Sweden - Global health

With a strong focus on SRHR, Sweden channels most of its health ODA multilaterally 

According to data from the Organisation for Economic Co-operation and Development (OECD), Sweden’s funding to global health stood at US$594 million in 2020, making it the ninth-largest DAC donor in absolute terms.1 This represented 9% of its total ODA in that year—slightly below the DAC average of 10%—making it the 15th-largest donor in relative terms. Sweden’s health ODA in 2020 represents Sweden’s largest funding to health in recent years, with the 16% increase between 2019 and 2020 closely tied to Sweden’s COVID-19 support. Also associated with this increase is Sweden’s funding for health earmarked for multilateral organizations, which rose from US$117 million in 2019 to US$213 million in 2020.   

In 2020, 43% of Sweden’s health ODA consisted of core contributions to multilateral organizations (DAC average: 44%), and the other 57% was disbursed bilaterally, although 36% of the total was earmarked for multilateral organizations (reported to the OECD under bilateral funding). This means that in total, 79% of Swedish health ODA went to or through multilateral organizations in 2020. Bilateral funding for health has experienced a steady increase in recent years except for 2018, when it fell by 1% from the previous year. Bilateral health ODA stood at US$338 million in 2020, a 33% increase compared to 2019 levels.  

Key multilateral partners include the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund; to which Sweden pledged a total of SEK3.0 billion, or US$300 million, for 2020-2022); Gavi, the Vaccine Alliance (Gavi; SEK1.8 billion, or US$202 million, for 2021-2025 in direct contributions); the International Development Association (IDA; US$1.1 billion for 2022-2025); and the United Nations Population Fund (UNFPA; US$300 million for 2022-2025). Altogether these four organizations received about 32% of Sweden’s total health ODA in 2020.  

In September 2021, the government announced a new pledge of SEK2.1 billion (US$243 million) in cash contributions and dose donations to Gavi’s COVID-19 Vaccines Global Access (COVAX) Advance Market Commitment (COVAX AMC ) which will be made available through 2021 and 20222. This comes on top of a SEK2.5 billion (US$286 million) pledge made earlier in April 2021 to COVAX AMC, which includes a SEK2.3 billion (US$263million) via the International Finance Facility for Immunization (IFFIm), Gavi’s innovative financing mechanism over 10 years, and another SEK200 million (US$23 million) contribution made to COVAX AMC for the period 2021-2025. This makes Sweden the world’s largest per capita contributor to COVAX. In line with its overall multilateral funding, the Swedish government is also a strong supporter of United Nations (UN) agencies.  

Health features prominently in the priorities set in Sweden’s 2016 ‘Policy framework for Swedish development cooperation and humanitarian assistance,’ but specific priorities for health fall under the scope of the global strategy for sustainable social development (published in July 2018) which covers the period from 2018 to 2022 and comes with a SEK7.1 billion (US$771 million) envelope. Objectives of the strategy include sustainable quality systems for health (also known as ‘health systems strengthening’ or HSS); sexual and reproductive health and rights (SRHR); water and sanitation; enhanced capacity to promote healthier lives; and the prevention of the adverse health impacts of environmental pollution and climate change. Rights-based and anti-discrimination approaches form the basis of Sweden’s activities in global health, with the principal objective of promoting equitable health. 

In 2020, COVID-19 control, SRHR, child and maternal health, and initiatives to strengthen health systems were clear priorities in development assistance for health. These issues are largely reflected in Sweden’s bilateral funding for health in the same year. The largest health sub-sector was reproductive health care (35% of bilateral health ODA in 2020); followed by COVID-19 control (22%); basic health care (14%); STD control, including HIV/AIDS (7%); and medical services (7%). Improvements to SRHR and other global health efforts are currently governed by 13 bilateral strategies (see box), one regional (Regional Cooperation in Africa), and one global strategy

Support in the area of health is achieved not only through financial support but also through dialogue and advocacy. In 2019, Sweden was instrumental in advocating for SRHR to be included in the UN ‘Political Declaration on Universal Health Coverage’ (UHC). In 2020, it played a key role in the integration of a strong SRHR perspective in the EU’s strategy for Sub-Saharan Africa. 

Sweden is also committed to tackling antimicrobial resistance (AMR), with the Uppsala-based organization ReAct, which is leading a global effort against AMR. To support low-income countries' fight against AMR, between 2019 and 2022, Swedish funding to ReAct is expected to reach SEK72 million (US$8 million). As a complement to its support for ReAct, in January 2021, Sweden provided an additional SEK70 million (US$8 million) to the UN Fund AMR Multi-Partner Trust Fund (the AMR MPTF)—a funding mechanism to support the World Health Organization (WHO), the United Nations Food and Agriculture Organization (FAO), and the World Organization for Animal Health (OIE) in their joint work on AMR. Sida will also support research on AMR, with an estimated SEK35 million (US$4 million) allocated to the ‘Joint Programming Initiative on Antimicrobial Resistance’ (JPIAMR) between 2020 and 2022. Its 2020-2023 cross-governmental strategy ‘Swedish Strategy to Combat Antibiotic Resistance’ highlights seven objectives: 1) Increased knowledge through enhanced surveillance; 2) continued strong preventive measures; 3) responsible use of antibiotics; 4) increased knowledge for preventing and managing bacterial infections and antibiotic resistance; 5) improved awareness and understanding of antibiotic resistance; 6) supporting structures and systems; and 7) leadership with the EU and international cooperation.  

Health and/or SRHR is included as a goal in country stategies for:

  • Afghanistan
  • Bangladesh
  • Bolivia
  • Democratic Republic of the Congo
  • Ethiopia
  • Guatemala
  • Mozambique
  • Myanmar
  • South Sudan
  • Uganda
  • Zambia
  • Zimbabwe

Sweden supports its partners in responding to the COVID-19 crisis both through humanitarian assistance and long-term development cooperation. In 2020, Sweden allocated about SEK1.9 billion (US$206 million) as COVID-19 specific support and an additional SEK673 million (US$73 million) to mitigate indirect consequences from the pandemic, primarily for humanitarian assistance. This SEK1.9 billion includes SEK1.5 billion (US$163 million) channeled through Sida, of which SEK360 million (US$39 million) was allocated toward health-specific efforts for containing the pandemic and strengthening health systems. Sida’s response has been structured in line with the UN’s three-pronged response to COVID-19: 1) Health response, 2) humanitarian response, and 3) socio-economic response. Each element of its response has been carried out in close collaboration with multilateral organizations.  

The MFA leads on strategy; Sida manages the implementation of bilateral cooperation 

Within the Ministry of Foreign Affairs (MFA), the main departments that focus on global health are the United Nations (UN) Policy Department, which is responsible for relations with global health funds, and the Department for International Development Cooperation, which coordinates thematic and strategy development for Sida. With regard to global health, the most important division within Sida is the ‘Global Social Development Unit’ in the Department for International Organizations and Policy Support.  
Sida’s investments in global health are guided by the ‘Strategy for Sweden’s global development cooperation in sustainable social development 2018-2022.’ This strategy includes both health and education as two primary goal areas, into which SRHR and water, sanitation, and hygiene (WASH) are integrated. Country-specific programming is guided by country strategies, while regional programs are guided by regional strategies under the leadership of the respective regional departments.