Posted by: africanpressorganization | 15 January 2009

Introduction to the Special Report 10/2008 “EC Development Assistance to Health Services in sub-Saharan Africa” / Press statement by Mr Jan Kinst





Introduction to the Special Report 10/2008 “EC Development Assistance to Health Services in sub-Saharan Africa” / Press statement by Mr Jan Kinst


BRUSSELS, Kingdom of Belgium, January 15, 2009/African Press Organization (APO)/ — Press statement by Mr Jan Kinst


Ladies and Gentlemen,

You are no doubt aware that good health is a major factor in economic growth and development while ill health is both a cause and an effect of poverty. The central place which health occupies in poverty reduction has been recognised in the Millennium Development Goals which, over the period 2000-2015, are intended to be the focus of international development cooperation – three out of the eight MDGs directly relate to health: MDG 4 – reduce child mortality, MDG 5 – improve maternal health and MDG 6 – combat HIV/AIDS, malaria and other diseases. The European Commission in common with other donors has made strong policy commitments to assisting developing countries to achieve the MDGs.

Well, despite this, the 2007 midterm review by the United Nations on progress towards the MDGs in all regions of the world, shows that the most problematic area concerns the health MDGs in sub-Saharan Africa.

In the light of the above, the Court of Auditors decided to carry out an audit in order to assess how effective EC assistance has been since 2000 in contributing to improving health services in sub-Saharan Africa.

Before I proceed to describing the scope and results of our audit, let me remind you that the Commission uses different financing instruments for implementing its development aid. As well as traditional project-based financing, the Commission is making increasing use of Budget Support which involves the transfer of resources directly to the national treasury of a partner country and which can take the form of General or Sector Budget Support. In addition, specifically in the field of health, financing is also given to the Global Fund, the international public/private partnership to fight three major diseases – HIV/AIDS, tuberculosis and malaria. The Commission is one of its founding partners and the fourth largest contributor to it.

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The audit asked the following key questions:

• Has the amount of resources allocated by the Commission to the health sector reflected its policy commitments?

• Has the Commission accelerated its funding of assistance to the health sector?

• Has the Commission used the available instruments effectively and coherently to contribute to improving health services?


Allow me now to summarize the main conclusions and recommendations resulting from the Court’s audit:


One of the Court’s key messages is that the level and balance of financial resources allocated to the health sector do not adequately reflect the Commission’s MDG policy commitments. Despite these commitments and the health crisis in sub-Saharan Africa, EC funding to the health sector has not increased since 2000 as a proportion of its total development assistance. The funding also falls well short of the European Parliament benchmark of allocating 20 % of funds to basic health and education in country development assistance programmes. Concerning the allocation of resources, the Commission contributed significant amounts to help launch the Global Fund Against AIDS, Tuberculosis and Malaria. However, the Commission has focused on this disease specific funding at the expense of strengthening health systems in beneficiary countries which was intended to be its policy priority. Strengthening of health systems in developing countries is absolutely essential if the health MDGs are to be met.


The Court recommends that the Commission should consider increasing its support to health sector and review the balance of its funding to ensure that this reflects its policy priority of focusing on health systems support. The Commission should also ensure it has sufficient health expertise to properly implement its health sector policies and interventions and play an effective role in health sector dialogue with beneficiary countries.


Concerning the speed of implementation, a positive feature here has been that the Commission has accelerated its health assistance 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 Global Fund, but the actual rate of disbursement of the Global Fund itself has been relatively slow mainly because of low absorption capacity in most beneficiary countries. The Court is of the opinion that the Commission should work more closely with the Global Fund management mechanisms in beneficiary states and also by providing technical assistance support to beneficiary countries to increase their ability to obtain and manage the Fund’s grants.

Regarding the question of effectiveness and coherence, the Court examined the three main instruments for aid disbursement, which I mentioned a minute ago: Budget Support, projects and the Global Fund.

Budget support has the potential to play a key role in improving health services by increasing funds available to governments for their health budget and by linking funding to performance indicators which target improvements in health service delivery. In sub-Saharan Africa the Commission has mainly used General Budget Support but in the Court’s view, General Budget Support hasn’t yet made an effective contribution to improving health services.

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In most countries examined General Budget Support has not been associated with an increase in health budgetary resources in relative terms. Moreover, the Commission’s so-called “dynamic interpretation” of eligibility for granting General Budget Support means that 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 the recipient countries. General Budget Support programmes have also not sufficiently addressed the poorer sections of the population, particularly in rural areas. While Sector Budget Support is likely to be more effective in improving health services, because it is more focused on the health sector, the Commission has made relatively little use of this type of budget support in sub-Saharan Africa.

Health projects in general were reasonably effective although as for all projects there were problems with sustainability. 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.

Concerning the Global Fund, the Commission played a key role in setting it up and the Fund has already produced significant outputs. If we focus on the projects for combating the HIV/AIDS pandemic, where about 60% of funds are allocated, the Fund has been particularly successful in scaling-up Anti-Retroviral Therapy and HIV Counselling and Testing but less effective in the Prevention of Mother to Child Transmission. It was found that an important factor necessary to increase the effectiveness of the Global Fund was greater complementary long-term health system support from donors.

The audit also concluded that the Commission could do more to ensure that the different instruments are used together coherently. For instance, complementarity between Global Fund activities and Commission’s own financing in a beneficiary country needs to be improved as do the links between sectoral projects interventions and General Budget Support. In the Court’s view, the Commission should establish and disseminate clearer guidance on when each instrument should be utilised and how they can be used in combination to maximise synergy. When choosing which instruments to use, the Commission should also take more account of the specific situation in individual countries, in particular whether they have a well defined health sector policy.

In closing, let me express my thanks to the Commission services for their good cooperation during the course of audit. We have had a number of debates and exchanges of different views but I hope our report will contribute to a more effective assistance in such a critical and sensitive sector of EU development policy as health.



SOURCE : European Commission



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