Press Statement: Introduction to the Special Report 10/2008 EC Development Assistance to Health Services in sub-Saharan Africa

The objective of this audit was 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 (MDGs). The audit 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 audit 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 (Global Fund).

Overall, EC funding to the health sector has not increased since 2000 as a proportion of its total development assistance despite the Commission’s MDG commitments and the health crisis in sub-Saharan Africa. The Commission contributed significant funding to help launch the Global Fund in order to address AIDS, tuberculosis and malaria but has not given the same attention to strengthening countries’ general health systems although this was intended to be its priority. The Commission has had insufficient health expertise to ensure the most effective use of health funding.

The Commission has speeded up the implementation of the health assistance it manages itself. While the Global Fund has mobilised a large volume of funding, its rate of disbursement has been slower than for the European Development Funds (EDF). There is scope for improving the predictability of the flow of funding from all instruments to enable countries to better budget the resources available for their health sectors.

The Commission has made little use of Sector Budget Support to directly assist the health sector although this instrument could make an important contribution to improving health services. It has used General Budget Support much more widely but the links of this instrument to the health sector are less direct and the Commission has not used it very effectively. Overall, projects have proved reasonably effective although sustainability is often problematic. The Commission played a key role in setting up the Global Fund, which has already produced significant outputs, but greater involvement by the Commission in Global Fund activities in the beneficiary countries could have made this instrument more effective.

The Commission has not paid sufficient attention to ensuring the different instruments are used together coherently. When choosing which instruments to use, it could also take more account of the situation in individual countries, in particular whether they had a well defined health sector policy. Given their importance to the effectiveness of each instrument, there is a need for the Commission to contribute more to the development of such policies and to ensure its interventions are integrated into them.

The report’s main recommendations are that the Commission should:

consider increasing 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 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;
continue to use projects, especially for support to policy development and capacity building, pilot interventions and assistance to poorer regions;
work more closely with the Global Fund in beneficiary countries;
establish clearer guidance on when each instrument should be utilised and how they can best be used in combination;
make greater efforts to contribute to the development of well defined health sector policies in beneficiary countries.

• Primary Source

European Court of Auditors: ECA/09/3: Information note of the European Court of Auditors concerning Special Report No 10/2008 – EC Development Assistance to Health Services in Sub-Saharan Africa http://europa.eu/rapid/pressReleasesAction.do?reference=ECA/09/3&format=HTML&aged=0&language=EN&guiLanguage=en

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