Norway - Global health

Global health remains a key priority, with Norway taking international leadership on multilateral initiatives

Norway’s official development assistance (ODA) to health stood at US$514 million in 2019, making it eight-largest Organisation for Economic Co-operation and Development (OECD) Development Assistance Committee (DAC) donor to health in absolute terms. This represented 12% of its total ODA, well above the DAC average of 8% putting Norway in fifth place among OECD DAC countries. Health ODA has remained rather stable at high level (US$510-540 million) over the past five years. According to Norad’s 2020 statistics, Norway’s contributions towards health-related ODA, including core support for multilateral organizations, stood at NOK6.6 billion (US$750 million) in 2020. NOK2.8 billion (US$318 million) of that went toward combatting COVID-19 and its impacts in low-income countries.

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For 2021, the government’s budget line for health ODA stands at NOK4.0 billion (US$450 million), though it is important to note that this budget line only covers parts of Norway’s total health contributions (additional funding comes from multilateral and bilateral cooperation budget lines). It is a slight increase from what was originally budgeted for health in 2020 (NOK3.7 billion, or US$420 million), though following the outbreak of COVID-19, an additional NOK541 million (US$61 million) was added for health in 2020.

Norway’s support to the international response to COVID-19 reached NOK12 billion (around US$1.4 billion) at the end of 2020. Norway has been particularly supportive of the Access to COVID-19 Tools Accelerator (ACT-A): it is one of its four leaders (along with South Africa, the WHO, and the European Commission), and has pledged a total of US$470 million (4.3% of the total) to the facility. The majority of this funding (US$390 million) will go toward the COVID-19 Vaccines Advance Market Commitment (COVAX AMC). Note that not all ACT-A funding is reportable as ODA.

Over the past ten years, Norway has been an international champion and influential actor in the field of global health. The former Prime Minister (PM), Jens Stoltenberg, placed global health high on the government’s agenda, and the current PM, Erna Solberg, has maintained this focus during her two terms.

Global health is one of five development policy priorities spelled out in the Ministry of Foreign Affairs’ (MFA) 2016 white paper, ‘Common responsibility for a common future – the Sustainable Development Goals and Norwegian Development Policy’. The strategy paper ‘Global health in foreign and development policy’ (2012) — which remains the most comprehensive summary of Norway’s focus areas in global health, — outlines three priorities for the sector: 1) Mobilizing at an international level for women’s and children’s rights and health; 2) reducing the burden of disease, with an emphasis on prevention; and 3) promoting human security through health. This is still an accurate statement of the current government’s priorities.

In early 2020, the Norwegian government published its strategy specifically on non-communicable diseases, titled ‘Combating Non-Communicable Diseases in the Context of Norwegian Development Policy (2020-2024). This document highlights three priorities: 1) preventing and reducing risk; 2) strengthening health systems, with a focus on primary healthcare; and 3) supporting global public goods. Norway also tackles global health issues through its work on gender equality. Core components are sexual and reproductive health and rights (SRHR; for more details see our Donor Tracker’s insights piece: ‘Generation Equality? Trends from a decade of donor funding for SRHR’), maternal health, and safe and legal abortions.

In addition, health is a key component of Norway’s humanitarian efforts. In its 2018 humanitarian strategy, the government committed to supporting lifesaving and basic health services in connection with Norway’s humanitarian efforts. This commitment aimed to increase support for SRHR in crisis situations, as well as to promote closer coordination between humanitarian and development efforts in health.

In line with its overall ODA policy, much of Norway’s funding for health goes through the multilateral system. In 2019, Norway channeled 53% of its total health ODA as core contributions to multilaterals (DAC average: 50%). In addition, it provided 33% as earmarked funding through multilateral organizations (funding channeled through multilateral organizations but earmarked by Norway for a specific purpose). Norway’s commitment to multilateral funding for global health was cemented in the white paper entitled ‘Norway’s Role and Interests in Multilateral Cooperation’, published in June 2019.

Key multilateral partners include Gavi, the Vaccine Alliance (Gavi; 26% of Norway’s health ODA in 2019), and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund; 16%). These multilaterals will remain key partners: In May 2020, as part of its international response to the COVID-19 crisis, the government announced a US$1.1 billion pledge for Gavi for 2021 to 2030, split between US$655 million in direct contributions to Gavi (2020 to 2025) and US$421 million contributions for the International Finance Facility for Immunisation (IFFIm; 2021 to 2037). Norway’s pledge for the Global Fund amounts to US$224 million for 2020 to 2022. (See section ‘global health R&D’ for information on support to the Coalition for Epidemics Preparedness Innovations, CEPI).

Other important multilateral recipients of Norway’s ODA include the United Nations Population Fund (UNFPA; 4% of Norway’s health ODA in 2019), and the Global Financing Facility (GFF).  Norad, Norway’s international development agency, highlights the UNFPA as Norway’s single largest partner for SRHR. UNFPA received more than 40% of the NOK1.6 billion (US$182 million) Norway dedicated to the issue in 2019. In November 2018, Norway co-hosted the GFF replenishment conference (of which it is a founding member) and pledged US$360 million to the organization for the 2018-2023 period, the largest commitment made by any donor.

In 2018, Norway’s bilateral ODA to health amounted to US$244 million according to OECD data. However, 69% or US$167 million of this was channeled as earmarked funding through multilaterals, which is reported to the OECD as bilateral ODA. This share that has been steadily increasing since 2015 (when it stood at 47%). Bilateral ODA investments focus on basic health care (30% in 2019), health policy and administration (US$20%), infectious disease control (16%), and reproductive healthcare (10%).

Strategic orientation for global health is set within the MFA

The Ministry of Foreign Affairs (MFA) traditionally sets Norway’s global health priorities. Norway’s Ambassador and Permanent Representative to the United Nations (UN) and other international organizations in Geneva, is a key actor in the implementation of Norway’s multilateral funding for health. The Mission in Geneva represents Norway at the World Health Organization (WHO) and participates in the governance of global health organizations. Within MFA, the Department for Sustainable Development has a Section for Global Health, Education and Inclusion, which has responsibility over global health investments. Bilateral global health programs are handled directly by the individual bilateral departments, under the Department of Regional Affairs. At Norad, global health issues fall under the mandate of the Department of Global Health and Education. Norad manages funds in accordance with annual allocations from the Ministry of Foreign Affairs.