Norway - Global health

8 - Norway bi-multi health ODA

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

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 relevant paper, 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. It 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). It 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), maternal health, and safe and legal abortions.

11 - Norway health ranking absolute

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12 - Global Health ranking Percentage - Norway

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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.

According to data from the Organisation for Economic Co-operation and Development (OECD), Norway’s ODA to health was US$617 million in 2016 (the latest year for which multilateral and bilateral OECD data is available), which represented 12% of its total ODA. This was well above the average among OECD’s Development Assistance Committee members (DAC average: 8%): Norway ranked sixth in relative terms.

Norway steadily increased its support for health between 2011 (when it was US$427 million) and 2016, mostly as a result of increased engagement with health-related multilateral organizations. According to the government, ODA to health increased by NOK417 million (US$51 million) between 2016 and 2017 and remained relatively stable through 2018. Government documents indicate that ODA to health totaled NOK5.2 billion in 2019 (US$639 million), about NOK100 million (US$12 million) more than in 2018.

Norway’s budget line for health-related funding in 2020 was originally set at NOK3.7 billion (US$454 million), but increased to NOK4.2 billion (US$516 million) in May 2020. This was the result of a reshuffling of funds within the ODA budget to finance the international response to the COVID-19 crisis. Norway’s budget line for health, however, only covers parts of its total health contributions, with additional funding coming from within the multilateral funding and bilateral cooperation budget lines.

In line with its overall ODA policy, much of Norway’s funding for health goes through the multilateral system. In 2016, Norway channeled 59% of its total health ODA as core contributions to multilaterals (DAC average: 56%). In addition, it provided 23% 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 whitepaper entitled ‘Norway’s Role and Interests in Multilateral Cooperation’, published in June 2019.

Key multilateral partners are the Global Financing Facility (GFF), the United Nations Population Fund (UNFPA), the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), and Gavi, the Vaccine Alliance (Gavi; see section ‘global health R&D’ for information on support to the Coalition for Epidemics Preparedness Innovations). 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 addition, Norad, Norway’s international development agency, highlights the UNFPA as Norway’s single largest partner for SRHR. The UNFPA received more than 40% of the NOK1.6 billion (US$197 million) Norway dedicated to the issue in 2019. Norway’s pledge for the Global Fund amounts to US$224 million for 2020 to 2022. In May 2020, as part of its international response to the COVID-19 crisis, the government announced a US$1.0 billion pledge for Gavi for 2021 to 2030.

In 2018, Norway’s bilateral ODA to health amounted to US$270 million according to OECD data. (65% or US$175 million of this was channeled as earmarked funding through multilaterals, which is reported to the OECD as bilateral ODA. Bilateral ODA investments focus on basic health care (33% in 2018), infectious disease control (15%), health policy and administration (13%), and reproductive healthcare (11%).

In 2019 and 2020, debate around Norway’s development cooperation revolved around the use of ‘vertical’ multilateral funds (multilateral organizations that have a narrow focus on one or a few specific issues). Norway is a strong supporter of multilateral organizations and the government considers thematic funds an effective way to pursue its priorities internationally. Critics — mainly members of the Norwegian academia and members of the opposition in government — have argued that while they are effective, the focus of such funds is often too narrow (e.g., on vaccination or on specific diseases) and leads to fragmentation within global health. In addition, they warn that the use of such funds might lead Norway to lose control over its own funding. Nonetheless, the current government has reiterated its support for ‘vertical’ multilateral funds.

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 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 for 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.