“Since its creation, Expertise France has fully taken on board France’s Global Health Strategy”
On Thursday 12 October, Catherine Colonna, Minister for Europe and Foreign Affairs, Sylvie Retailleau, Minister of Higher Education and Research, and Aurélien Rousseau, Minister of Health and Prevention, presented France’s new Global Health Strategy 2023-2027 at the International Agency for Research on Cancer in Lyon, in the presence of Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO).
To address the needs of its partner countries, Expertise France will continue to carry out its activities in line with this strategy.
In this interview, Antoine Peigney, Director of the Health Department at Expertise France, tells us about France’s vision and commitments in the field of global health.
France’s Global Health Strategy 2023-2027
Expertise France, as a public agency for the design and implementation of international technical cooperation projects, operates in the framework of this strategy which guides the activities of the Health Department. Can you tell us about how the Health Department plans to align its activities with the priorities of this new strategy, and the possible implications this could have for ongoing and future projects?
Since the Government created Expertise France in 2015, the Health Department has fully taken on board France’s Global Health Strategy, which is built around four pillars. Between 2017 and 2022, the Health Department contributed to France’s positive results every year, through the projects and technical assistance deployed to strengthen health systems (the first pillar), international health security (second pillar), and promote population health (third pillar), while seeking to mobilise French expertise and research (fourth pillar).
In Lyon, on 12 October 2023, the new French Global Health Strategy 2023-2027 was adopted and has five priorities:
1. Promoting people-oriented health systems to achieve universal health coverage (UHC)
2. Promoting population health and combating diseases at all ages
3. Anticipating and addressing public health emergencies and climate change, taking a One Health approach (human, animal, environmental)
4. Promoting a new global health architecture, drawing on the complementarity of our bilateral and multilateral action
5. Making research and public and private expertise levers for action and influence to serve the Global Health Strategy
We were closely involved in the preparation of this new strategy, building on our achievements in recent years, which have established our legitimacy as a lead implementing agency.
So, Expertise France will continue its mission, with a mandate fully in line with France’s strategy and in the same spirit of consistency, through its dual role as an operator for ministries (Foreign Affairs, Health and Prevention) and a subsidiary of AFD Group. This mission includes the implementation of L’Initiative (management of €319 million for 2023, 2024, 2025, delegated to Expertise France by the Ministry for Europe and Foreign Affairs, from France’s contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria).
To contribute to the achievement of the Sustainable Development Goals, in particular SDG 3, France has clearly defined key priorities. Can you tell us a bit more about the objectives that France aims to achieve by 2027, in particular concerning universal health coverage (UHC) and One Health?
The major focus of this new strategy is the “One Health” approach. With the Covid-19 pandemic, as well as the effects of climate change, we’ve become aware of the absolute need to combine the three components of health: the health of humans, animals and ecosystems. The challenge now lies in getting France’s partner countries to make explicit requests, so that Expertise France can take action that will have an impact. At this stage, we have gained experience from three projects that incorporate the One Health approach, in the Democratic Republic of Congo, the Dominican Republic, and Togo.
Universal health coverage (UHC) also continues to be a major priority, bearing in mind that 24% of the world’s population lives in fragile contexts that are challenged in delivering quality health services.
In all its areas of expertise, since 2015, Expertise France has had a mission to give priority to action in these countries with complex situations. This has been renewed by the State through its Means and Objectives Contract (COM 2024-2027).
In addition to this geographical focus, the COM 2024-2027 states that in the health sector, Expertise France will step up its action for sexual and reproductive rights and health, maternal, newborn and child health, healthcare provision, from hospitals to community health, public health laboratories and, more generally, everything that contributes to strengthening health systems. This is in addition to our continued priority for pandemics through L’Initiative.
Finally, the strategy aims to make health human resources (HHR) a key marker that conditions the objectives outlined. Indeed, there is a shortfall of 10 million health workers in low- and lower-middle income countries, hence this commitment by France to actively contribute to training health workers, 70% of whom are women.
