Strong focus on SRHR; Sweden channels much of its health ODA multilaterally
Sweden’s funding to global health stood at US$506 million in 2015 (latest year for which complete data is available), or 7% of its total official development assistance (ODA). This is slightly below the average among members of the Development Assistance Committee of the OECD (DAC; 9%). Development funding for health has remained rather stable since 2013 in absolute amounts. Health features prominently in the priorities set in Sweden’s 2016 Aid Policy Framework.
Gender equality has been a key element of Sweden’s interventions in global health, especially since Sweden’s adoption of the ‘feminist foreign policy’ for 2015 to 2018. Priorities for health are currently being developed in the new strategy for socially sustainable development, which will be operational in the last quarter of 2018. A continued focus on sexual and reproductive health and rights (SRHR), as well as on health systems strengthening (HSS), is expected, with strong link between the two core elements of Swedish global health policy.
SRHR is one of six objectives of the policy; funding to this area is increasing under the strategy. In 2017, in response to the US decision to cut funding to organizations providing abortion-related services, the Swedish government announced increased support to the area: this includes increased support to the UN Family and Population Fund (UNFPA), a €20 million pledge (US$22 million) to the ‘She Decides’ initiative (a fund established by the Netherlands to counter the anticipated impact of cuts in US funding), and strengthened involvement towards organizations working around abortion.
Other priorities within global health include HSS and healthcare, and non-communicable diseases. Sweden is committed to showing leadership in tackling antimicrobial resistance (AMR), with the Uppsala-based organization ReAct leading a global effort against AMR.
SRHR is one of six objectives of Sweden’s feminist foreign policy
According to the government’s 2015-2019 strategy for SRHR in sub-Saharan Africa, Sweden will allocate SEK1,750 million (US$204 million) in this region specifically. Funding will focus on four main issues: 1) women’s and children’s health, 2) access to education about SRHR for young women and men, and the LGBT community; 3) health systems strengthening (HSS) to enable greater access to healthcare; and 4) strengthening of democracy and gender equality based on a human-rights approach. HIV/AIDS interventions are integrated within the first two objectives of the strategy.
The Swedish Government chooses to channel most of its health ODA through core contributions to multilateral organizations: US$327 million in 2015, or 65% of Sweden’s total health ODA (latest year for which data is available). This is more than the average share of 55% via multilaterals amongst DAC members. Moreover, almost half of Sweden’s bilateral ODA to health is actually channeled as earmarked funding to multilaterals (US$81 million in 2015). In total, 81% of Swedish health ODA went to or through multilateral organizations in 2015. The largest recipient of Swedish core contributions to health multilaterals is the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund): it receives around 20% (US$101 million in 2015) of Sweden’s total contributions to the health sector. For the Global Fund’s 2017-2019 replenishment period, Sweden pledged US$347 million to the organization. In line with its overall multilateral funding, the Swedish Government is also a strong supporter of UN agencies: altogether they receive about one-quarter of Sweden’s total health ODA. In addition, Sweden is the third-largest funder per capita to Gavi, the Vaccine Alliance (Gavi). Sweden’s total pledge to Gavi for 2016 to 2020 amounts to US$211 million.
Sweden’s bilateral ODA increased between 2015 and 2016: it went from US$179 million to US$201 million, driven by significant increases in funding for reproductive health care, and health policy and administrative management. Focus on reproductive health thus also increased, reaching 46% of Sweden’s bilateral health ODA in 2016. Sexually transmittable diseases, including HIV/AIDS control, is the second-largest sector of bilateral health ODA (14%). Health policy and administrative management, and basic health care, follow with 12% and 11% respectively. Health is currently a priority sector in twelve country strategies (see box).
Health is a priority sector in 12 countries :
- Democratic Republic of the Congo
- Occupied Palestinian territories
- South Sudan
SRHR is a priority sector in two countries :
- Burkina Faso
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 UN Policy Department, in charge of relations with global health funds, and the Department for International Development Cooperation, which coordinates thematic and strategy development for Sida. With regards to global health, the most important division within Sida is the Social Development Unit in the Department for International Organizations and Policy Support. Sida’s investments in global health are guided by Sida’s strategy for ‘Sustainable Social Development’, which includes both health and education. For country-specific programming, the respective regional departments take the lead.