EU Council Conclusions on EC Development Assistance to Health Services in Sub-Saharan Africa

Sommaire: 23 April 2009, Luxembourg - Council of the European Union, 2937th AGRICULTURE and FISHERIES Council meeting, Conclusions on Special Report No 10/2008 concerning EC Development Assistance to Health Services in Sub-Saharan Africa together with the Commission's replies

The Council adopted the following conclusions:

"I. INTRODUCTION

The Council welcomes the Court of Auditors' Special Report No 10/2008 concerning EC Development Assistance to Health Services in Sub-Saharan Africa, its recommendations and the Commission's replies.

Convinced that building up and strengthening health systems is crucial to ensure access to comprehensive health services and accelerating the progress towards the MDGs in Sub-Saharan Africa, the Council notes the concerns expressed by the Court in its report in particular regarding the fact that direct 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 Council considers that the EU Agenda for Action on the MDGs, agreed in June 2008¹, can be an important contribution to strengthening health services and systems across the African continent.

The EU is strongly committed to enhancing aid effectiveness, on the basis of partner country ownership and the 2005 Paris Declaration on Aid Effectiveness, the 2008 Accra Agenda for Action² , the EU Code of Conduct on Complementarity and Division of Labour³ and the "Three Ones" principles⁴ . The International Health Partnership (IHP) launched in 2007 is a way to apply these principles to the health sector.

II. SPECIFIC ASPECTS

The Global Fund

The Council recognises that the Commission has contributed significant funding to help launch and support the activities of the Global Fund in order to address HIV/AIDS, tuberculosis and malaria. In the framework of the global Fund's renewed efforts to support national health systems, the Council recognizes that the Commission 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 financing.

The Commission has speeded up the implementation of the health assistance it manages itself. The Council acknowledges that the Commission response to the Special Report recognises the points made on the Global Fund and indicates areas where it has taken steps to improve performance, including the Commission's participation in the International Health Partnership (IHP). The Council considers that the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action (AAA) should also be further promoted in the activities of the Global Fund.

Budget Support

The Council notes that the Commission has made little use of Sector Budget Support (SBS) to directly assist the health sector although this instrument could make an important contribution to improving health services. It has used General Budget Support (GBS) 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 with regard to strengthening these links. In this context, it is therefore important to ensure adequate room for health issues within the context of political dialogue and to set the right conditions and indicators within the Policy Assessment Frameworks (PAFs).

The Council invites the Commission to combine GBS in an effective and coherent manner with Sector Budget Support as well as with technical assistance, and to reconsider, in the limits of the respect of the ownership and aid effectiveness principles, the current distribution of resources between Sector Budget Support and General Budget support, while underlining that this should not be a simple reallocation of funds from GBS to SBS. In this regard, the Council encourages the Commission to increase transparency on the choice and combination of instruments.

The Council considers GBS an appropriate and effective tool in order to support the implementation of poverty-oriented reforms and foster partner countries' capacities, including in the health sector, provided that it is accompanied by the aforementioned sector specific instruments.

Capacity

The Council notes that human resources for health are a crucial element in strengthening health systems, but also a broader approach is needed, particularly including sickness risk coverage and financing of health systems in developing countries, as approved by the Council on 11 November 2008.

The Council acknowledges that donors' expertise in the partner countries is an essential condition for the Sector Wide Approach (SWAp).

In order to improve the capacity in delegations, the Council would welcome innovative in-country opportunities and invites the Commission and the Member States to strive to address this issue. In this regard, the Commission could investigate the possibilities of increasing its health expertise particularly in countries where health is a focal sector and where it uses general budget support, through working in closer partnership with other partners including the Member States and the UN organisations, in particular with the WHO Country Offices, and draw on their expertise.

III. RECOMMENDATIONS AND CONCLUSIONS

The Council approves the Court's recommendations to the Commission that is invited to:

• consider increasing its aid to the health sector during the tenth EDF mid-term review to support its commitment to the health MDGs;⁵

• continue improving the predictability of its funding provided through various instruments to enable countries to better secure the resources needed for their health sectors;

• take into account the Aid Effectiveness principles enshrined in the Paris Declaration and the AAA while respecting the EU Code of Conduct on Complementarity and Division of Labour;

• monitor the EU collective increased support to health, based where possible on existing mechanisms;

• 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 relying on the resources of other in-country partners (particularly the Member States), building on further consultations with the Member States and other global partners on a division of labour;

• make more use of Sector Budget Support in the health sector and focus its General Budget Support more on improving health services; SBS should be aligned with national sector policies;

• continue to use projects, especially for support to policy development and capacity building, pilot interventions and assistance to poorer regions, while ensuring they contribute to development of sustainable financing mechanisms for the whole health system;

• seek to clarify its comparative advantages, inter alia increase health-related assistance to fragile states and post-crisis countries;

• continue and strengthen, together with the Member States, efforts to support and build the institutional and technical capacity of the beneficiary countries in the preparation of Global Fund grant applications and in the implementation of Global Fund grant contracts, as well as to contribute to improved disbursement rates from the Global Fund and to ensure that it also effectively supports national health systems;

• establish clearer guidance on when each instrument should be utilised and how they can best be used in combination;

• pursue its efforts jointly with partner counties and the donor community to contribute to the formulation of well defined health sector policies and common development oriented results frameworks in beneficiary countries;

• pay more attention to sexual and reproductive health and rights, while respecting the established EU positions and to achieve the goals and the objectives of and taking into account the Programme of action of ICPD, the Beijing Platform for action and internationally-agreed development goals including the MDGs. The Council notes the importance of increased accessibility to maternal health services, including in the fight against HIV/AIDS.

The Council recalls its conclusions of November 2008 and in particular its request to the Commission to present, in 2009, a communication on the sickness risk coverage and financing of health systems in developing countries in developing countries.

In conclusion, the Council considers the answer of the Commission adequate, and encourages the Commission to work on those answers to the conclusions of the report. It welcomes the fact that the Commission accepts the Court's recommendations in general and that it has already begun to take some measures to act on them, in particular the Council is pleased to see in the Commission responses that it will look at the sectoral allocations as part of the mid-term review of the 10th EDF. The Council asks the Commission to provide the Council in 2010 with an update of the concrete steps that have been taken on the recommendations and conclusions of the report."
________________________

¹ Doc. 11096/09 : "The EU as a global partner for pro-poor and pro-growth development: - EU Agenda for Action on MDGs".
² Adopted at the High-level Forum on Aid Effectiveness (Accra, 2 to 4 September 2008).
³ Council conclusions of 15 May 2007 (doc. 9558/07).
⁴ The principles were endorsed in April 2004 by representatives of governments, donors, international organizations and civil society and include one national HIV/AIDS framework, one broad-based multi-sectoral HIV/AIDS coordinating body, and one agreed country-level monitoring and evaluation system. UNAIDS is acting as facilitator and mediator to realize these principles.
⁵ Reserve by IT

Ref: CL09-086EN
Source UE: Conseil
UN forum:
Date: 23/4/2009

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