The strategy highlights the importance of both public and private research and expertise as key levers for action and influence. How does Expertise France plan to work with these experts to maximise the effectiveness and impact of this strategy?
Expertise France is very actively involved in the field of research through L’Initiative. Every year, we launch calls for projects that specifically focus on research. For example, the call for 2023, which we have just completed, has selected two research projects on malaria amounting to almost €5.7 million. Last year, we supported three research projects related to HIV. There are also the research projects conducted by the ANRS – Emerging Infectious Diseases agency, for which we have provided almost €1 million of financing, in connection with the Covid-19 pandemic. It should also be noted that we have a close relationship with the French National Research Institute for Sustainable Development (IRD) and the Pasteur Network in several countries.
The mobilisation of expertise is the core mission of the agency Expertise France. In 2023, €17 million were committed to mobilise experts, deployed for technical assistance by the teams of the L’Initiative in 2023 to support countries eligible for Global Fund grants. There are currently more than 100 experts mobilised for the Health Department’s projects. And as a lead contracting authority, we obviously endeavour to mobilise French expertise from the French public ecosystem to contribute to our Government’s objective of influence. In this respect, we conduct a bilateral dialogue with the actors in this ecosystem. They include the Public Health Agency (SPF), university hospital centres (CHUs), the National Authority for Health (HAS), the National Agency for the Safety of Medicines and Health Products (ANSM), the National Blood Service (EFS), the Mérieux Foundation, the School of Public Health (EHESP), the Lille Institute of Mental Health (EPSM), the National Cancer Institute (INCA), the Curie Institute, and the Hospital Federation of France (FHF). The objective is to ascertain their capacities and know how to request their support for our projects. The high point of this privileged dialogue is the Operational Consultative Committee (OCC) which we organise under the dual aegis of the Ministry of Health and the Ministry for Europe and Foreign Affairs. It gathers all the public actors and the coordination of French NGOs to share our issues, exchange views, and subsequently facilitate the operational partnerships. The next OCC will be held in December 2023, and will obviously be another opportunity to look together at the French Global Health Strategy, which now requires us all to work in “Team France” format.
What are the main issues and challenges that you anticipate in the context of the implementation of this strategy? And how is Expertise France gearing up to address them?
The challenges are immense, despite the progress seen for many years now. Global health knows no borders, and viruses cross them regardless of the sovereignty of States. The most vulnerable countries are unable to provide their entire population with access to health services, which increases the desire among a number of people to go elsewhere. This comes on top of the vulnerabilities, threats and other stigma that leave no choice but to migrate in the hope of finding a better life.
Too many countries do not invest enough in their health system. There are also too few health professionals, they are unevenly spread within countries, and there is an urgent need to better recognise, remunerate, train and support them.
We also need to increase awareness of our range of expertise among France’s partner countries. In AFD Group format, we are currently building our “Group Services” for strengthening health human resources (HHR), improving healthcare services and access to health products, and social health protection. The objective will be to give visibility to the references we have acquired and our expertise.
Everyone, from the State to NGOs, and including public operators, has a mandate, and they all add together to create an impact in the countries where we operate. In this context, Expertise France has a clear mandate defined by the State, with financial resources allocated to it through it being part of AFD Group, but also with European financing through it being the French technical cooperation agency.
We organise ourselves accordingly to ensure that we live up to our mission. This is firstly thanks to the quality of the women and men, our teams, who show a commitment to their projects and positions on a daily basis.
Secondly, we need to be exemplary in the implementation of our projects, to address requests from countries to assist them with their reforms, national programmes, and with everything that can help them build a resilient, equitable and sustainable health system.
In conclusion, I would say that the challenge for the “Team France for health” will lie in really being able to work as a “team”, with everyone in their place, in confidence, to increase the impact for “global health”, and continuously improve our response to the needs of partner countries.