Data-driven insights into the Netherlands' global health policy and spending
Welcome to Cordaid's interactive tool tracking Dutch global health financing and policymaking. We transformed IATI datatooltip::The International Aid Transparency Initiative (IATI) is a global initiative aimed at improving transparency and reporting standards on development aid activities. Since 2016, the Dutch Ministry of Foreign Affairs has adopted the IATI standard in their reporting. between 2018 and 2023 into interactive visuals to provide data-driven insights into the Netherlands' aid spending for health in low- and middle-income countries. We aim to increase clarity of resources flowing from the Netherlands' foreign spending into low- and middle-income countries.
This tool is divided into three parts. The first one is dedicated to understanding the global health architecture. The second delves into the general state of Dutch spending and policymaking related to global health. And finally, a dive into six priority thematic areas selected by global health advocatestooltip::A co-creative process with a range of stakeholders lies at the basis of our analysis..
An innovative research method was employed to bring you the most accurate and up-to-date data. Are you wondering about where the data comes from, and how it was processed? All the data used is referenced and transparent. Click here to learn more.
Use the content menu on the left or on the top right corner to jump to specific chapters and explore.
Health is complex. Let alone when placed on a global scale.
Global healthtooltip::Global health can be defined as "an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide" (Koplan et al. 2009) looks at improving health for people worldwide. It understands that health is increasingly international and interconnected. At the same time, there are major inequalities. Half of the world's population is without access to quality healthcare. Particularly in low- and middle-income countries where resources for health can be scarce. In this context, mobilising resources from high-income countries, like the Netherlands, is necessary to tackle global health inequities. The Netherlands is among the countries committed to advancing health equity through achieving the 2030 Sustainable Development Goals.
Thousands of people and organisations work together to advance global health. That includes the government of the Netherlands. New initiatives are started, money is invested, and innovative partnerships are made. This is the 'global health architecture': the collaboration between different stakeholders in global health and the processes through which they work together. This collaboration has the potential to better health for all, but also carries complexity. Towards which goals are we working? Who are the key stakeholders? How does the money flow?
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What does it look like and how does it 'work'?
Governments are crucial stakeholders in global health. They have the responsibility to provide public health services, formulate health policies, and allocate resources for healthcare infrastructure and programmes. They play a key role in regulating and coordinating health systems, ensuring access to essential healthcare services, and responding to health emergencies.
International organisations, such as the World Health Organizations (WHO), have a broad mandate in global health. They facilitate collaboration among governments, NGOs, and other stakeholders, provide technical guidance, set standards, and coordinate global health initiatives. International organisations play a critical role in promoting global health security, tackling health inequalities, and addressing cross-border health challenges like pandemics, epidemics, and emergency responses. Some donor organisations are also recognised as international organisations.
Donor organisationstooltip::Yet, in theory these entities can be donating as well as receiving organisations. play a significant role in global health by providing financial and technical support to countries and organisations working on health-related issues. They include bilateral and multilateral aid agencies contributing funds, expertise, and resources to initiatives aimed at improving healthcare access, disease prevention, and health system strengthening in low- and middle-income countries. Donor organisations (private, public, foundations, etc.) can sometimes be recognised as international organisations as well.
NGOs are non-profit organisations that work on various health issues globally. In alignment with government guidelines, they often operate in areas where governments have limited reach or in emergency situations. NGOs contribute by delivering healthcare services, implementing health programs, raising awareness, advocating for policy changes, and providing support to populations in vulnerable situations. They can address specific health challenges, such as HIV/AIDS, maternal and child health, or access to clean water and sanitation.
Private sector entities, including pharmaceutical companies, medical device manufacturers, and healthcare providers, play a vital role in global health. They contribute through research and development of new drugs and technologies, production and distribution of medicines, vaccines, and medical supplies, and investment in healthcare infrastructure. Private sector partnerships with governments and NGOs can in some cases contribute to global health.
Research institutes, including academic institutions and specialised research organisations, contribute to global health by conducting scientific studies, generating evidence, and developing innovative solutions. They conduct research on diseases, public health interventions, and health systems, which informs policy decisions and shapes global health agendas. Research institutes also play a critical role in training healthcare professionals and building research capacity in low-resource settings.
