Health ODA has dropped significantly since 2008
Spain’s funding to global health stood at US$149 million in 2016, ranking it 16th among major donors in the Organisation for Economic Cooperation and Development (OECD). This corresponds to 3% of its total ODA, which is below the OECD Development Assistance Committee (DAC) member average of 8%. Although health was underlined as a key strategic priority in the ‘Master Plan for Spanish Cooperation 2013-2016’, this did not prevent cuts to the health sector during and after Spain’s economic crisis. According to the ‘Master Plan for Spanish Cooperation 2018-2021’ (Master Plan), within its health official development assistance (ODA), Spain takes a rights-based and equity approach: it focuses on strengthening universal health coverage (UHC) by supporting public health systems, as well as on providing vulnerable populations with health resilience capacity and tackling infectious and non-communicable diseases in developing countries. Specific sectorial strategies will be developed in the coming months.
ODA to health has fallen significantly since 2008, when it stood at US$554 million. However, 2016 also marked an increase over recent years and the most Spain has spent on the sector since 2012. The majority of Spain’s health ODA in 2016 was channeled through multilateral organizations: 66% in 2016 (US$98 million). A large share of this funding is made up of assessed, binding contributions to EU institutions. In 2016, they made up 31% of Spain’s total health ODA (US$45 million). The World Bank’s International Development Association (IDA) was the second largest recipient, receiving US$26 million in 2016, accounting for 18% of total health ODA in 2016. The World Health Organization comes third, with US$11 million (7%).
Bilateral cooperation accounted for 34% of Spain’s ODA for health in 2016, amounting to US$51 million. This is mostly driven by increased investments for medical research. This was the largest sector of Spain’s bilateral health ODA (US$10 million, or 20%). Besides this, Spain focused on health policy and administrative managements and reproductive health care (each US$9 million, or 17%), and providing basic health care (US$8 million, or 15%). Based on the Master Plan, Spain’s chief global-health priority is to contribute to achieving universal health coverage; it outlines four strategic interventions: 1) strengthen public health systems; 2) support sexual and reproductive health; 3) reinforce Spain’s system to respond to health emergencies; and 4) support access to medicines, vaccines, and other health goods, including research and development.
As for commitments to global health, the Spanish government pledged US$57 million to the IFFIm for 2016 to 2020. IFFIm is 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 had not provided direct funding to the Global Fund since 2010 as a result of budget constraints. At the Fifth Replenishment Conference of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) in September 2016, Spain announced that it would resume funding to the Global Fund as soon as a new government was formed. In November 2016, the Spanish Congress’ Development Committee approved an all-party resolution calling for an overall pledge of €100 million (US$111 million, with €30 million to be disbursed in 2017). In November 2017, the Spanish Ministry of Economy and Competitiveness (MINECO) announced a US$17 million contribution for the Global Fund’s Debt2Health initiative.
MAEC defines strategic orientations; AECID implements policy
Within the Ministry of Foreign Affairs and Cooperation (MAEC), the most relevant departments covering health issues are the General Directorate for Sustainable Development Policies (DGPPOLDES) 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 for Latin America), which manage bilateral programs on the ground. In addition, the Ministry of Health provides advice to MAEC and AECID on key issues, and attends some global health forums such as the World Health Assembly.