Which countries fund global health?

According to the latest available data (2021), 4.5 billion people - more than half of the world’s population - are not fully covered by essential health services. It means that they are deprived of access to the health services they need throughout their lives, including prevention, treatment, rehabilitation and palliative care, and that they aren’t able to benefit from them when and where they need them without suffering financial constraints.

Yet, universal access to healthcare is one of the targets of Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being for all, at all ages, by 2030.

Therefore, significant progress is needed. To achieve this goal, the WHO estimates that between 200 and 328 billion dollars per year must be allocated to developing countries until 2030.

The recent downturn in the global economy primarily affects the poorest countries. Between 2019 and 2021, 62 developing countries devoted more resources to debt repayment than to their healthcare systems; they were 34 between 2012 and 2014.

To achieve SDG3 by 2030, an increase in resources for global health is essential. While the Addis Ababa Action Agenda on Financing for Development calls for greater mobilisation of domestic resources to achieve the SDGs, Official Development Assistance (ODA) remains a crucial tool for supporting essential services in many countries. In 2022, almost 34 billion dollars were allocated to health in developing countries by the industrialised countries of the OECD’s Development Assistance Committee (DAC).

2024 and 2025 will be decisive as several multilateral institutions promoting global health will replenish their resources, including the WHO, Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Pandemic Fund.

Analysis of the main funding allocated to the promotion of global health by industrialised countries, particularly France.

Official development assistance for global health: key figures

In 2021, high-income countries, home to 16% of the world’s population, accounted for 79% of total health spending worldwide, compared to 3.8% for low- and lower-middle-income countries, which account for 52% of the world’s population. One of the objectives of official development assistance is to reduce these inequalities in access to health and enable everyone to have access to quality health services.

According to the Institute for Health Metrics and Evaluation, 60% of the world’s total healthcare expenditure comes from national governments, but this amount varies considerably from one income group to another and from one country to another. It averages 26% in low-income countries (compared with 66% in high-income countries), where 36% of expenditure is covered by official development assistance.

Between 1995 and 2020, the share covered by the governments of low-income countries remained stable, but the share covered by ODA increased considerably from 8% to 32%: this contributed to a reduction in expenditure borne by individuals in low-income countries from 60% to 37% of total health expenditure in 25 years.

Therefore, in 2001, the World Health Organisation recommended that industrialised countries devote 0.1% of their gross national income (GNI) to financing global health, as part of their official development assistance. However, in 2022, the DAC countries devoted 34 billion dollars to this, or 0.06% of their GNI. Only one country, Luxembourg, met the WHO recommendation in 2022 (0.12%), followed by Germany and Norway (0.09%).

However, the proportion of ODA devoted to health in 2022 is one of the highest ever observed: between 2012 and 2019, it fluctuated between 0.04 and 0.05% of the GNI of DAC countries. It was not until 2021 that it exceeded 0.06%, mainly because of the Covid-19 pandemic: the fight against the pandemic accounted for 49% of bilateral health ODA from DAC countries in 2021 and 2022.

Multilateral organisations in global health: what funding?

• The budget of the World Health Organisation (WHO) is renewed every two years. It is made up of various types of contributions (compulsory and voluntary) from the organisation’s member states and other partners (foundations, private sector, etc.). The WHO budget for 2022-2023 amounts to 10.4 billion dollars]. From 2025, the WHO’s funding model should evolve towards a replenishment model, in order to provide the organisation with more predictable and flexible funding. This change will be put to a vote by the Member States at the World Health Assembly in May 2024. For the period 2025-2028, the financial requirements for the WHO’s core budget are estimated at 7.1 billion US dollars.
• The Global Fund to Fight AIDS, Tuberculosis and Malaria operates in three-year cycles, with a replenishment period prior to each cycle. For the period 2024-2026, 15.7 billion dollars have been pledged by contributors. The Global Fund’s main historical donors are the United States, France, the United Kingdom and Germany. The 8th replenishment cycle for the period 2026-2028 will be held in 2025.

• Funding for Gavi, the Vaccine Alliance, is organised around five-year periods. During its last replenishment for the period 2021-2025, held in June 2020, 8.8 billion dollars were pledged by donors in direct contributions. Since its foundation in 2000, Gavi has received $22.5 billion from sovereign donors, including $6.4 billion from the UK (28% of the total), $3.6 billion from the US (16%), $2.9 billion from Norway (13%), 1.9 billion from France (9%) and $1.6 billion from Germany (7%). Gavi’s new investment opportunity for the 2026-2030 period was launched on June 20, 2024 in Paris, at the Global Forum for Vaccine Sovereignty and Innovation organized by France and CDC Africa. It details needs of up to $9 billion, including $1.7 billion for the International Finance Facility for Immunization (IFFIm), in order to vaccinate an additional 500 million children by 2030 and preserve 8 to 9 million lives.

• In 2021, the Global Polio Eradication Initiative (GPEI) adopted a strategy for the period 2022-2026, which estimated the costs of polio eradication at $4.8 billion over these 5 years. During its last replenishment period, donations from the international community totalled 2.6 billion dollars, including 48 million from France. Since 1985, the main sovereign donors to the GPEI have been the United States ($4.3 billion), the United Kingdom ($1.7 billion) and India ($1.3 billion).

To what extent does France fund global health?

In 2022, France ranks 5th among DAC donor countries in total ODA (bilateral + multilateral) allocated to global health ($1,822 million) and 8th in proportion of its GNI (0.064%, slightly above the DAC average of 0.060%). According to Global Health Advocates, the increase in France’s ODA for health since 2020 is largely due to the response to the Covid-19 pandemic: donations of vaccines and other strategies to respond to the pandemic represented 58% of France’s bilateral health ODA in 2021 and 45% in 2022.

Part of France’s official development assistance is allocated to multilateral health organisations. France is the second largest historic donor to the Global Fund, and will distinguish itself in 2024 by hosting the launch event for the Gavi investment opportunity in Paris. The table below summarises French contributions to the main multilateral health institutions.