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Spain’s influence in the global health system

Published 27 March 2023 in Analysis

On January 30th 2023, the Real Instituto Elcano and the Barcelona Institute for Global Health (ISGlobal), two think tanks specialized in international relations and partners of Focus 2030, published the report "Ayuda al desarrollo e influencia en el sistema de salud global" (Development aid and influence on the global health system), which analyzes the governance architecture of the global health system and the capacity of Spain and other actors to influence it.





Through case studies of key multilateral organizations such as the COVAX mechanism for Covid-19 vaccines and the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Elcano Institute and ISGlobal study the structure and decision-making processes of these organizations. At the same time, they establish different criteria that could condition the ability of donor countries to influence the governance of these institutions. These influencing factors include the following :


  • Structural capacities : economic size, total volume of official development assistance (ODA), financial contributions, aid conditionality, distribution of aid aligned with health priorities, national pharmaceutical R&D capacity, role of national laboratories, regulatory power, health diplomacy, identification and exploitation of donor value added, and adaptive capacity.
  • Proactivity : ability to identify and reach relevant areas, high-level political presence, presence of national experts, conduct of specific initiatives, high-level political lobbying, participation in communication and advocacy campaigns, G7 and G20 presidencies, hosting of high-level meetings or replenishment conferences
  • Political vision : strategic vision of global health (explicit, clear, coordinated and shared national strategy, diplomatic vision beyond aid, with a multisectoral approach), and coordination of actors at national level.
  • Partnerships : with governments, the private sector and other stakeholders.

The Elcano Institute and ISGlobal report also examines Spain’s participation in the COVAX initiative and the Global Fund, and provides strategic recommendations for increasing Spain’s capacity to influence global health. In particular, the study points out that Spain is generally not sufficiently proactive on the boards of these organizations, although it considers the personal involvement of Prime Minister Pedro Sánchez in replenishment conferences and other international forums related to global health a positive sign.

The Elcano Institute and ISGlobal also recommend that Spain align itself with multilateral organizations operating in the health field :

  • Explore the possibility of strengthening the geographic focus of its interventions beyond Latin America ;
  • Further leverage its extensive experience in public health ;
  • Develop new alliances with other donors and partner countries ;
  • Strengthen its strategic priorities in relation to multilateral health institutions ;
  • Capitalize on its comparative advantages in global health R&D;
  • Work actively to organize high-level summits on global health ;
  • Improve policy coordination among the different governmental units responsible for defining global health interventions.

To go further :

Real Instituto Elcano – Policy Paper ‘Ayuda al Desarrollo e Influencia en el Sistema de Salud Global