The health workforce plays a critical role in the global health system, as the backbone of healthcare delivery. They are responsible for providing essential medical services, conducting research, and implementing public health interventions. From doctors and nurses to pharmacists and community health workers, the health workforce ensures that individuals and communities receive the necessary care and support to maintain and improve their health. Their expertise, dedication, and collaboration are vital in addressing global health challenges and achieving equitable access to healthcare worldwide.
Particularly important among global health stakeholders are communities. These are the people who will ultimately be impacted by interventions and as such offer a crucial perspective. They are central to the development, implementation and evaluation of global health initiatives.
This graph illustrates how global health financing flows from high-income donor countries to low- and middle-countries. Within high-income donor countries, like the Netherlands, government raises taxes, a fraction of which is used for ODAtooltip::Official Development Assistance (ODA) is an internationally agreed indicator of government aid provided to developing countries. It refers to money, goods or services that promote the economic development and welfare of such countries (source: <a href="https://www.government.nl/topics/development-cooperation/the-development-policy-of-the-netherlands" target="_blank">Government of the Netherlands</a>). and non-ODAtooltip::Government spending on international policy, not recognised as official development assistance (ODA) (source: <a href="https://www.government.nl/topics/development-cooperation/the-development-policy-of-the-netherlands" target="_blank">Government of the Netherlands</a>) activities related to global health. This is typically (but not only) done in four manners: providing direct support to recipient countriestooltip::Also known as bilateral aid., channelling funds through international organisationstooltip::Also known as multilateral aid, in which governments contribute to institutions such as the World Health Organisations (WHO) or donor organisations such as the Global Fund, financing NGOs, or collaborating with the private sector.
Resources allocated to international organisations often get distributed among NGOs, the private sector, and to governments in recipient countries to be used for health programmes. At times, recipient governments undertake these endeavours in collaboration with NGOs. NGOs, on their part, can also independently engage in these activities.
The private sector, which frequently receives funding from international organisations and donor governments, can collaborate with recipient governments and NGOs on health programmes, interventions, and systems. Alternatively, they can directly involve themselves in health-related activities.
Ultimately, the objective of these programmes is to enhance the health of people and communities.
This graph shows the average proportion of GDP (in %) going to Health ODAtooltip::The share of the Official Development Assistance (ODA) budget allocated to health. overtime in selected OECD countries. The OECD countries selected in these calculations are those most similar in terms of development cooperation spending and policymakingtooltip::Besides the Netherlands, the selected OECD countries include nine other countries: Germany, Sweden, Norway, France, Japan, Canada, Australia, South Korea, the UK, and the USA.. The graph shows that the pandemic years distorted the overall trends in global health spending in terms of ODAtooltip::Official Development Assistance (ODA) is an internationally agreed indicator of government aid provided to developing countries. It refers to money, goods or services that promote the economic development and welfare of such countries (source: <a href="https://www.government.nl/topics/development-cooperation/the-development-policy-of-the-netherlands" target="_blank">Government of the Netherlands</a>)..
Responding to the COVID-19 pandemic required an urgent increase in government spending towards health worldwide. According to OECD data, on average the selected countries needed to increase their percentage of GDP to Health ODA to 0.037% in 2021 to respond to COVID-19. That is more than double the percentage of 2019.
This heightened expenditure highlights the possibility of raising large amounts of resources to effectively address global health challenges during emergencies. This surge also reveals a financing gap that exists between spending required to face emergencies and the amount typically allocated to global health during non-crisis periods.
The massive mobilisation of resources during the COVID-19 crisis should serve as a wake-up call, urging governments, international organisations, and the private sector to bridge the persistent health financing gap. By prioritising sustainable investment in health systems, fostering international collaboration, and strengthening pandemic preparedness, we can ensure that the surge in spending witnessed during emergencies becomes the norm, nurturing a resilient and equitable global health landscape for the benefit of all.
This is in a general sense what the global health architecture looks like in terms of financial flows. Yet, there are many differences across contexts. Due to global inequalities, some countries rely more on external financing for health than others.
Another important feature of the global health architecture is the so-called 'division of labour'. This entails that some countries focus on certain areas, while others focus on other topics. This may be due to specific expertise around certain themes in high-income countries, as well as the result of bilateral and multilateral agreements on priorities in global health . An example is the longstanding focus of the Netherlands on sexual and reproductive health and rights (SRHR).
In light of the above it is important to view global health spending not at face value, but within its particular context.
