May 2007 ∙ HEALTH DIVISION Sida’s contributions 2006 Progress in health development Published by Sida Health Division. Date OF PUBLICatION: May 2007 EDITORIal SUppORT: Battison & Partners DeSIGN & LAYOUT: Lind Lewin kommunikation/Satchmo IMAGES: PHOENIX Images PRINteD BY: Edita AB ISBN: 91-586-829-7 ISSN: 1403-5545 ART.NO: SIDA37036e CONTENTS Preface ........................................................................................... 2 Introduction .................................................................................... 4 Swedish health development cooperation – an overview .......... 6 Africa ........................................................................................... 6 Asia ............................................................................................... 76 Central America ......................................................................... 92 Eastern Europe and Central Asia .............................................104 Global cooperation .................................................................118 Sida research cooperation ......................................................18 Emergency health ....................................................................154 NGO support ..............................................................................156 Appendix I: Total health disbursement all countries and global programmes 2000–2006 .............................158 Appendix II: Sector distribution ...................................................160 Appendix III: Sida health cooperation by department ....................161 Appendix IV: List of frequently used acronyms .............................162 Preface The Health Division at Sida has previously published annual statistics of disbursements under the name “Facts and Figures”. This year we have decided to increase our level of ambition to include more results and analysis and this is the result of our efforts. Why have we done this? Partly for ourselves. In our efforts to improve quality and introduce results-based management, statistical facts and reports and analysis of results are necessary. Secondly we believe that a solid presentation of what we achieve can serve as an important input for both Sida management and the Ministry for Foreign Affairs (MFA). Thirdly, we direct this information to our partners in development, academic institutions, government agencies, NGOs and an interested Swedish public. The analysis is divided into two main parts. The overview contains the overall statistics of disbursements and an analysis of trends over the period 2000-2006. In the second part we describe and analyse individual projects and programmes, by region and country. We have not been able to include all projects. The material has been produced by many different individuals from the Embassies, and from Sida’s departments in Stockholm, including Sida’s Department for Research Cooperation (SAREC), and Sida’s Department for Cooperation with NGOs, Humanitarian Assistance & Conflict Management SEKA( ). We hope and believe that the process itself has increased our capacity to analyse results and that others can use our facts and figures to form their own opinion. We hope that we can stimulate an analytical discussion on the Swedish contribution to improved global health. When looking at the total picture of Sida’s contributions (we have included multilateral disbursements directly from the MFA for comparison) there are a few facts that stand out. One example is that the amount going to programme support in 2006 was about SEK 500 million, representing about 25 percent of Sida contributions in the health sector. If all health support is included (including research, humanitarian and multilateral through MFA) only about 12 percent goes through programme support to governments. This gives rise to several questions. What should be the balance between support directly to governments and through other channels, such as the UN system, global partnerships or NGOs? What proportion should programme support in health have three years from now, considering the targets in the Paris agenda? If we want programme support to increase, how do we go about it? This is one example of an important discussion on the future of Swedish health development cooperation, and we hope that this document will stimulate and contribute to this discussion and many others. Anders Molin Head, Health Division DESO Sida 2 Introduction The Millennium Development Goals Three of the UN’s Millennium Development Goals (MDGs) directly address health problems: those relating to child health (MDG 4), maternal health (MDG 5), and HIV/AIDS, malaria and other diseases (MDG 6). With the present development it is unlikely that MDGs 4-6 will be reached. Sub-Saharan Africa is the region with the highest morbidity and mortality, and where progress is also slowest. The global health gap is widening. Child survival has improved markedly in Latin America, the Caribbean, Southeast and East Asia and Northern Africa. But sub-Saharan Africa, with only 20 percent of the world’s young children, accounted for half of the total deaths, a situation that has shown only modest improvement. Overall, 10.5 million children died before their fifth birthday in 2004, mostly from preventable causes. Maternal mortality has not been substantially reduced in regions where most deaths occur – sub-Saharan Africa and Southern Asia. The number of people living with HIV has continued to rise, from 36.2 million in 2003 to 38.6 million in 2005. The number of AIDS-related deaths 4 also increased 2005 to 2.8 million, despite greater access to antiretroviral treatment and improved care in some regions. The epidemic remains centred in sub-Saharan Africa. Rates of new HIV infections in the region peaked in the late 1990s, and prevalence rates in Kenya, Zimbabwe and in urban areas of Burkina Faso show recent declines. HIV prevalence among people aged 15 to 49 in sub-Saharan Africa appears to be levelling off, though at extremely high levels. The number of new tuberculosis cases is growing by about 1 percent per year, with the fastest increases in sub-Saharan Africa. Sexual and Reproductive Health and Rights (SRHR) continues to be highly controversial, with strong controversies around issues such as abstinence only, condom use, access to contraceptives and safe abortion. Maternal mortality has not been substantially reduced during the last 20 years. Of the 20 countries with the highest maternal mortality ratios in the world, 19 are in Africa and only one – Afghanistan – in Asia. The African Region accounts for about one-tenth of the world’s population and 20 percent of the global births, yet nearly half of the mothers who die globally as a result of pregnancy and childbirth are in this region. Trends in health development cooperation The global health architecture has changed dramatically over the last 30 years. In the 1970s the emphasis was on primary health care, in the 1980s focus was largely on health reforms, while the 1990s was characterised by the emergence of a great number of global health initiatives, many of them private-public partnerships. In the 2000s, the Paris agenda has added a strong emphasis on alignment and harmonisation and today we see on one hand a development towards programme support among several bilateral donors and on the other hand a number of large global health initiatives often organised around specific diseases, the most important beingHIV and AIDS. The resource mobilisation for HIV/AIDS has been highly successful to the point that some countries receive resources for HIV and AIDS that exceed the resources for their entire health sectors. Health is today high on the global development agenda. There is a growing realisation of the importance of health as a broad development issue, not only as a human rights issue. The HIV/AIDS pandemic has of course been the driving force for this, but there are other pandemics, such as SARS and Avian Influenza that also illustrate the global nature of health and disease. Swedish priorities The Government defines health priorities on the development agenda, for example, through its instructions in its annual directive and letter of appropriation for Sida and the budget bill to Parliament. There have been strong references to SRHR and HIV/AIDS in recent years, and there is now a Swedish policy on SRHR and a special programme for infectious diseases. In the letter of appropriation for 2006, there are specific reporting and financial conditions for SRHR and infectious diseases. 5 Swedish health development cooperation – an overview Sida’s total disbursements for the main Health1 sector amounted to SEK 1,912 million for 2006. In addition, health research disbursement amounted to SEK 207 million (main sector Research), emergency health programmes and refugee health came to SEK 5362 million (main sector Humanitarian assistance). This means a total of SEK 2,669 million from Sida in 2006, an increase of more than 25 percent from 2005 (SEK 2,096 million). Health research Humanitarian health Main sector health MFA health Figure 1: Total disbursement for Health 2006 MAJOR PROGRammES/ DISBURSEMENT COmpONENTS 2006 UNICEF (not all defined as health) 440 000 000 UNFPA 400 000 000 UNAIDS 200 000 000 Global Fund against HIV/AIDS, TB and Malaria 600 000 000 International AIDS Vaccine Initiative (IAVI) 15 000 000 International Partnership for Microbicides (IPM) 15 000 000 Population Council 15 000 000 WHO; by 5 support to ARV treatment (continuation