Sweden - Global health

8 - Sweden bi-multi health ODA

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Strong focus on SRHR; Sweden channels much 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$532 million in 2016 (the latest year for which multilateral and bilateral data is available). This represented 10% of its total ODA in that year, above the average among members of the OECD Development Assistance Committee (DAC; 8%). According to the government’s numbers (which are not exactly comparable to OECD DAC numbers), total funding for health amounted to SEK5,287 million in 2018 (US$608 million), or 12% of total ODA, and 5,208 million in 2019 (US$599 million), or 11% of total ODA.

In 2016 (the latest year for which multilateral data from the OECD is available), 61% of health ODA consisted of core contributions to multilateral organizations (above the DAC average of 56%), and 39% was disbursed bilaterally, although 18% of the total was actually earmarked for multilateral organizations (reported to the OECD under bilateral funding) meaning that in total, 79% of Swedish health ODA went to or through multilateral organizations in 2016. According to government data, this share remained stable in 2018 (79%), and slightly decreased in 2019 (77%). Since 2016, overall bilateral funding for health increased from US$206 million to around US$250 million in 2017 and 2018. In 2018, almost half of Sweden’s bilateral ODA to health is channeled as earmarked funding through multilaterals (US$115 million in 2018, out of a total of US$246 million).

Key multilateral partners include the Global Fund to Fight AIDS, Tuberculosis and (Global Fund; to which Sweden pledged US$290 million for 2020-2022), the United Nations Population Fund (UNFPA; US$286 million for 2018 to 2021), and Gavi, the Vaccine Alliance (Gavi; US$189 million for 2021-2025 in direct contributions). In March 2019, the government released a new strategy for its engagement with the Global Fund between 2019 and 2023, with a focus on promoting sexual and reproductive health and rights (SRHR) and health system strengthening. In line with its overall multilateral funding, the Swedish government is also a strong supporter of United Nations (UN) agencies. Altogether they receive about one-quarter of Sweden’s total health ODA. Sweden is also the third-largest per capita funder of Gavi.

Health features prominently in the priorities set in Sweden’s 2016 ‘Aid Policy Framework’. Priorities for health fall under the scope of the global strategy for sustainable social development (July 2018). The strategy covers the period from 2018 to 2022 and comes with a SEK7.1 billion envelope (US$817 million). Objectives of the strategy include sustainable quality systems for health (also known as health systems strengthening), 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.

Gender equality has been a key element of Sweden’s interventions in global health, especially since the adoption of the ‘Feminist Foreign Policy’ in late 2014. SRHR is one of six objectives of the policy, and funding to this area has been increasing since the introduction of the policy. In 2017, in response to the US’ decision to cut funding to organizations providing abortion-related information and services, the Swedish government announced increased support to the area. This includes increased support to the United Nations Family and Population Fund (UNFPA; US$286 million in unearmarked funding for 2018 to 2021), a €20 million (US$22 million) pledge to the ‘She Decides’ initiative (a fund established by the Netherlands to counter the anticipated impact of cuts in US funding), and strengthened support for organizations that give women and girls access to advice, sex and relationship education, contraceptives, maternity care, and safe abortions. In 2019, Sweden was instrumental in advocating for SRHR to be included into the UN Political Declaration on universal health coverage (UHC).

In addition, Sweden is committed to showing leadership in tackling antimicrobial resistance (AMR), with the Uppsala-based organization ReAct leading a global effort against AMR. Between 2019 and 2022, funding to ReAct is expected to amount to SEK72 million (US$8 million). In addition, Sida supports research on AMR, with an estimated SEK35 million (US$4 million) 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 43% of total bilateral funding in 2018 (US$105 million), a share that went up to 63% in 2019 according to government data. Basic health care is the second-largest sector of bilateral health ODA (18% in 2018), followed by medical research (14%) and health policy and administrative management (9%). Health (SRHR and other health programs) is currently a priority sector in 14 country strategies (see box) and strengthening SRHR will be a priority for the upcoming country strategies in Kenya and Bolivia.

Sweden supports its partners in responding to the COVID-19 crisis both through humanitarian assistance and long-term development cooperation. As of June 25, 2020, Sweden’s development agency, Sida, had allocated SEK797 million (around US$85 million) to partners as COVID-19 specific support, SEK147 million of which was humanitarian support. 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.

Health and/or SRHR is a priority sector in 12 countries

  • Bangladesh
  • Democratic Republic of the Congo
  • Ethiopia
  • Liberia
  • Mozambique
  • Myanmar
  • Occupied Palestinian territories
  • Somalia
  • South Sudan
  • Uganda
  • Zambia
  • Zimbabwe

11 - Health Ranking absolute - Sweden

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12 - Health ranking relative - Sweden

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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 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 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.