European development cooperation and global health

Health is no longer seen solely as a product of development, but is now also understood to be one of the keys to economic growth. Good health can be a major source of economic and social development. The rapid transition out of poverty of Pacific rim countries was aided by an increase in life expectancy of some 18 years, which resulted in a huge increase in productivity. Conversely, the economic and social impact of bad health can be devastating.

 The Commission on Macroeconomics and Health (CMH) estimated that the economies of certain sub-Saharan countries would shrink by 20 per cent as a result of HIV and AIDS. The potential impact of a global pandemic such as avian or swine flu could result in millions of deaths and a further downturn in global economic growth. Even the minor outbreak of SARS in 2004, which was insignificant in terms of population health, was estimated to have resulted in a loss of US$ 15 billion to the global economy. In poor countries, a lack of equitable access to health and care means that the poorest pay a higher percentage of their resources for health. This both limits development and is corrosive to society. There are warnings that HIV and AIDS could destabilize the South Asian region and contribute to an increase in failing states.

European donors, including the European Community, have repeatedly acknowledged the importance of health for development and have made a number of political commitments to health in international cooperation. Internationally, all 27 EU member states are signatories to the United Nations Millennium Declaration made in 2000.

At EU level, the main legal instruments governing the EU's relations with resource-poor countries are the Cotonou Agreement and the Development Co-operation Instrument (DCI). The DCI provides the overall legal framework for Community policies in the field of development cooperation. Adopted in December 2006, the DCI incorporates both thematic and geographic regulations, including several that deal explicitly with the EU's support to the health sector. Article 5 obliges the EU to focus on increasing access to and provision of health services, with a central focus on the health-related Millennium Development Goals. The Cotonou Agreement includes specific commitments to improving health systems, basic healthcare, reproductive healthcare and family planning, preventing female genital mutilation, and fighting HIV and AIDS.

In addition to its legal instruments, the EC has recently developed several policy instruments that aim to improve coordination and harmonization for aid effectiveness among European donors. These include the strategic theme Investing in People, and the European Consensus on Development.

European Development Funding for Health
The European Union has made a commitment to increase levels of official development assistance (ODA) to meet the 0.7 per cent target for aid as a proportion of gross national product; aid is now more commonly compared to gross national income (GNI) by 2015. This target, which was first agreed by the UN in 1970, has so far only been reached by five countries. In June 2005, the Council agreed a new intermediate target for the EU of reaching ODA levels of 0.56 per cent of GNI in 2010. Furthermore, "in a declaration on the occasion of the agreement of the DCI, the Commission committed itself to ensure that by 2009, 20% of funds under the geographic programmes covered by the DCI would be allocated to basic health and basic and secondary education."

Despite these commitments, European aid (from the EU and its member states) fell from 0.43 per cent ODA/GNI in 2006 to just 0.40 per cent ODA/GNI in 2007. European aid still accounted for 64 per cent of all ODA - about US$ 61.5 billion - but, in real terms, total European ODA decreased by 1.6 billion euros. Further available figures suggest that, in 2007, European ODA allocated to health decreased by 10 per cent compared with 2006 to US$ 2.6 billion - just 5-6 per cent of European ODA commitments. At first glance, it appears that EU health aid grew substantially from 1996 to 2006; however, as a proportion, health allocations fell from 7 per cent in 1996-97 to 5 per cent in 2005-06. Moreover, only one-third of these commitments for health were actually disbursed during this period. ODA in 2008 increased further, in most cases, but not at a rate that would inspire confidence in meeting the 2010 or 2015 commitments.

These developments have placed even greater emphasis on the importance of aid effectiveness. A 2008 audit report of the EC's development assistance to health services in the priority region of sub-Saharan Africa found that: "Overall, EC funding to the health sector has not increased since 2000 as a proportion of its total development assistance despite the Commission's MDG commitments and the health crisis in sub-Saharan Africa. The Commission contributed significant funding to help launch the Global Fund but has not given the same attention to strengthening health systems although this was intended to be its priority (paragraphs 8 to 17). The Commission has had insufficient health expertise to ensure the most effective use of health funding (paragraphs 18 to 20)."

In its conclusions, the report recommends that the European Commission should:

  • consider increasing its aid to the health sector during the tenth EDF midterm review to support its commitment to the health MDGs
  • review how its assistance to the health sector is distributed to ensure it is primarily directed to its policy priority of health systems support
  • ensure each delegation has adequate health expertise either in the delegation or through drawing on the resources of other partners
  • make more use of sector budget support in the health sector and focus its general budget support more on improving health services
  • continue to use projects, especially for support to policy development and capacity-building, pilot interventions and assistance to poorer regions
  • work more closely with the Global Fund in beneficiary countries
  • establish clearer guidance on when each instrument should be utilized and how they can best be used in combination, as the Commission has not paid sufficient attention to ensuring the different aid instruments are used together coherently. When choosing which instruments to use, it could also take more account of the situation in individual countries, in particular whether they had a well-defined health sector policy.
  • make greater efforts to contribute to the development of well-defined health sector policies in beneficiary countries

Thus European performance in delivering aid, and particularly aid for health, has not lived up to the commitments of the EU or its member states. This can be said to show stagnation in European health aid.



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