What is the impact of global health investments on local communities? Here is an example of an effective health programme. Read what people and communities have to say about it.
How do you bring care closer to communities? How do you do that when it comes to HIV/AIDS and tuberculosis? These are two of the deadliest infectious diseases that often strike in combination. In addition, many patients face discrimination and even aggression.
Since 2012, Cordaid is part of a large group of people and organisations that want to achieve exactly that in the Democratic Republic of the Congo (DRC): adequate and affordable HIV and tuberculosis care for everyone. This group consists almost entirely of Congolese professionals: hundreds of doctors, nurses, pharmacists, laboratory technicians, transporters, healthcare authorities, data specialists.
The challenges are enormous. Think of the logistics. Together we provide care in a country the size of Western Europe. Reaching the groups that are most at risk of infection, that's the objective.
Too often, those most affected by HIV are the same people who don’t have access to healthcare. Discrimination, gender inequality, poverty, and criminalisation are all barriers that can prevent them from accessing healthcare. As a result, HIV disproportionately affects so-called “key populations”. These include sex workers, transgender people, men who have sex with men, people living in prisons, and people who inject drugs.
The fight against HIV and tuberculosis is advancing worldwide. For example, the number of AIDS-related deaths worldwide has decreased by 68% since the peak of 2004. Great strides have been achieved, and the work must go on till we can end these epidemics worldwide.
Global health programmes, like this one funded by the Global Fund, can support thousands of people worldwide. Read some of the stories from the people affected by the programme.
The Dutch government has committed itself to various global health targets. Explore the Netherlands' focus areas, and the way interrelated Dutch policy goals are shaped.
The Dutch government has been a longstanding vocal advocate for global health. What have been the country's main areas of focus?
The Dutch government has been a longstanding advocate for SRHR globally. The country is elaborate in its approach towards SRHR, emphasising comprehensive sexuality education, family planning services, and access to safe abortion. The Netherlands is recognised for its expertise in this area and actively supports initiatives to improve SRHR worldwide.
The Netherlands has extensive expertise in water management and sanitation, which is crucial for global health. The country has developed innovative solutions in areas such as water purification, wastewater treatment, and flood control. This knowledge and experience have been shared internationally, particularly in regions where access to clean water and sanitation is limited.
The Netherlands has a longstanding track record in health research and innovation. Dutch researchers and institutions have made significant contributions to various fields of global health, including infectious diseases, epidemiology, health economics, and health systems research. Dutch universities and research institutes are actively engaged in cutting-edge research, leading to advancements in healthcare practices and policies.
Though not top priorities, international development and, to a lesser degree, global health, are mentioned by the Dutch government as policy goals. Why is the Netherlands striving towards these targets?
The United Nations 2030 Sustainable Development Goals (SDGs) are the guiding principles for Dutch development cooperation. The Netherlands has committed to contribute to achieving the targets set by the SDGs. The most relevant SDGs to global health are:
The basis for each government is the coalition agreement. This document is the basis of governing political parties' cooperation for the four-year period until the next elections. It states the most important policy changes and goals the government wishes to achieve.
The coalition agreement can only function if there is consensus among a majority in the Dutch house of representatives. Yet, consensus typically also has to be reached with parties in the senate, for bills to pass. This results in a dynamic political environment in which it is in the government's best interest to take non-governing parties preferences into account.
Usually, the coalition agremeent is written on a relatively abstract level, with not more than one paragraph dedicated to the topic of international development cooperation. Generally, the policy on this area is more trade-focused, rather than aid focused.
As of recently, the Dutch government is working on the establishment of a Feminist Foreign Policy, which attempts to apply a focus Dutch foreign policy on "equality, equal treatment and equal opportunity to participate in politics and society."
The international development component of the Dutch coalition agreement has been operationalised in a number of dedicated strategies. These show how the government is trying to achieve these goals.
The policy document ‘Do what we do best’ (2022), is an example of the Dutch government describing a strategy for foreign trade and development cooperation. It elaborates on the coalition agreement, and is supplemented by targeted strategies, such as the Dutch Global Health Strategy (see below). The aim of ‘Do what we do best’ is to introduce more cohesion and focus into trade and development policies, with the following policy goals.
