France - Global health
At a glance
Health is a priority of French development policy; France hosted 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 February 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 (Global Fund) for the 2020-2022 period, in October 2019, in Lyon.
France’s health strategy, promoted by a thematic Global Health Ambassador, has traditionally included the fight against AIDS and tuberculosis, and universal health coverage (UHC). The strategy for global health for 2017 to 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 2016 (the latest year for which both bilateral and multilateral OECD data is available), France was the fourth-largest donor country to health. Its total official development assistance (ODA) to the sector stood at US$1.0 billion, a 17% increase from 2015, and accounted for 8% of its total ODA (on par with the Organisation for Economic Co-operation and Development (OECD) Development Assistance Committee (DAC) average. In 2016, 30% of funding to health was channeled bilaterally and 70% as core funding to multilaterals. France’s multilateral engagement in this sector is much higher than the average among DAC countries, which channeled on average 56% of their ODA to multilateral organizations in 2016.
Since 2016, France’s bilateral ODA to health has decreased. Bilateral health ODA peaked at US$311 million in 2016 due to a US$113 million project to the sub-Saharan region focused on infectious disease control. It dropped significantly in 2017 to US$181 million, before increasing again to US$243 million in 2018 (a 34% rise). In 2018, the largest share of the funding was allocated for basic health care (29%), medical services (18%), and medical research (14%).
The bilateral chapter of France’s 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 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$100 million) annually to the organization, drawn from innovative finance mechanisms such as its financial transaction tax (FTT) and air ticket levy.
As host of the Global Fund’s sixth replenishment, France pledged €1.3 billion (US$1.5 billion) towards its US$14 billion target. This is a 20% increase compared to its contributions for the previous pledging period (2016 to 2020). In February 2020, the MAE and Expertise France – France’s public technical cooperation agency – renewed their 5% Initiative for 2020-2022. The 5% Initiative 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$46 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.
In April 2020, and as a response to the COVID-19 outbreak, France launched the ‘COVID-19 – Health in Common’ initiative aimed at mitigating the public health crisis caused by the pandemic in African countries, providing it with €1.2 billion (US$1.4 billion). The AFD is taking part in this initiative by financing six new projects worth a total of €12 million (US$14 million) with a particular focus on the urgent needs of research, monitoring, testing, formulating effective health policies, and patient treatment.
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.