Health is a priority of French development policy; support to multilateral organizations is strong
France is the fourth-largest donor country to global health, following the US, the UK, and Germany; its contributions reached US$944 million in 2016 a 16% increase from 2015. This is slight below a peak in 2014 that was largely due to a US$267-million loan to Colombia, to support the country’s health system. In total, in 2016, France allocated 8% of its ODA to health: this is on par with the average spent on health by the donors of the Development Assistance Committee (DAC) of the OECD. Health is a strategic priority of French development policy, as reiterated in the conclusion of the Interministerial Committee for International Development Cooperation (CICID) in February 2018.
Next to France’s traditional focus on the fight against AIDS, tuberculosis, and malaria, on maternal and child health, and on universal health coverage (UHC), the strategy for global health for 2017 to 2021 emphasizes four priorities for health interventions: 1) health systems strengthening (HSS), 2) global health security, 3) the promotion of health for the most vulnerable, and 4) the development of expertise, innovation and research in global health. 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 with regard to maternal and newborn health, and sexual and reproductive health and rights (SRHR). In 2016, the Ministry of Foreign Affairs (MAE) published its 2016-2019 strategy on SRHR. Within this sector, French ODA focuses on three areas: First, HSS, second, family planning and access to contraception, and third, facilitating youth access to SRHR.
Priority countries for bilateral cooperation on health:
- 19 ‘Priority countries’ almost all in sub-Saharan Africa: Benin, Burkina Faso, Burundi, the Central African Republic, Chad, Comoros, Democratic Republic of the Congo, Djibouti, Ethiopia, Gambia, Guinea, Haiti, Liberia, Madagascar, Mali, Mauritania, Niger, Senegal, and the Togo.
- Crisis and post-crisis areas, including Afghanistan, Palestine, Haiti and Côte d'Ivoire
- Mediterranean region
Global health is also a key sector for France’s multilateral engagement. In 2016, France channeled 70% of its health ODA multilaterally (US$658 million), which is a much higher share than average among DAC countries (56%). In 2016, France delivered 45% of its total health ODA to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), and France remains the second-largest donor to the Global Fund after the US. France pledged €1.1 billion (US$1.3 billion) to the Global Fund for the 2017-2019 period. Other key multilateral recipients are the EU institutions, the World Bank’s International Development Association (IDA), and the International Finance Facility for Immunization (IFFIm). France 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 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. France plans on allocating €85 million annually to the organization, drawn from innovative finance mechanisms such as its financial transaction tax (FTT) and air ticket levy. 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.
Due to its strong support for global health through multilaterals, bilateral ODA accounted for only 30% of health ODA in 2016 (US$287 million), a 70% increase compared to 2015. This increase is driven by a US$100 million-increase in funding for infectious diseases control in 2016, making it the largest sub-sector of France’s bilateral health ODA. This is largely accounted by a US$111 million loan to Gavi for the purchasing of vaccines and for health systems strengthening programs targeting the Sahel region. This strongly aligns with strategic priorities of global health. Funding for medical services (13%) and personnel development for population and reproductive health (9%) follow. Geographic focus areas of France’s bilateral support for health are its 19 priority countries in sub-Saharan Africa (the ‘pays pauvres prioritaires’, or ‘PPPs’), the Mediterranean region, and crisis and post-crisis areas.
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 ‘Subdirectorate 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.