Strategy
Moreover, health today is seen as a lever for economic growth, especially since it fosters individuals’ “capacities” to participate in economic life. If it is true that health is a lever for development, then the same goes for development and the improvement of living conditions being indispensable to the sustainable improvement of populations’ health. Thus progress in the area of health is made possible or strengthened by joint interventions in the sectors of water, education, urban development and rights.
The Global Priorities
Faced with the sudden increase of uncertain employment in the 1980’s, the fight against poverty and inequality progressively moved back into the arena of development to once again become a priority, and to be seen as such by the international community. The Millennium Summit in 2000 endorsed the Millennium Development Goals (MDGs), three of which target health: the fight against contagious diseases, the fight against child mortality and maternal health, providing the latter with priority status in development problems.
At the same time, recent years have seen the appearance of global occupations, linked to the multiplication of planetary risks: Global Public Goods are currently being produced in insufficient quantities and their deficit could compromise development over the medium term. In the area of health, the appearance of AIDS played a decisive role in this collective awareness, strengthened by the recurring risks of the emergence of major epidemics. Similarly, demographic priorities, which an active birth control policy has contributed to controlling, determine the potential of sustainable development in the poorest countries and the stability of entire regions. Health, which is characterized by many “cross-border” properties, has thus become a major planetary priority, inseparable from local development, since care and prevention both come first and foremost from the local level.
The Intervention Framework and the Strategic Objectives
After an initial reform in coopération française, carried out in 1998, AFD became involved in the health care sector.
In 2004 the Inter-Ministerial Committee for International Cooperation and Development (ICICD) identified the priority intervention orientations and increased the responsibilities entrusted to AFD, which was mandated to finance all bilateral French programs in the area of health. In this area, the projects corresponding to the Priority Solidarity Fund (PSF), until recently managed by the Ministry of Foreign Affairs, were transferred to the Agency in 2005.
AFD’s intervention strategy is operationally broken down in the Framework of Strategic Interventions (FIS) developed by AFD and reviewed every three years. It is based, on one hand, on Partnership Framework Documents (DCP) signed by each of the partner countries which “specify the sectors—in a limited number for each country—on which the means of coopération française will be concentrated”, and, on the other hand, health and AIDS, strategy notes, approved by the ICICD.
The three intervention axes are thus identified according to international concerns about achieving the MDGs and the production of Global Public Goods: the fight against contagious diseases and pandemics on one hand, and maternal and child health on the other, are underpinned by a third complementary transversal axis: the strengthening of the health care system. Making significant advances in maternal or infant health or in the fight against diseases requires massive and long-term intervention in terms of financing health care systems, managing human resources and providing medical goods and services (medication, vaccine, infrastructure, general organization of care in the public and private sectors).
Moreover, AFD’s historical anchoring in the overseas collectivities is at the origin of a fourth intervention axis: improving their sanitary and medico-social situation as compared to the situation in Metropolitan France and strengthening their regional insertion.
Thus four strategic orientations structure AFD’s intervention strategy for health, and reflect the thematic and geographic priorities. At the same time, AFD’s strategic orientation plan encourages tackling new operational objectives in the area of health, such as enlarging the scope of activities in the more developed zones (Medium Income Countries {MICs} and the emerging countries) or turning the Social and Environmental Responsibility (RSE) into projects.
Lastly, the characteristics of the sector, more than any other area, require an investment in intellectual production and strengthened collaboration between partners. Health is a very complex sector, characterized by a wide variety of intervention areas, needs that must be continually answered, a multiplicity of actors and financial instruments and deep-rooted cultural, socio-economic and demographic issues. The reinforcement of AFD’s strategy for health is based on the ability to understanding changing priorities, anticipating contexts and adapting to them. It is substantially enriched by doing research and developing partnerships.
AFD’s Intervention Strategy
As its volume is modest when compared with multilateral contributions, bilateral French aid for health should be first and foremost discriminating. To do this, it first targets areas of expertise in which it has an added value, and seeks to develop, whenever possible, lever effects, providing technical aid for the implementation of programs financed by global partners, massively supported by multilateral aid from France, but also by participating in sectorial approaches, by developing co financing and forging public-private partnerships.
In an environment characterized by the development of global or multilateral financial initiatives, where France plays an increasingly important role, bilateral aid remains indispensable and must seek out complementary strategies and niches. Bilateral aid makes it possible to:
- Contribute to defining France’s positions within multilateral governance bodies, thanks to insightful knowledge of the policies carried out by the countries and the results achieved;
- Highlight the needs and priorities of the priority cooperation countries, especially the French-speaking ones, in discussions and decisions of multilateral funds and bodies;
- Make the multilateral financing that France contributes to more efficient, by targeting country-level capacity building, as well as themes for which the lever effects are considerable (public-private partnerships against AIDS, for example, strengthening the health care system, etc.);
- Contribute to France’s visibility and influence in the priority countries and partnerships, and technical fora;
- Support innovative or experimental projects.
This selectivity is conducted within the strategic framework laid out by the ICICD, which defines three major strategic orientations, to which AFD’s specific mandate in the overseas collectivities can be added. The four chosen axes are: the fight against diseases and epidemics, the promotion of maternal and child health, the strengthening of health care systems and supporting the sanitary systems in the overseas collectivities. These strategic axes contribute directly to:
- The fight against poverty, by targeting the three MDGs dealing with health or interventions on health care systems, crucial to achieving the Goals;
- The production of Global Public Goods via an intervention in the fight against pandemics and emerging diseases.
They also contribute to economic development through the improvement of populations’ productive capacities.
Within the four strategic axes, the emphasis is more specifically on the targeted activities, such as the support for countries to implement the programs financed by the Global Fund, epidemiological monitoring and epidemic control, strengthening the supply and demand of reproductive health care services, the implementation of sectorial approaches, human resources for health, systems to share risks and targeted support in the overseas collectivities.
In keeping with AFD’s Strategic Orientation Plan 2 (SOP2), a considerable effort is being made for development interventions in the LICs, especially to the benefit of the private non-profit sector or participating in a public service mission, as well as in the emerging countries for the Global Public Goods.