There are shortcomings in the way European aid is allocated to partner countries’ healthcare systems, and the effectiveness of the projects funded may suffer from poor coordination and shaky sustainability, according to an audit report published on Wednesday 2 October by the European Court of Auditors.
The European Union contributes to the financing of health systems in its partner countries through bilateral and regional programmes and global health initiatives. This support amounted to more than €3 billion during the two previous programming periods (2007-2013 and 2014-2020), and at the beginning of 2024 it will be more than €2 billion for the current period (2021-2027).
The Court examined a sample of projects in various partner countries (Burundi, the Democratic Republic of the Congo and Zimbabwe). These projects involved providing free healthcare, organising training for health professionals, supplying medicines and equipment and rebuilding health centres.
Empty shelves. “We found that the EU supported different health interventions which were in line with countries’ needs. However, there was insufficient coordination at the district level, which led to shortcomings in the distribution of equipment and medicines”, states the report. Examples: empty shelves in dispensaries or equipment that is under-used because it has been supplied in excess during uncoordinated interventions. In some cases, despite investments by several donors, medicines and vaccines were only available in small quantities and essential items remained out of stock for months.
High management costs. In addition, the cascade of players involved in carrying out the projects has had repercussions on the cost of interventions in the health sector and has led to an increase in implementation costs. Indeed, management costs were sometimes almost twice as high as the amount allocated to health interventions, particularly in areas such as maternal and child health or nutrition.
In the case of bilateral assistance, results are “not shared satisfactorily” with the in-country EU delegations, and the data collected by project implementers for their reporting was sometimes not made available.
The Commission is engaged in the governance of global health initiatives to ensure they are better aligned and thus end fragmentation. However, more needs to be done to achieve these goals and to rationalise the international approach to global health challenges, says the Court.
The sustainability of health projects and programmes is at risk due to the lack of clear transition and exit strategies and the inadequate maintenance of equipment.
The authors of the report therefore recommend that the Commission “better matches countries’ needs and the allocation of health funding” and to set clear criteria for the funding of global health initiatives. See the Court of Auditors report: https://aeur.eu/f/dok (Original version in French by Lionel Changeur)