AFD, HEALTH AND SOCIAL PROTECTION

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Women and children come first!

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AFD’S FINANCING FOR HEALTHBetween 2004 and 2011, AFD committed EUR 850.6m in the health sector, 49% was in the form of loans. This fund-ing has more specifically served to strengthen health systems, mainly in Sub-Saharan Africa (38% of the total amount), and to upgrade the hospital systems of the French Overseas Communities (39% of commitments). This financial support has generally been allocated to public health services, but also to health projects led by French NGOs (EUR 31.3m for 52 grants) and private health operators (EUR 77.6m of the loans from the private sector arm, Proparco, and EUR 6.5m of bank guarantees).

Annual Commitments by Financial Instrument(in EURm)

Grants on behalf of third parties Grants

Loans to local authorities Non-sovereign loans

Sovereign loans

2004 2005 2006 2007 2008 2009 2010 2011

200

180

160

140

120

100

80

60

40

20

0

Asia 48

Latin America and Caribbea 58

Multi-country 18

French Overseas Communities 321

Mediterranean 83

Sub-Saharan Africa 322

Health Commitments for 2004-2011 by Geographical Sector

(in EURm)

Health Commitments for 2004-2011 by Area of Operation

(in EURm)

Improve maternal and child

health 242.6 (28%)

Improve healthcare provision in the French Overseas Communities and developing local synergies 320.6 (38%)

Combat diseases and epidemics 47.7 (6%)

Support health systems

240.6 (28%)

HEALTH: GLOBAL CHALLENGESGlobal health challenges have changed considerably over the past decade:

The mobilization for HIV/AIDS, tuberculosis and malaria has made a significant improvement to a number of health indicators.

At the same time, the increase in life expectancy and improvement in living standards have made chronic diseases a real issue for public health. They come in addition to infectious diseases, including in least developed countries.

The globalization of trade also fosters the emergence of new epidemics. Epidemiological surveillance is therefore becoming a global challenge and the impacts of environmental factors on health require greater attention.

Sub-Saharan Africa today has the poorest health indicators, including for maternal and neonatal mortality. This situation is partly explained by the insufficient provision of healthcare and management problems, but the high rate of population growth exacerbates the difficulties. Governments recognize the importance of population policies in order to improve both growth and health in this part of the world.

HEALTH AND AFD: BACKGROUND HISTORY

1999: AFD began to finance health infrastructure.

2004: AFD became the operator for France’s bilateral health cooperation policy (with the exception of higher education and research, which remained within the remit of the Ministry of Foreign Affairs).

January 2009: AFD was tasked with co-financing development projects initiated by French NGOs, particularly in the health sector.

December 2009: AFD provided support to the Hospital Networks and Partnerships (HNP) project.

2012: AFD’s third Strategic Orientation Plan underscored its support for health and demographic transition in the priority poor countries for French cooperation.

OPERATIONS TO SUPPORT HEALTH AND SOCIAL PROTECTION FOR 2012-2014AFD’s Intervention Framework in the health and social protec-tion sector for 2012-2014 is in line with France’s health strategy defined by the Ministry of Foreign Affairs and AFD’s 2012-2016 Strategic Orientation Plan.

AREA 1: Improve maternal and child health and support population policies in Sub-Saharan Africa

The objective is to reduce mortality rates for women, newborns and children and to promote demographic transition in countries which are eligible for Muskoka Initiative. For this reason, AFD supports the projects that aim to strengthen maternal and infant health services and the projects that try to implement popula-tion policies, as well as supply and demand for family planning, with a focus on mobilizing NGOs.

AREA 2: Strengthen health and social protection systems

Efforts are made to ensure that more account is taken of non-communicable diseases (NCDs) by financing the upgrading of public sectoral policies and health systems. The specific focus will be on health financing, institutional strengthening, human resources development, the production/management of generic drugs and consumables and the modernization of hospitals and medico-social facilities. Finally, AFD assists in the development

of health and social protection policies by supporting knowledge production and the creation of stakeholders’ networks.

In the French Overseas Communities, AFD supports the exten-sion and upgrading of hospitals, as well as the development of medico-social structures for elderly patients and the disabled. It allocates subsidized loans to hospitals, local authorities and certain associations. For example, the François Hospital (Martinique) has received a EUR 8m loan to streamline and refurbish health facilities in accordance with anti-earthquake standards and high environmental quality criteria (total cost: EUR 12.5m).

