CASE STUDY: EC HEALTH, HIV/AIDS AND POPULATION
The EC's Health, HIV/AIDS and population programmes
(HAPs) are one example of effective development despite scarce
human resources. When Dr Lieve Fransen joined the Commission in
1987 the Community's "social focus" was so weak it was
almost invisible. Since the establishment of the Health Unit in
DG Development, commitments have risen from an annual average
of 35 million euro for the 1986-90 period to 170 million euro
for 1991-95, rising again to 273 million euro for 1996-98. Aid
to HAP activities has grown from barely 1 per cent of EC aid in
1986 to more than 8 per cent of the total, compared to an OECD
average of 5.5 per cent in 1998. In 1999 the European Community
committed around 700 million euro in total to health, AIDS and
population, making it the second largest donor behind the World
Bank. The EC now supports health-related programmes in more than
70 countries around the world.
HAP assistance has moved away from an initial
focus on curative medicine and health infrastructure to support
for basic health services, developing fully fledged HIV/AIDS and
reproductive health population programmes and supporting health
Recently the EC has begun to adopt more collaborative,
innovative partnerships with country governments. As part of this
approach, efforts have been made to involve the private sector
in the fight against HIV/AIDS.
The Community also supports research on health
problems in developing countries, including active collaboration
between scientists from the European Institutions and developing
countries. This approach allows European scientists to better
understand the health problems faced by developing countries,
and gives scientists from those countries access to high level
research of particular relevance to their countries.
The EC HIV/AIDS programme has emphasised a broad
developmental focus since the early 1990s, and has supported the
development of innovative multi-sectoral strategies, which now
provide the basis for wider national and international initiatives
in developing countries.
HIV/AIDS was defined by the EC as a multi-sectoral
issue from the outset. Over the last decade this has resulted
in the involvement of mining, transport, education, and agricultural
sectors in recognition of the fact that many sectors of the economies
of developing countries have an important role to play in the
prevention of HIV transmission. Correspondingly a set of tools
for multi-sectoral planning were developed and reinforced by workshops
and training. This in turn resulted in EC-funded projects for
industries such as transport adopting EU guidelines on HIV/AIDS.
A significant step forward in the strengthening
and facilitation of multi-sectoral programmes was the EU-SADC
HIV/AIDS regional conference held in Malawi in 1996, which brought
together the regions key policy makers and other key actors involved
in different sectors at a regional and national level in South
Africa. Themes for discussion at the conference ranged from education
to tourism. The conference was ground breaking as it involved
all those involved in the fight against HIV/AIDS. The Malawi 1996
Conference Plan of Action was adopted by the SADC Council of Ministers
in 1997, and led to a specific programme of financial assistance
from the EU. An additional 5 million euro was recently announced
by Commissioner Poul Nielson for the SADC HIV/AIDS Regional Action
Programme. Action includes the implementation of the SADC code
on HIV/AIDS and Employment, which provides a basis for dealing
with the problem in the work place, in all sectors of the economy.
Actions by civil society and non-governmental
organisations have been an important aspect of EU multi-sectoral
and development policy initiatives. EU assistance to legal NGOs
in India and other countries have had a significant impact on
the formulation of non-discriminatory policies on HIV/AIDS, as
well as providing important legal assistance to people living
The EU has also been active in working with
other world donors. One outcome was a publication produced by
the World Bank, UNAIDS and EU, which has now been adopted as the
foundation for the World Banks strategy paper on HIV/AIDS.
The EC has also been instrumental in facilitating
better links between Member States in their approaches to HIV/AIDS
in developing countries. A recent meeting of population experts
in Brussels concluded that EU Member States programmes were increasingly
cohesive in their strategies, no longer viewing HIV/AIDS as an
issue for action by health services alone but as part of an integrated,
multi-sectoral and development approach.
Whilst the SCR has improved the state of disbursements
relative to commitments it has deprived DG Development of much
needed human resources. Staff were moved elsewhere and not replaced.
Doctor Fransen heads a team of 5 dealing with health, population,
gender, and HIV/AIDS projects world-wide. When asked why she stays
in the Commission, instead of trying to work on these subjects
elsewhere, she told me; "I am still convinced Europe has
a major role to play and is a major donor. We have money, instruments,
some good people and the expectations of the countries we have
been working with. We do well by bringing the best out of bilateral
donors and we can be stronger on influencing the different scenes.
We do not do that enough at the moment but I think we can."