The EU and its Member States belong collectively among the largest funders of global health. Nevertheless, it is not only about “how much” but also “how effective” the financing is. Furthermore, an influential role in shaping the global health agenda requires a match between political commitments and financing support. 

Therefore, an important element of the EU Strategy for Global Health is the topic of “effective funding”. Aim is that the different programmes, policies, instruments, and actions of the EU work together synergistically. The new approach of the EU regarding its financial contribution includes commitments within the EU budget lines, innovative finance, co-investment from partners and pooling with other international actors as well as advocacy and exercising influence for sustainable financing. 

Reaching the ambitious objectives of the EU strategy requires not only high political commitment globally, but also significant commitment of resources. Therefore, the EU prioritizes Global Health across all relevant EU budget finance programmes such as EU4Health, Horizon Europe, NDICI-Global Europe, IPA, Twinning and TAIEX. Budget support will remain a key method, where appropriate, to steer national policies and reforms and ensure strong policy dialogue with partner countries. 

Following a Team Europe-approach the EU will seek new ways of effective financing through pooling resources of the EU and the Member State to achieve maximum impact.  

In addition, the EU will prioritize pooled financing with other international stakeholders, and co-investment initiatives with local partners. 

The EU encourages the use of innovative financial instruments and building on the European Fund for Sustainable Development Plus (EFSD+) that facilitates access to blended finance and budgetary guarantees. A specific window on human development under the EFSD+ open architecture provides opportunities to leverage further investment in health.  

Together with the European Investment Bank (EIB) and the European Bank for Reconstruction and Development EBRD), the Commission intends to develop a framework for global health financing. The EU encourages participation of private investors where relevant and in line with EU priorities. 

In addition, new financing methods, including debt swaps or loan buy-downs to convert debt into investment in health system reforms and new life-saving programmes will be promoted. Through facilitating such transactions by concessional loans and guarantees in partnership with development finance institutions, public funds could be made available and health system reforms incentivized.   

Environmental taxation could help increasing revenues and reducing debt financing, and thus mobilize resources for public health services.  

The EU will support domestic resource mobilisation and efficiency as the most sustainable source of public financing for preventing health threats, improving health, and investing in health services. Areas of action include diversifying domestic health financing, supporting health financing and system reforms, and strengthening public expenditure management. 

The EU will encourage partner countries to make and meet ambitious commitments to increasing domestic resources for health in the long term. This includes for example advancing in Africa towards the target set in the 2001 African Union Abuja Declaration to allocate “at least 15% of [the] annual budget to the improvement of the health sector while taking account of the necessary fiscal space”. 

The EU will advocate for EU Member States to increase financing for global health in line with the priorities in the strategy. 

Furthermore, the EU wants to exercise influence over priorities, financial flows and action of various funds and initiatives through participation in their governance mechanisms. 

The EU advocates for increased accessible finance for countries through multilateral development bank lending and for increased sustainable finance.  

The EU plans to undertake permanent mapping of key measures and financing efforts of the EU and its Member States.   

In addition, the EU will monitor health expenditures benefiting low- and middle-income countries (LMICs), notably Official Development Assistance (ODA), trends in domestic financing and other donors funding. 

The COVID-19 pandemic has shown the importance of preparedness and response capacities and adequate funding to save lives.  

“Spending billions would have saved trillions.” 
EU Strategy for Global Health

According to the EU GH-Strategy a robust global health governance requires adequate financing to fill existing gaps as well as coherence and coordination of global health initiatives. 

The EU advocates for a strong and responsive multilateral system with the World Health Organisation at its core that is sustainably financed. The EU wants to enhance cooperation with the WHO and provide it with sizable voluntary contribution.  In 2020 and 2021, the voluntary contributions of the EU Commission were the fourth largest overall. The EU and its Member States accounted for more than 20% of the WHO budget, being the largest contributor. 

In addition, financing for innovative ways to fill gaps such as the Pandemic Fund should be ensured. This G20-born instrument finances critical investments to strengthen pandemic prevention, preparedness, and response capacities at national, regional, and global levels, with a focus on low- and middle-income countries. 

Building on the work of the G20 Joint Health and Financing Task Force, the EU supports the idea of a permanent cooperation and synergies between the health and finance tracks. Such an arrangement could contribute to mobilizing the necessary financial resources after the WHO declares a pandemic emergency.   

Global projects of the EU include for example support for: 

• United Nations Population Fund’s Supplies Partnership on reproductive health commodities through NDICI-GE: EUR 45 million pledged, 2023-2027. 
• Global Fund against AIDS, Tuberculosis and Malaria, and health system strengthening through the NDICI-GE: EUR 715 million pledged, 2023-2025. 
• UHC-Partnership administered by the WHO, supported by the NDICI-GE and the Emergency Support Instrument: EUR 125 million programmed, 2023-2027. 
• Gavi, the Vaccine Alliance to ensure the expanded uptake of vaccines against childhood illnesses and support adult health through NDICI-GE:  EUR 300 million pledged, 2021-2025. 
• Pandemic Fund, supported by NDICI-GE: EUR 427 million pledged, 2023-2027. 
• Support R&D of vaccines against emerging infectious diseases, including through the Coalition for Epidemics Preparedness Innovations (CEPI), supported by Horizon Europe, 2021-2024. 
• the roll-out of COVID-19 vaccines in selected most under-vaccinated countries through NDICI-GE and the Emergency Support Instrument: EUR 375 million pledged, 2023. 

EU Strategy for global health

Further information on EU funding and technical assistance instruments:

​​​​​​EU funding and technical assitance instruments (in German)

Horizon Europe (in German)

Neighbourhood, Development and International Cooperation Instrument – Global Europe (NDICI-GE)

Instrument for Pre-Accession Assistance (IPA)

Twinning und TAIEX (in German)

Image source: Unsplash / Marek Studzinski