Spain - Global health
At a glance
Health ODA has dropped significantly since 2008 but the sector is being reprioritized in response to the COVID-19 crisis
According to Organisation for Economic Co-operation and Development (OECD) data, Spain spent US$162 million in ODA (both bilateral and multilateral) on health in 2016 (the latest year for which multilateral and bilateral OECD data is available). This represented 3% of its total ODA, putting Spain well below the Development Assistance Committee (DAC) average of 8%. This makes Spain the 16th-largest donor to health in absolute terms. In 2016, Spain channeled 32% of its health ODA bilaterally and 66% multilaterally. Only 1.4% of Health ODA funding was earmarked for multilaterals.
According to the ‘Master Plan for Spanish Cooperation 2018-2021’ (Master Plan), global health is one of the key strategic priorities of Spain’s development policy. Nonetheless, funding to the sector was cut during and after Spain’s economic crisis that stretched between 2008-2014. In 2016, bilateral funding stood at US$56 million and was reduced to only US$51 million in 2018.
Spain takes a rights-based and equity approach to health, focusing its policy on strengthening universal health coverage (UHC) and promoting access to essential drugs and vaccines. The Master Plan outlines four strategic priorities within the health sector: 1) strengthening public health systems, 2) supporting sexual and reproductive health, 3) reinforcing Spain’s system to respond to health emergencies, and 4) supporting access to medicines, vaccines, and other health goods, including research and development.
In line with Spain’s strategic priorities, in 2018, the largest share of bilateral health funding went to basic health care (23% of bilateral health ODA in 2018), reproductive health care (19%), medical research (12%), and health policy and administrative management (12%).
Between 2010 and 2014, Spanish voluntary contributions to multilaterals were also limited as a result of austerity measures; however, the new Spanish government under Prime Minister Sánchez is determined to resume contributions. In September 2019, Spain’s Prime Minister announced that Spain will resume disbursements to multilateral institutions and pledged €100 million (US$118 million) to the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund) for its 2020-2022 period. Similarly, in 2020, Spain resumed funding for the International Finance Facility for Immunisation (IFFIm), a long-term financing entity that makes immediate funding available to Gavi, the Vaccine Alliance (Gavi) for immunization programs, by issuing ‘vaccine bonds’ in the capital market. Spain pledged €50 million (US$59 million) to IFFIm over the 2026-2030 period.
In response to the COVID-19 crisis, Spain has announced that global health and epidemic preparedness will be prioritized within its development cooperation policy. Spain’s development leadership plans to focus Spain’s development policy on global health intervention support. The Ministry of Foreign Affairs and Cooperation (MAEUEC) has released the ‘the Spanish Cooperation joint response to COVID-19’, a new strategy that outlines priority measures for addressing the COVID-19 crisis in partner countries. In order to ensure that “no one is left behind” the Spanish government will support the most vulnerable populations (particularly women and girls) in middle- and low-income countries by strengthening public health systems and guaranteeing universal access to essential COVID-19 vaccines, medicines, and diagnostics.
In terms of financing commitments, the Spanish government has provided US$33 million to national research institutions to address the COVID-19 crisis. At the EU-led ‘Coronavirus Global Response’ pledging event in May 2020, Spain’s Prime Minister pledged €75 million (US$89 million) over the next 15 years to the Coalition for Epidemic Preparedness (CEPI). Spain also provided funding for the International Finance Facility for Immunization (IFFIm), a long-term financing entity that makes immediate funding available to Gavi, the Vaccine Alliance (Gavi) for immunization programs, by issuing ‘vaccine bonds’ in the capital market. Spain pledged €50 million (US$59 million) to IFFIm over the 2026-2030 period. These funds will be used to advance the manufacturing of COVID-19 vaccines through the Gavi’s COVAX Advance Market Commitment (AMC).
MAEUEC defines strategic orientations, AECID implements policy
Within the Ministry of Foreign Affairs and Cooperation (MAEUEC), the most relevant departments covering health issues are the General Directorate for Sustainable Development Policies and its health division. With regards to implementation, the Spanish development agency (AECID) covers health-related programs through its Directorate for Multilateral and Sectoral Cooperation and its regional departments (i.e., the Directorates for Africa and Latin America), which manage bilateral programs on the ground. The Spanish Ministry of Health provides advice to MAEUEC and AECID on key issues and participates in global health forums such as the World Health Assembly.