Among other things, it argues the Netherlands should invest more in ODAtooltip::Official Development Assistance (ODA) is an internationally agreed indicator of government aid provided to developing countries. It refers to money, goods or services that promote the economic development and welfare of such countries (source: <a href="https://www.government.nl/topics/development-cooperation/the-development-policy-of-the-netherlands" target="_blank">Government of the Netherlands</a>). with a sharp focus on themes in which the Netherlands has a longstanding track record (e.g. water, agriculture and SRHR). It also announces an increased budget for development cooperation, extra investment in global health and earmarked budgets emergency aid in crisis situations.
It must be noted that budget cuts for international development have been announced in the Spring of 2023.
Stemming from the policy document ‘Do what we do best’, the Netherlands published the Dutch Global Health Strategy in 2022. It is a vision document that presents a coordinated and targeted approach to improve public health globally and therefore also in the Netherlands itself. It takes the SDGs (especially SDG3) as the foundation. It aims to 1) strengthen the global health architecture and national health systems, 2) improve international pandemic preparedness and minimise cross-border health threats, and 3) address the impact of climate change on public health, and vice versa.
Through this global health strategy, the Dutch government aims to contribute to global health in a coordinated and targeted way by promoting a 'Health in all Policies' approach that bolsters policy coherence.
The government of Netherlands has also published an Africa Strategy (2023), in which it aims to sharpen the focus of its collaboration with Africa by investing more, more specifically, and more sustainably, in both the continent and in relations with African countries. The strategy intendeds to position the Netherlands and the EU as attractive partners for countries in Africa. Doing so will facilitate collaboration between the Netherlands and its African partners in order to address cross-border issues such as migration, trade, the energy transition, security and food security, the document argues.
In the end, government policy is not just about focus, but also about finances. What are the budgetary consequences of the policies mentioned?
Dutch governmental policies and dedicated strategies are operationalised in the yearly budgets presented on Prinsjesdag, every third Tuesday in September. For 2023, a number of relevant policy choices regarding global health were made in the Foreign Trade & Development Cooperation (BHOS) budget.
These include increases in the development cooperation budget, an emphasis on 14 'combination countries', elaborate cooperation with other ministries and closer European and multilateral cooperation.
In this section, you can explore to what, whom, and where funds have been allocated since 2018. We have also included a more specific analysis of selected global health themes.
What are the general trends of Dutch global health spending? How does the Netherlands compare to other countries? And who are the main organisation partners?
In the following section, you can explore the general trends of Dutch global health spending.
Interested in a more finegrained overview? Explore our thematic analysis.
This graph maps the ODAtooltip::Official Development Assistance (ODA) is an internationally agreed indicator of government aid provided to developing countries. It refers to money, goods or services that promote the economic development and welfare of such countries (source: <a href="https://www.government.nl/topics/development-cooperation/the-development-policy-of-the-netherlands" target="_blank">Government of the Netherlands</a>). allocated towards global health and non-global health themes in the Dutch BHOStooltip::BHOS refers to the Foreign Trade and Development Cooperation (Buitenlandse Handel en Ontwikkelingssamenwerking) budget. budget.
As can be seen in this graph, the amount of finances attributed to global health themes is much lower than the investments that are unrelated to global health.
The total BHOS budget has increased slightly over the last few years, as has the relative proportion of global health related investment.
Examples of this type of spending include investment in sexual and reproductive health and rights (SRHR), food security and humanitarian aid.
How does the Netherlands compare to other like-minded OECD countries in terms of their Health ODAtooltip::The proportion of the Official Development Assistance (ODA) budget allocated to health. spending as a proportion of their GDPs? The OECD countries selected in these calculations are those most similar in terms of development cooperation spending and policymakingtooltip::Besides the Netherlands, the selected OECD countries include nine other countries: Germany, Sweden, Norway, France, Japan, Canada, Australia, South Korea, the UK, and the USA..
It can be observed in this chart that since around 2015, the Netherlands has dropped to the bottom of this selection of like-minded countries. The Netherlands has allocated an average of 0.01% of its GDP to Health ODAtooltip::The proportion of the Official Development Assistance (ODA) budget allocated to health. in recent years. In 2021 this moved towards 0.02%. The United Kingdom, Germany and Sweden are, relatively speaking, the high-income countries performing most often at the top of this list.tooltip::Note that ODA earmarked for health reported here does not equate to our operational definition of global health that is used in the rest of this tool.