IMPROVING MATERNAL AND INFANT HEALTH IN BENIN

In Benin, where there is a high rate of maternal and neonatal mortality and vigorous population growth, AFD is financing a EUR 10m project. This project aims to: improve the quality of caesarean section – they are free for patients – and neonatal care in 44 hospitals throughout the country; to support the supply and demand for family planning services, mainly for young people and adolescents; to integrate population policies into sectoral policies.

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Raising young girls’ awareness of family planning in Benin

FRANCE’S COMMITMENTS IN MUSKOKA AND OUAGADOUGOU

During the G8 Summit Muskoka in 2010, France pledged to allocate an additional EUR 100m per year until 2015, to support the Millennium Development Goals for maternal and child health (MDGs 4 and 5) in eligible countries (Afghanistan, Benin, Burkina Faso, Cameroon, Chad, Central African Republic, Comoros, Congo, Côte d’Ivoire, Democratic Republic of Congo, Guinea, Haiti, Madagascar, Mali, Mauritania, Niger, Senegal and Togo). An amount of EUR 48m out of this total is delegated annually to AFD, to support priority countries defined by the French Inter-ministerial Committee for International Cooperation (CICID).

Af ter the Ouagadougou Conference in February 2011 (“Population, Development, and Family Planning in French-speaking West Africa: An Urgency to Act”), France became involved in the Ouagadougou partnership in 9 countries (Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, Togo) and has supported their population policies, together with the Gates and Hewlett Foundations and USAID.

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The François Hospital in Martinique undergoing reconstruction

In developing countries, the private sector plays a key role in the health sector. According to the 2010 WHO report, almost 60% of healthcare expenditure has been financed by private stakeholders (including 85% by households in low-income and lower-middle income countries) and about 50% of this expendi-ture goes to private providers.

Population growth, particularly in Africa, increases health demands, which are estimated at between EUR 25bn and EUR 30bn. If its action is properly regulated, the private sector can play an important role in complement to public sector.

SUPPORTING THE PRIVATE SECTOR IN THE FIGHT AGAINST

NON‑COMMUNICABLE DISEASES

AFD has allocated a USD 35.3m concessional non-sovereign loan to the Aga Khan network for the construction of a Heart and Cancer Center, as part of the expansion of the Aga Khan University Hospital in Nairobi (Kenya).

Similarly, a USD 18m concessional non-sovereign loan has been allocated to the Dominican Foundation Centro de diagnostico y medicina avanzada y de conferencias medicas y telemedicina (Patronage CEDIMAT) for the construction and equipment of a cardiovascular center.

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Aga Khan Hospital “Heart and Cancer” Center in Nairobi

AFD group supports the private sector for health projects via:

Direct financing tools:– Subsidized loans: for projects that contribute to a

public service mission: training of healthcare workers, producing vaccines and generic drugs, supporting prevention campaigns, extension of health coverage to hard-to-reach areas, management of vulnerable communities, or hospital waste treatment;

– Market rate loans: Proparco offers private stakeholders different kind of loans: senior, junior, mezzanine and subordinated, with the period of time ranging between 5 and 15 years;

– Equity investments: Proparco makes minority interest equity investment in the capital of companies, which are intended to be transferred in a period of 7 to 10 years, once the enterprise is in a position to raise capital on markets or from private investors.

Indirect financing tools:– Proparco’s bank credit lines, guarantees to banks and

equity investments in investment funds: these prod-ucts meet the moderate financing requirements of small companies (the average financing requirement of a clinic is estimated at between EUR 100,000 and EUR 500,000, which is too low to allow direct financing). In Sub-Saharan Africa, Proparco supports the creation and development of regional funds for SME financing, particularly via the Investment and support Fund for Businesses in Africa (FISEA).

SUPPORT FOR THE EXTENSION OF HEALTH RISK COVERAGE IN WAEMU

MEMBER COUNTRIESThis EUR 5.4m regional project financed by AFD aims to increase the number of beneficiaries of health risk coverage. Consequently, it supports the definition and implementation of effective and sustainable national strategies, by member countries, to extend health risk coverage. This includes peer exchanges, training, the mobilization of expertise on financing, the implementation of social protection policies and the health risk coverage tools. The focus is on WAEMU community regulation on social mutual schemes, the subsidization of the insurance premium by public funds, and the use of new information and communication technologies (NICTs) for the management of health insurance products. A pilot project will be implemented in one of the States.

