The French contribution to the health of developing countries takes a variety of forms, including the creation of health centers or technical and financial support for existing establishments.
France has long experience in health matters in the developing countries of the South. Today it is putting its world-renowned expertise at the service of the poorest countries and in these days of globalization, it is in the multilateral institutions that France is making its voice and its choices heard.
Toward a multilateral cooperation is a commitment of the French state and people.
In the Calmette hospital in Phnom Penh (Cambodia), a program funded by French cooperation from 1994 to 2002 resulted in a fourfold increase in the establishment’s income and a threefold increase in its work, with childbirth numbers rising from 500 to 3,000 per year and providing free treatment for 30 percent of patients.
This huge project covered a number of aspects: construction, equipment, management, organization and training.
In Ivory Coast, France has since the 1990s set up treatment centers in urban areas, with UNICEF, The United Nations Children’s Emergency Fund. As a result the number of consultations handled by public bodies rose from 600,000 before 1991 to 800,000 four years later, including 200,000 in centers supported by French cooperation.
In Afghanistan, the Ali Abad hospital in Kabul has been brought back into operation thanks to a cooperation project with the Hospices Civils de Lyon university teaching hospital.
France has a long history of expertise in health matters in the developing countries of the South. For example, it distinguished itself early on in tropical medicine research: discovery of the malaria parasite by Alphonse Laveran in 1880; of the plague bacillus by Alexandre Yersin in 1894; development of the vaccine against yellow fever, etc. In parallel, research centers were established in developing countries.
France is now putting these skills gained on the ground at the disposal of the international community. In these days of global risks and responsibilities — of which AIDS, bird flu and Chikungunya are examples — public development aid for health has become, since the 1990s, primarily a matter for multilateral institutions.
France today allocates two thirds of its aid budget to health — i.e. 110 million euro out of 185 million a year — to multilateral programs; only a third of this now takes the form of bilateral aid, 87 percent of which is directed toward Africa.
This global trend toward multilateral cooperation is due first and foremost to the exponential growth in the needs of developing countries, which are experiencing a demographic explosion: Africa today has nearly 1 billion inhabitants. France, which until the 1980s was the main financial backer of several French-speaking African countries, could not meet their needs on its own.
French NGOs, big and small, are often key contributors to health and not only in emergency situations.
Moreover, in the 1990s, the World Bank and the European Union (EU) began to fund health programs, and are now the main financial backers in this sector in terms of volume: loans or donations from the World Bank average $50 million over five years, and those of the EU from 10 to 20 million euro for the same period.
For instance, in Senegal, while France has just funded the refurbishment of Dakar hospital with 1 million euro, the World Bank is funding a parallel project to combat AIDS with $20 million...
This change in cooperation policies toward fewer bilateral initiatives is explained also by the success of past policies, and notably by the creation in several countries of a highly qualified local body of doctors, surgeons, pharmacists, nurses, hospital managers and even advanced researchers, through the world-renowned Pasteur Institutes of Dakar, Tunis, and Algiers.
Now the schools of medicine of Tunisia or Abidjan train doctors who are themselves called upon to carry out cooperation missions in other countries!
What’s more, some researchers from these countries occasionally contribute their skills to French laboratories, like Moroccan biologist Rachida Guennoun, who has a degree from the Rabat medical school and now works under Professor Baulieu at the INSERM, the French National Institute for Health and Medical Research, doing research into the spinal cord.
So France has adapted to the changes in development aid and is using its world-renowned expertise to make its voice and its choices known internationally. It contributes 24 percent of the budget of the EDF, the European Development Fund. Furthermore, with the strength of its reputation in research on epidemics, it is the second largest contributor to the Global Fund to Fight AIDS, Tuberculosis and Malaria, with an allocation of 150 million euro per year.
France, which was one of the first countries to demand access to anti-retrovirals for all, is today seeing this option becoming widely available in several countries...
France has longstanding expertise in tropical medicine and especially in research on epidemics. A study of viruses at the Institut Pasteur, whose centers abroad are very much involved in the public health of the countries in which they are located (medical biology, microbiological monitoring, research into infectious diseases).
Similarly, France will soon become the second largest contributor to the GAVI, the Global Alliance for Vaccines and Immunization, with 100 million euro over 20 years. For years it has championed the production of generic medicines and vaccines. With Sanofi-Aventis, the third largest pharmaceutical group in the world and leader in the development of vaccines, France is now able to argue the case for the production and marketing of medicines at differing prices.
Also for funding health, a crucial point — developing countries devote no more than 10 percent of their budget to this area — France is proposing that its ‘solidarity tax’ on airline tickets, in force since July 2006, be allocated to an International Drug Purchase Facility (IDPF).
But the most striking change in recent years is that French aid to developing countries is no longer just a government responsibility, but involves millions of French men and women through voluntary organizations, local authorities, hospitals, businesses, etc. Thus large nongovernmental organizations (NGOs) such as Secours Populaire, Secours Catholique (Caritas France) and Médecins sans Frontières and smaller ones like the Association des Médecins Rennais, are sometimes, in some places, key players in health, and not only in cases of emergency.
France is arguing for generic medicines, especially vaccines, to be manufactured and marketed.
Finally, decentralized cooperation is on a roll with twinning arrangements between Orléans (center of France) and Parakou in Benin, or between Bagnolet (near Paris) and Akbou in Kabylia (Algeria), enabling wells or dispensaries to be built at minimal cost, but with maximum real impact.
The tragedy of the tsunami disaster demonstrated just how much French people are showing solidarity with developing countries. It is sometimes forgotten that one in three French people has a grandparent born abroad, often in a country well to the south of France ...