Note: as we have made use of OECD data to generalise across countries, the data is up-to-date until 2021.
What if we look at the relative proportion of total ODAtooltip::Official Development Assistance (ODA) is an internationally agreed indicator of government aid provided to developing countries. It refers to money, goods or services that promote the economic development and welfare of such countries (source: <a href="https://www.government.nl/topics/development-cooperation/the-development-policy-of-the-netherlands" target="_blank">Government of the Netherlands</a>). allocated to health?
Interestingly, this graph paints a similar picture as the analysis on Health ODAtooltip::The proportion of the Official Development Assistance (ODA) budget allocated to health. as a proportion of GDP: the countries that spend more Health ODA as a proportion of their GDP also spend more Health ODA as a proportion of their total ODA.
Once more, the analysis shows The Netherlands is structurally at the bottom of this list.
The Netherlands allocates global health funds to many different implementing partnerstooltip:: The organisation that physically carries out the activity or intervention (source: IATI). Who are the main stakeholders?
In this visual, these can be explored. It can be observed that there are many recurring implementing organisations. There are also a number of Dutch-based NGOs, including the Netherlands Red Cross, Oxfam Novib and Wemos.
The largest contributions go to international or multilateral organisations, such as The World Bank, Gavi, and UNICEF.
Where do the global health resources go? In this visual, you can explore the geographical distribution of the funds allocated to global health.
Data shows it is a relatively stable set of countries, with Ethiopia and Mali as the ones featuring most often at the top of the list.
These countries are in line with the list of countries with which the Dutch Ministry of Foreign Affairs and Development Cooperation notes the Netherlands has a "broad-based development cooperation relationship". The Palestinian Territories and Sudan are notable exceptions as they are mentioned by the Ministry but not featured in this top-10 in any the selected years.
Note: For some projects, the destination country is not specified.
In a collaborative effort with stakeholders in the global health field, consisting of international organisations, research institutes and NGOs, we have selected a set of global health themes for further scrutiny. In our view, the themes below represent the most pressing global health challenges of this day. Read more on how we approached the selection of global health themes in the methodological section.
Wondering how we allocated projects from IATItooltip::The International Aid Transparency Initiative (IATI) is a global initiative aimed at improving transparency and reporting standards on development aid activities. Since 2016, the Dutch Ministry of Foreign Affairs has adopted the IATI standard in their reporting. to each theme? You can find a translation table for the DAC5 codes we have assigned to our global health themes here.
Strengthening health systems in low- and middle-income countries through six building blocks.
Strengthening health services related to sexuality and reproduction, and the health of mothers and children.
Provision of humanitarian support and health services in conflict and fragile settings.
Reducing illnesses caused by pathogens, such as bacteria, viruses, parasites or fungi.
Addressing diseases not caused by infectants, such as diabetes and cancer.
Not all global health issues can be captured in overarching themes. Examples include gender, community engagement and pandemic preparedness.
This graph visualises how finances invested by the Dutch government have been distributed across global health themes. For the Netherlands, the theme SRHR and maternal and child health has steadily been at the top. Foreign investment in addressing communicable diseases likely took off due to COVID-19, whereas there has recently been little to no foreign investment towards non-communicable diseases.
Note: this analysis does not include domestic health-related investments.
What are the sources, channels and end destinations of Dutch global health financing towards low- and middle-income countries? This diagram shows how the money eventually flows to the selected global health themes. Most funding comes from the Ministry of Foreign Affairs as ODAtooltip::Official Development Assistance (ODA) is an internationally agreed indicator of government aid provided to developing countries. It refers to money, goods or services that promote the economic development and welfare of such countries (source: <a href="https://www.government.nl/topics/development-cooperation/the-development-policy-of-the-netherlands" target="_blank">Government of the Netherlands</a>)., while the Netherlands Enterprise Agency contributes to a lesser extent.
Health Systems Strengthening (HSS), coined by the World Health Organization (WHO), refers to the the process of identifying and implementing policy and practice changes in a given country's health system, which should make the country more resilient towards health and health system challenges. HSS includes an array of initiatives and strategies aimed at improving one or more functions of the health system, which result in better health through improvements in terms of access, coverage, quality, or efficiency. Hence, according to the WHO, HSS includes six components, or 'building blocks':
Our analysis adheres to these building blocks with corresponding DAC-5 codes.
