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What?

Volume-wise, France has been in the top 5 ODA donors over the past years. According to the DAC, ODA represented 0.37% of its GNI in 2014 and 2015 (respectively €8 billion and €8.15 billion in volume).

According to our methodology, France allocated €1.118 billion and €906 million to global health in 2014 and 2015, which respectively represented 0.046% and 0.036% of its GNI; far from the recommendation of the WHO Commission on Macroeconomics and Health, and below the performance of the UK.

However the relatively good performance in 2014 was mainly due to a substantive loan to reform the health sector in Colombia. In 2015, the ratio decreased sharply and plummeted to its lowest level since 2007.

14% of overall ODA was dedicated to DAH (Development Assistance for Health)
in 2014 and 12% in 2015. The ratio has remained the same since 2007 in average.

How?

France presents a unique global health financing structure. It has chosen to prioritize its investments towards multilateral organisations in order to mobilise and lever more resources; and to increase the impact and efficiency of the response to some specific issues such as the fight against pandemics or child immunisation.

Indeed France has been allocating 70% of its DAH to multilateral organisations [2014-2015 average].

The Global Fund to Fight AIDS, Tuberculosis and Malaria is the main recipient of multilateral ODA (49%), followed by the European Union and UNITAID (respectively 20% and 12.5%).

We also noticed a misreporting of the Gavi contributions: first being reported as bilateral into the CRS databases, then not being consistent with the amount in the French budget bills. This could have biased the ranking.

France is also one of the sole donors to have substantially increased loans to the health sector: in 2007 France was providing nearly 100% of its DAH though grants; and only 76% in 2014 (due to a massive loan to Colombia). In 2015, it was back to a pretty good 96%.

Our methodology is able to take the grant element -which represents the real budgetary effort- out of the total amount of the loan, meaning the principal and interest repaid by the recipient countries. This shows that French bilateral loan DAH was negative in 2015 because of considerable repayments for loans granted in previous years.

In 2014, France tied 5% of its aid to health and 6.5% in 2015. This is more or less the average of the overall tied ODA, which was respectively 8% and 3% and is rather low compared to the EU (only 46% of EU aid to health was not tied in 2014).

To Whom?

The geographic distribution of DAH is interesting to analyse the priority countries of France. We notice that 8 out of the 16 priority countries were among the top 10 grant recipients for health in 2014 and in 7 in 2015. If we aggregate gross loans and grants, we identify 6 countries in 2014 and 5 in 2015.

It’s worth noting that in 2014 the first recipient was Colombia and in 2015, Wallis and Futuna, none of them being amongst the priority countries and the latter being a French overseas territory.

The distribution is logically different for the loans, since most priority countries are not creditworthy. None of the priority countries received gross loans for health.

93% of gross loans for the health sector were going to upper-middle-income countries in 2014 (mainly due to the loan to Colombia) and 65% to upper-middle-income and lower-middle-income countries in 2015 (due to a loan to Wallis and Futuna which is considered as a high-income countries).

It is interesting to note that France is granting loans to Tanzania (2014 and 2015) and Mozambique (2015), which are both low-income countries, meaning that France participates to the debt of those poorer countries.

As a consequence of the massive loan allocated to Colombia in 2014, France has channelled the majority of its bilateral DAH to upper-middle-income countries: 59% in 2014 against 21% for lower-income countries. In 2015, the situation reversed: 32.5% was allotted to lower-income countries.

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”.

It’s worth noting that in 2014, 11% of the projects were unallocable by income groups, up to 36% in 2015. This could bias the analysis.

This shows that if France keeps on raising the volume of loans to health, the geographical distribution of its aid will evolve towards a bigger share to upper middle-income countries.

It’s also worth noting that France is mostly channelling its DAH through the public sector (80% in 2014 and 54% in 2015).

In Sub-Saharan Africa specifically, where all the priority countries stand, France is channelling its ODA for health through the public sector (47% in 2014 and 70% in 2015) and NGOs (27% in 2014 and 23% in 2014).

Unlike other donors France was not providing ODA to health to private recipient in 2014 or in 2015.

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.

It is interesting to see that France financing priorities fit pretty well with its development policies.

In 2014, the distribution of bilateral grants was mainly going to health system support (29%) and to the fight against epidemics (19%). Surprisingly, research and development came in the third place (18%). In 2015, health systems support stayed in the first place (27,5%), but reproductive health came second (22.6%) before research and development (20%).

If we aggregate bilateral and multilateral grants, the podium varies notably. The fight against epidemics came first (57%), followed by reproductive health (16%) and child health (13%) in 2014. The year after, the fight against epidemics still held the first place (53%), but health systems support came second (19.6%) followed by child health (16%).

It’s worth noting that specific issues such as mental health or neglected tropical diseases received little ODA both in 2014 and 2015. Non-communicable diseases saw a sharp decrease from €7 million in 2014 to €3 million in 2015. France is also performing quite badly on family planning with an average of €4 million per year.

The majority of loans (98%) for the health sector is dedicated to the strengthening of health systems which turns out to be consistent as the bulk of projects are to support reforms of the sector. Fight against epidemics, and child and reproductive health are not prone to the use of loans, and France is making little use of them.

Transparency

In this project, we 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 1% of the projects of France for 2014 and 2015 are contributing to UHC, mainly due to a lack of detailed information provided through the CRS.