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What?

Because the European Union (EU) institutions are an important donor of ODA, we’ve decided to analyse its aid to health as an independent funding body from the Member States. To avoid any double reporting of the Member States contributions to the development funds managed by the EU, we won’t be comparing the volumes but rather the modalities.

The European Union institutions have granted €591 million and €788.5 million of DAH (Development Assistance for Health) in 2014 and 2015 respectively. As indicated in our methodology, we are not including general budget support in our calculations as the share of health is difficult to determine accurately. It is important to mention however that given the amount invested by the EU institutions as assistance through general budget support, the inclusion of budget support would impact final conclusions.

How?

The EU institutions are singular in the development aid scene since they are both a recipient and a donor.

The EU never reported any equity investment nor loans as ODA for health, meaning that 100% of its financing is composed of grants.

This was equivalent to 5.8% of total ODA in 2014 and 7.4% in 2015. 
The trend from 2007 onwards is pretty unsteady as shown in the graph.

The EU has contributed to multilateral organisations for health up to 10% of total DAH. The two significant contributions are towards the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Gavi, the Vaccine Alliance. There also some slight core contributions to UN agencies such as the World Health Organisation or the UN Development Programme.

The EU is used to reporting Gavi as a bilateral project in the CRS, which we consider as inaccurate. Moreover the 2015 contribution to Gavi was reported under a wrong channel and code, which makes the tracking of those outflows difficult.

In terms of tied aid, the EU is a very bad practice.
In 2014, only 46.6% of its DAH was untied and 77.6 in 2015.

To Whom?

The African, Caribbean and Pacific Group of States is the main recipient of DAH from the EU institutions. In 2014, it received 65% of total EU aid for health and 60% in 2015; a large majority going to the African countries of the Group (respectively 62% and 57% of total DAH in 2014 and 2015).

In volume, some non-ACP countries still received some substantial amounts of DAH such as Afghanistan, which was the main recipient in 2014 or South-East Asian countries like Vietnam and Philippines, which were in the 10 first recipient countries in 2015.

Since the CRS database does not allow providing multiple recipients for one activity, all the multi-countries or multi-regions projects are reported as “unspecified”.

Therefore we could not allocate 7% of the amount in 2014 and 10.6% in 2015 to a specific country or income group.

In terms of income groups, the EU institutions are targeting the poorest countries. It provided 83.3% of its bilateral DAH to low-income and lower-middle-income countries (respectively 57.9% and 25.4% in 2014 and 47% and 36.3% in 2015).

As a consequence, upper-middle-income countries received 9.3% in 2014 and 6% in 2015 of DAH.

The implementers of the EU bilateral DAH are mainly civil society, the public sector and the UN organisations.

It should be underlined that the EU institutions are financing public-private partnerships, even if it represented a small share of the total DAH (less than 1%). 

Those PPPs are nearly all being implemented in Sub-Saharan Africa.

What for?

Our methodology is proposing an alternative classification to the CRS purpose codes. We’ve tried to classify the health projects according to the SDGs as an attempt to suggest different codes than those proposed by the Working Party on Development Finance Statistics and to produce more detailed information. As mentioned in the methodology, this report is made for food for thought and to trigger the discussions on improving the accuracy of ODA for health.

The EU institutions are mainly financing support to health systems, it represented 48% of total DAH in 2014 and 43% in 2015. Since the Global Fund is the main multilateral organisation financed by the EU institutions, the fight against epidemics is logically the sector that is the most financed with multilateral outflows.

The 2014 reported contribution to the Global Fund is smaller than the one in 2015, which could explain the discrepancy between the two years. Although the EU is also providing substantial bilateral funding to the fight against the three pandemics which complement global health initiatives, the majority is specifically allocated to the fight against HIV/AIDS.

The EU has also been largely financing the fight other communicable diseases. The EU institutions are also considerably financing nutrition, which was the second main recipient sub-category in 2014 and 2015.

It’s worth noting that specific issues such as non-communicable diseases, neglected tropical diseases or family planning are basically under-funded, each receiving less than €3 million per year.

Transparency

In this project, we have tried to assess to what extent each donor is contributing to Universal Health Coverage (UHC) taking into account the difficulty to formulate an extensive procedure to determine what is UHC and what is not.
So far, we could only claim that 2.5% of the projects of the EU institutions for 2014 and 2015 are contributing to UHC, mainly due to a lack of detailed information provided through the CRS.