France - Global health
At a glance
Health is a priority of French development policy; France hosted the 2019 Global Fund replenishment
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. It is a key area of its multilateral engagement, and France successfully hosted the sixth replenishment conference of the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund) for the 2020-2022 period, in 2019.
France’s health strategy, promoted by a thematic Global Health Ambassador, has traditionally included the fight against HIV//AIDS and tuberculosis, and the promotion of universal health coverage (UHC). The strategy for global health for 2017-2021 emphasizes four additional priorities for health interventions:
- Health systems strengthening (HSS);
- Global health security;
- Promotion of health for the most vulnerable; and
- Development of expertise, innovation, and research in global health.
In 2019 France was the fifth-largest donor country to health. Its total official development assistance (ODA) to the sector stood at US$935 million, a 1% increase from 2018, and accounted for 6% of its total ODA, on par with the Organisation for Economic Co-operation and Development (OECD) Development Assistance Committee (DAC) average. In 2019, 33% of funding to health was channeled bilaterally and 67% as core funding to multilaterals. France’s multilateral engagement in this sector is much higher than other DAC countries who, on average, channeled 50% of their ODA to multilateral organizations in 2019.
France’s bilateral ODA to health increased by 35% from 2018 to reach US$308 million in 2019. The largest share of this funding was allocated to health policy and administrative management (31%), basic nutrition (13%), and basic health care (11%).
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 to 2019. The focus is on the intersection of social protection and global health, particularly regarding 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: HSS, family planning and access to contraception, and facilitating youth access to SRHR.
France is a pioneer in supporting innovative financing mechanisms for health. It is the second-largest donor to 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 (ACT) Accelerator, a global collaboration to accelerate development, production, and equitable access to COVID-19 tests, treatments, and vaccines.
As host of the Global Fund’s sixth replenishment, France pledged €1.3 billion (US$1.4 billion) towards its US$14 billion target, a 20% increase over its contributions for the previous pledging period of 2016-2020. 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. The renewal will see the initiative increase its activity from providing 5-7% of France’s Global Fund contribution through Expertise France to 9% (i.e. €39 million or US$44 million per year). The Global Fund, UNITAID, and IFFIm are all quoted in the 2017-2021 ‘Strategy for multilateral aid’ as key partners of France’s multilateral engagement.
As of April of 2021, France has provided US$185 million to ACT-A. In May of 2020, France had announced it would contribute €500 million (US$590 million) to ACT-A. This included:
- Vaccines: €100 million (US$118 million) was announced conditionally for Gavi and confirmed at the Paris Peace Forum on November 12, 2020, to accelerate the pace of research and development of a vaccine that must be accessible and affordable to all. In addition, €50 million (US$56 million) was pledged to CEPI.
- Therapeutics: €10 million (US$12 million) has been confirmed for Unitaid to carry out the essential work necessary to guarantee equitable access to resources to eliminate COVID-19, in particular regarding patents; and
- Health systems: US$56 million has been confirmed to support the WHO.
These multilateral efforts complement the COVID-19 Health in Common bilateral response initiative of €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 on the ground against COVID-19 (NGOs, foundations, networks, research centers, etc.).
The MAE’s sub-directorate for human development leads on global health
The MAE drives the development of 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 lead role.