US$1.4 billion) for 2020-2022, a 20% increase over its contributions for the previous 2016-2020 pledging period. In 2020, the MAE and Expertise France – France’s public technical cooperation agency – renewed their ‘5% Initiative’ for 2020-2022, which compliments France’s direct contribution to the Global Fund and mobilizes technical assistance to Global Fund recipient countries. This will increase France’s contribution to the Global Fund between 5-7% provided via Expertise France to 9% (€38 million, or US$44 million per year). The Global Fund, Unitaid, and IFFIm are all listed as key multilateral partners in the 2017-2021 ‘Strategy for multilateral aid’.

As of July 2022, France has provided US$518 million to ACT-A, nearly reaching its May 2020 announcement of a contribution of €500 million (US$570 million) to ACT-A. This includes:

  1. Vaccines: Of the total US$362 million committed to ACT-A vaccines, US$337 million has been pledged to Gavi to accelerate the pace of COVID-19 vaccine research and development (R&D) that is accessible and affordable;
  2. Therapeutics: US$49 million has been confirmed for Unitaid to carry out essential work necessary to guarantee equitable access to resources to eliminate COVID-19, especially regarding patents; and
  3. Health systems: A total of US$80 million has been pledged to ACT-A health systems, including a February 2022 pledge of €50 million (US$ 57 million) to the World Health Organization (WHO) for ACT-A’s Health Systems and Response Connector (HSRC).

Overall, France has doubled its contribution to the WHO since the COVID-19 pandemic, supporting a stronger WHO as principal coordinating health body. Advocating for health systems strengthening, France is committed to building up vaccine production capacity in African countries. Multilateral efforts complement the COVID-19 Health in Common bilateral response initiative, worth €1.2 billion (US$1.4 billion), carried out by the AFD to support hospitals in African countries, regional epidemiological surveillance networks, and all stakeholders actively involved in local and regional COVID-19 response (e.g., NGOs, foundations, networks, research centers, etc.). In total, this bilateral initiative supported 63 new projects in 33 countries. 71% of the activities were carried out in countries on the African continent.

The MAE’s sub-directorate for human development leads on global health

The MAE drives development strategies for French development policy, including around global health. Within the MAE, global health is covered by the ‘Sub-directorate 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 leading role.