Spain - Global health

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ODA to global health dropped significantly between 2008 and 2020, 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$133 million in ODA (both bilateral and multilateral) on health in 2019. This represented 5% of its total ODA (below the DAC average of 8%). This makes Spain the 16th-largest donor to health in absolute terms and the 23rd in relative terms. 


Spain channeled 64% of its health ODA (US$85 million) to multilateral organizations (above the DAC average of 50%). Most of this funding was channeled through the EU institutions (40% of total health ODA), followed by the World Bank’s International Development Association (14%), and the World Health Organization (WHO; 7%). 


According to the ‘Master Plan for Spanish Cooperation 2018-2021’ (Master Plan), global health is a top priority of Spain’s development policy. Spain takes a rights-based and equity approach, focusing its health policy on strengthening universal health coverage (UHC) and promoting access to essential drugs and vaccines. The Master Plan outlines four strategic priorities for support within the health sector: 1) public health systems, 2) sexual and reproductive health and rights, 3) health emergency response, and 4) access to medicines, vaccines, and other health goods, including research and development.


In line with Spain’s strategic priorities, in 2019, Spain allocated 22% of its bilateral global health ODA to reproductive health care. Basic nutrition and health policy and administrative management both received 16%, and medical research followed with 12%.
Between 2010 and 2014, Spanish voluntary contributions to multilaterals were limited as a result of austerity measures; however, the new Spanish government under Prime Minister Pedro Sánchez is determined to resume contributions. In September of 2019, Sánchez pledged €100 million (US$112 million) to the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund) for its 2020-2022 replenishment. 


In response to the COVID-19 crisis, Spain has announced that global health and epidemic preparedness will be reprioritized within its development cooperation policy. Spain’s development leadership plans to focus development policy on global health intervention support. The Ministry of Foreign Affairs and Cooperation (MAUC) has released the ‘the Spanish Cooperation joint response to COVID-19’, a new strategy outlining priority measures for addressing the COVID-19 crisis in partner countries.  To ensure that “no one is left behind”, the Spanish government will support the most vulnerable populations (particularly women and girls) in low- and middle-income countries by strengthening public health systems and guaranteeing universal access to essential COVID-19 vaccines, medicines, and diagnostics. 


Spain has provided US$33 million  to national research institutions to address the COVID-19 crisis. In 2020, Spain pledged US$86 million  over the next 15 years to the Coalition for Epidemic Preparedness Innovations (CEPI ), €50 million  (US$56 million) to Gavi COVAX Advance Market Commitment (AMC) for increased COVID-19 vaccine access for low- and middle-income countries, and additional disbursements amounting to €20 million (US$22 million) in ODA voluntary contributions to multilateral organizations. This new funding, which is in addition to Spain’s compulsory contributions to the multilateral system, will be channeled to the WHO, UN Women, the UN Program on HIV and AIDS (UNAIDS), and the World Food Programme, among other organizations.


ODA contributions to health are expected to continue to increase in 2021 and 2022 in response to the COVID-19 crisis and the growing importance of global health narratives. In April of 2021, the Spanish cabinet approved the new ‘Foreign Action Strategy 2021-2024’, outlining Spain's foreign priorities and goals for the next four years. The new plan prioritizes strengthening global health as one of the 'vertical axes' of Spain's development cooperation strategy.
 

MAUC defines strategic orientations, AECID implements policy 

Within MAUC, the most relevant departments covering health issues are the General Directorate for Sustainable Development Policies and its health division. The Spanish development agency (the Spanish Agency for International Development Cooperation or AECID) implements health-related programs through its Directorate for Multilateral and Sectoral Cooperation and its regional departments (including the Directorates for Africa and Latin America), which manage bilateral programs on the ground. The Spanish Ministry of Health provides advice to MAUC and AECID on key issues and participates in global health forums such as the World Health Assembly.