In 2001, twenty years ago now, four non-governmental organisations with broad experience in health cooperation agreed over the need for a specific report on health, from both a development and humanitarian perspective..
Therefore, medicusmundi, Médicos del Mundo, Prosalus and Médicos sin Fronteras set in motion the “Health in Development Cooperation and Humanitarian Action” report. For different reasons, Médicos sin Fronteras and Prosalus left the project during this period.
The goal that led to this initiative taking shape 20 years ago is still pertinent: to influence Official Development Assistance (ODA) policies in the health sector and the Humanitarian Action (HA) sector, improving their quality, effectiveness and efficiency, as well as meeting their general objective, which is to support a critical analysis of international, state and decentralised ODA in the sphere of health and HA.
Over this 20-year period, much has changed: the Millennium Development Goals (MDGs) made way for the Sustainable Development Goals (SDGs); the architecture of world health has been altered by the appearance of new actors, both public and private; there is increasingly more awareness that health is inter-related with other sectors, and that global aspects not controlled from the national sphere significantly influence local realities around health. Health indicators such as maternal and child mortality have improved considerably, despite not meeting the goals set. Since 2000, funding of the world health sector has grown by 3.9% -above global economic growth, which has been at 3%- but with huge disparities among countries. While ODA in health represents 1.5% of funding in the health sector in developing countries, it is 20% in Least Developed Countries (LDCs), indicating the importance of health cooperation, which has notably grown since the beginning of the century.
During this time, some aspects have remained unchanged, however, such as the inability to create a global response that puts health before other interests or significantly managing to reduce health inequality. This might have a say in the permanent non-compliance of signed commitments. In addition, inequality has increased, not diminished, just as the 2019 Human Development Report warned.
These two decades have also witnessed the best and the worst of Spanish Cooperation: if the first decade was about growth, a bolstering of its structures and greater participation in the international sphere, then the second can only be defined as a lost decade. It remains to be seen whether the decade now under way will be one of recovery.
On a final note, we would like to thank everyone who has helped us over this period to improve this report with their comments and contributions, in addition to those willing to celebrate this twentieth anniversary with their kind words.