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$493 million in 2019 making it the ninth-largest DAC donor in absolute terms.  This represented 9% of its total ODA in that year -- slightly above the DAC average of 8% --making it the ninth-largest donor in relative terms. Total health ODA has fluctuated since 2015, falling slightly in 2016 before rising to a five-year peak of US$527 million in 2018. The 6% drop between 2018 and 2019 was largely due to a decrease in its health ODA channeled through multilateral organizations (which fell from US$295 million to US$249 million).

In 2019, 50% of Sweden's health ODA consisted of core contributions to multilateral organizations (equivalent to the DAC average of 50%), and the other half was disbursed bilaterally, although 23% of the total was actually earmarked for multilateral organizations (reported to the OECD under bilateral funding). This means that in total, 73% of Swedish health ODA went to or through multilateral organizations in 2019. Bilateral funding for health has experienced a steady increase in recent years with the exception of 2018 when it fell slightly by 1% from the previous year. Bilateral health ODA stood at US$244 million in 2019, a 40% increase compared to 2015 levels.
 
Key multilateral partners include the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund; to which Sweden pledged SEK2.9 billion or US$290 million for 2020-2022), Gavi, the Vaccine Alliance (Gavi; SEK1.8 billion or US$195 million for 2021-2025 in direct contributions), the International Development Association (IDA; SEK9.2 billion or US$974 million for 2021-2023), and the United Nations Population Fund (UNFPA; SEK2.5 billion or US$286 million for 2018 to 2021). Altogether these four organizations received about 34% of Sweden's total health ODA in 2019. In November of 2020, the government topped up its pledge to the Global Fund with an additional US$10 million for the global COVID-19 response, bringing Sweden's total pledge to US$300 million and making it the partnership's eighth-largest public donor. In April of 2021, the government pledged a further SEK2.3 billion (US$258 million) to the COVID-19 Vaccines Global Access (COVAX) facility via the International Finance Facility for Immunization (IFFIm), Gavi's innovative financing mechanism, to be paid over a ten-year period. This comes on top of a SEK200 million (US$24 million) contribution made to Gavi's COVAX Advance Market Commitment (AMC) -- an initiative aimed at improving access to COVID-19 vaccines in low- and middle-income countries -- making 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 of 2018) which covers the period from 2018 to 2022 and comes with a SEK7.1 billion envelope (US$751 million). 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 2019, SRHR, child and maternal health, and initiatives to strengthen health systems were clear priorities in development assistance for health. According to Sida, nearly SEK1.5 billion (US$159 million), or 6% of its total support went to SRHR in 2019. This represented more than 60% of Sida's total health assistance. 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).

Sweden is also committed to tackling antimicrobial resistance (AMR), with the Uppsala-based organization ReAct 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). 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.
 
Sweden's bilateral health ODA is disbursed in line with its priorities. Funding for reproductive health made up 46% of total bilateral funding in 2019 (US$112 million), from 43% in 2018. Accounting for 23% (up from 18% in 2018), basic health care is the second-largest sector of bilateral health ODA. Medical research (7%) comes in third place with funding to this sub-sector having fallen by almost 46% compared to 2018. Improvements to SRHR and other health programs is currently given as a goal in 21 of Sweden's country strategies (see box).


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

  • Afghanistan
  • Bangladesh
  • Bolivia
  • Burkina Faso
  • Democratic Republic of the Congo
  • Ethiopia
  • Guatemala
  • Kenya
  • Liberia
  • Mali
  • Mozambique
  • Myanmar
  • Occupied Palestinian territories
  • Rwanda
  • Somalia
  • South Sudan
  • Sudan
  • Tanzania
  • 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$197 million) as COVID-19 specific support, and an additional SEK673 million (US$71 million) to mitigate its indirect consequences, primarily for humanitarian assistance. This includes SEK1.5 billion (US$159 million) channeled through Sida, of which SEK708 million (US$75 million) was allocated toward strengthening health systems and containing the pandemic. 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.  

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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 regards 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 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.