AREA 3: Address the environmental determinants of health and the fight against epidemics

AFD supports the regional epidemiological surveillance networks of communicable diseases in the Indian Ocean, West Africa and Southeast Asia, in partnership with specialized French institutions and local authorities in the French Overseas Communities. The SEGA project (epidemiological surveillance and alert management) was created after the Chikungunya epidemic in 2006. It was set up by the Indian Ocean Commission (IOC) and is subsidized by AFD (EUR 5.6m). This project allows the information, training and capacity to respond to an urgent sanitary situation to be consolidated. In addition, AFD aims to support knowledge production on the health impacts of environmental factors. Furthermore, AFD contribute to considering in water, agriculture and urban projects the measures that are likely to avoid negative impacts on health.

SUPPORT TO FRAGILE STATESIn its 2012-2016 Strategic Orientation Plan, AFD underscores its willingness to operate in fragile States, which is about pre-venting crises and strengthening the resilience of societies, as well as supporting post-crisis recovery efforts and the resump-tion of the development process. In these countries, it supports operations that have rapid impacts on communities and try to strengthen institutions, for example, the infrastructure reha-bilitation and the coverage of basic social needs (including mental health and psychosocial support). AFD tries to work with civil society organizations as much as possible.

Sinking of the Neptune, Haiti, 17 February 1993

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PROJECT TO SUPPORT THE STABILIZATION OF EASTERN CHAD

The psychosocial part of activities of this health project is implemented by an Italian NGO (COOPI). It aims to bring communities together. This situation hampers Chad’s development. Community mobilizers and self-help groups are organizing this component by developing training, awareness-raising and group counseling activities. AFD’s financing (less than EUR 300,000, i.e. 5.6% of the total project) for the psychosocial component helps to improve the well-being of population by denouncing the violence against women and children, contributing to conflic t resolution and strengthening interpersonal, interethnic and intercommunity bonds.

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Center for psychosocial activities in Chad

FIGHTING AGAINST POLIO, MALARIA

AND LEISHMANIASIS IN AFGHANISTAN

Southern Afghanistan is suffering from the re-emergence of polio. Leishmaniasis is endemic in the region and there is a high prevalence of malaria. The EUR 3m project (2009-2012) financed by AFD contributes to the fight against these three diseases. The project is being implemented by WHO, in close cooperation with the relevant national services, and mobilizes a specific network of experts and healthcare workers.

Polio immunization in Afghanistan © WHO – Kabul

This publication was printed in an environmentally responsible manner using vegetable-based ink and PEFC™ paper,

chain of custody n° 10-31-945 (sustainable forest management).

Education of girls in Mauritania, a decisive factor for the health of women and families © AFD – Didier Grébert

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AGENCE FRANÇAISE DE DÉVELOPPEMENT (AFD)

5 rue Roland Barthes 75598 Paris Cedex 12 – France

Tél. : +33 1 53 44 31 31 Fax : +33 1 44 87 99 39

www.afd.fr

HEALTH AND SOCIAL PROTECTION DIVISION (SAN)

You can consult the 2012-2014 Health and Social Protection Sector Intervention Framework and the list of health projects appraised by the Health And Social

Protection Division between 1999 and 2012 at:

http://www.afd.fr/home/AFD/ redevabilite-dialogues/Dialogue-autour-

de-nos-cadres-d-intervention-strategiques

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Agence Française de Développement (AFD) is a public development finance institution that has been working to fight poverty and foster economic growth in developing countries and the French Overseas Communities for seventy years. It executes the policy defined by the French Government.

AFD is present on four continents where it has an international network of seventy agencies and representation offices, including nine in the French Overseas Provinces and one in Brussels. It finances and supports projects that improve people’s living conditions, promote economic growth and protect Earth, such as schooling for children, maternal health, support for farmers and small businesses, water supply, tropical forest preservation, and the fight against climate change.

In 2012, AFD approved EUR 7 billion to finance activities in developing countries and the French Overseas Communities. Main outcomes of AFD’s funding are monitored every year. For instance, money delivered will help get 10 million children into primary school and 3 million into secondary school; they will also improve drinking water supply for 1.79 million people. Energy efficiency projects financed by AFD in 2012 will save nearly 3.6 million tons of carbon dioxide emissions annually.

www.proparco.fr

PROPARCO, AFD’s subsidiary dedicated to private investment, promotes private investment in emerging and developing countries in order to boost growth, promote sustainable development and reach the Millennium Development Goals. Its financing is tailored to the specific needs of investors in the productive sector, financial systems, infrastructure and private equity investment.