Health ODA has dropped significantly since 2008
Spain’s funding to global health stood at US$153 million in 2016 (the latest year for which complete data from the Organisation for Economic Co-operation and Development (OECD) is available), ranking it 16th among major donors, according to data from OECD. This corresponds to 3% of its total official development assistance (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), global health is underlined among the key strategic priorities 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. Under such an approach, 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.
ODA to health has fallen significantly since 2008 when it stood at US$569 million. However, 2016 marked an increase in spending over recent years, making it the year that Spain spent most on the sector since 2012. In 2016, Spain provided 66% of its health ODA (US$100 million) through core contributions to multilateral organizations. A large share of this funding is made up of assessed, binding contributions to the European Union (EU) institutions. In 2016, the EU was the largest recipient of Spain’s multilateral health ODA, receiving US$47 million, followed by the World Bank’s International Development Association (IDA) as the second-largest recipient receiving US$27 million and the World Health Organization receiving US$11 million.
Spain’s bilateral spending on global health did not change much between 2016 and 2017 (US$52 million in 2016 to US$53 million in 2017). Based on OECD data, and in line with Spain’s strategic priorities, the largest share of the funding went to health policy and administrative management (20% of total bilateral health ODA in 2017, followed by reproductive health care (14%). Other focus areas include basic nutrition at 12%, infectious disease control at 12%, basic health care at 11% and medical research at 9%.
As for commitments to global health, the Spanish government pledged US$33 million to the International Finance Facility for Immunisation (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. Additionally, the Spanish Ministry of Economy and Competitiveness (MINECO) provided US$17 million in contribution to the Global Fund’s Debt2Health initiative in 2017. Spain has not made a direct commitment to Gavi itself and had not been able to provide direct funding to the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) since 2010 as a result of budget constraints. However, at the 74th session of the United Nations General assembly held in September 2019, PM Sánchez announced that Spain would resume funding to the Global Fund with a €100 million pledge contribution for the next replenishment period 2020-2022.
MAEC 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 for Latin America), which manage bilateral programs on the ground. In addition, the Ministry of Health provides advice to MAEUEC and AECID on key issues and attends some global health forums such as the World Health Assembly.