EC Development Assistance to Health Services in Sub-Saharan Africa

Brussels - January 2009

Press Briefing: “EC Development Assistance to Health Services in Sub-Saharan Africa”

This Press Briefing was held today (14/01/2009) at the Résidence Palace in Brussels and it looked at the European Court of Auditors’ Special Report no. 10/2008 on "EC Development Assistance to Health Services in Sub-Saharan Africa", by Mr Jan Kin?t, Member of the Court.

The objective of this Report is to assess how effective EC assistance has been in contributing to improving health services in sub-Saharan Africa in the context of the EC’s commitments to poverty reduction and the Millennium Development Goals. The examined whether the financial and human resources allocated to the health sector reflected the EC’s policy commitments and whether the Commission had speeded up the implementation of this aid. The report also assessed how effectively the Commission had used various instruments to assist the health sector, notably budget support, projects and the Global Fund to fight AIDS, tuberculosis and Malaria.

Here you have some of the main points discussed:

The level and balance of financial resources allocated to the health sector do not adequately reflect the Commission’s MDG policy commitments: EC funding to the health system has not increased since 2000 as a proportion of its total development assistance. The Commission had focused on disease-specific funding such as AIDS, Tuberculosis and Malaria at the expense of strengthening health systems in beneficiary countries which was intended to be its policy priority.

The speed of implementation in health assistance was accelerated thanks partly to the devolution of management responsibilities from Headquarters in Brussels to delegations in the recipient countries. The Commission has also succeeded in disbursing a large volume of financial resources to the Global Fund, but the actual rate of disbursement of the Global Fund has been relatively slow mainly because of low absorption capacity in most beneficiary countries.

The effectiveness and coherence was examined as regards the three main instruments for aid disbursement: budget support, projects and Global Fund.

Budget Support increases funds available to governments for their health budget and it links funding to performance indicators which target improvements in health service delivery. In the Court’s view, in sub-Saharan Africa the General Budget Support has not yet made an effective contribution to improving health services. The Commission’s so-called “dynamic interpretation” of eligibility for granting General Budget Support means those countries with very weak public finance management capacity receive funding which puts at risk its effective use in the health sector. In addition, insufficient attention has been paid to strengthening the health sector policy and institutional framework in recipient countries.

Health projects were able to play an important role in improving the quality of health policies and health service delivery. The more problematic projects have been those which cover a number of countries, because of the management difficulties this entails.

The Global Fund has already produced significant outputs. An important factor necessary to increase the effectiveness of the Global Fund was greater complementary long-term health systems support from donors.

Some key recommendations for the Commission:

• increase its aid to the health sector during  the tenth EDF mid-term 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 that 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;
• 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;
• involve local civil society much more, not just in the implementation of the project but even in the policy dialogue with the EC Delegations and the Ministry (top-level).

Click here to read the Special Report