Strengthening health systems is a top policy goal for the Netherlands. It is actually mentioned as the first priority in the Dutch Global Health Strategy. There are two focus areas for Dutch policy here: international coherence and multilateral cooperation; and improved access to primary healthcare and sexual and reproductive health and rights (SRHR).
In this graph, Dutch spending on Health Systems Strengthening (HSS) has been disaggregated to the level of the WHO HSS building block level.
Data shows that spending towards 'service delivery' spiked in 2021, possibly due to the COVID-19 pandemic. Spending towards 'health financing' and 'human resources for health' and 'health information systems & research' has been relatively low over the last few years.
Wondering how we allocated projects from IATI to each HSS building blocks? Download our translation table for the DAC5 codes we have assigned to our global health themes here.
Regarding Health Systems Strengthening (HSS) spending, it can be seen in this bubble diagram that in most years, funding goes to a few large projects or contributions.
Some large ones that stand out are the PDP Funds (2022), the contribution to COVAX (2021), and GAVI's IFFIm (2019).
The Netherlands allocates funds to different implementing partnerstooltip:: The organisation that physically carries out the activity or intervention (source: IATI) in the field of Health Systems Strengthening (HSS). Who are the main stakeholders?
Looking at the data, a relatively stable list of implementing partners emerges. The Netherlands Enterprise Agency, GAVI, and the World Bank are mostly mentioned. Over the years, a number of NGOs are featured, athough they usually come and go as implementors.
The list of countries receiving funding related to Health Systems Strengthening (HSS) is a bit different to the more general list of countries receiving Dutch funding. While the generalised list is largely Africa-focused, the countries receiving HSS-related funding have been more geographically varied over the years.
Sexual and reproductive health and rights (SRHR) refer to the state of physical, emotional, mental, and social well-being in all matters related to sexuality and reproduction. It involves the ability to have satisfying and safe sexual experiences, make informed decisions about reproduction, and access necessary healthcare services (source: the World Health Organization). SRHR encompasses a range of rights, including the right to control one's own body, access to comprehensive information and services, and freedom from discrimination and violence.
SRHR has historically been a main focus area for the Netherlands, being at the forefront of promoting the issue internationally. The country is also known for its expertise in this field.
Maternal health refers to "the health of women during pregnancy, childbirth and the postnatal period" (WHO), while child health refers to the health and wellbeing of those up until the age of 18. Both are not mentioned as particular areas of focus by the Dutch government.
In sum, our analysis includes the following subthemes:
Dutch spending on SRHR and maternal & child health has been visualised in this graph on a subtheme level: SRHR, maternal & child health; and nutrition.
Even though the Dutch government does not mention maternal & child health as specific policy goals, spending on this subtheme is relatively high, and has increased over the past few years. There have also been relatively stable investments in SRHR and nutrition.
For Dutch spending on SRHR and maternal & child health, the bubble diagram shows a high degree of distribution among projects, mostly of a bilateral nature.
This broad landscape of projects confirms the traditionally active role the Netherlands has taken upon itself in this area.
The Netherlands allocates funds to many different implementing partnerstooltip:: The organisation that physically carries out the activity or intervention (source: IATI) in the field of sexual and reproductive health and rights (SRHR). Who are the most prominent ones?
It can clearly be observed that the health programmes and inverventions are implemented by a long list of partners. Unsurprisingly, a number of originally Dutch NGOs are listed here, such as Wemos, Cordaid and Oxfam Novib.
The list of countries receiving funding related to SRHR and maternal & child health is similar to the general list of countries receiving Dutch funding.
The list is largely Africa-focused, with Yemen, Ukraine and Bangladesh as recent notable exceptions.
In this analysis, the theme emergency health consists of both humanitarian assistance as well as health in conflict and fragile settings. According to the World Health Organization, emergency health refers to the rapid and effective response to unexpected and critical situations. For example, we can think of outbreaks of diseases, natural disasters and conflicts.
The Netherlands generally does not provide humanitarian aid directly. Instead, it donates to aid organisations such as the United Nations and several NGOs. (Source: Government of the Netherlands). The provision of health services in conflict and fragile settings is not mentioned as a specific policy objective by the Dutch government.
In sum, our analysis includes the following subthemes:
We have categorised spending by the Dutch Ministry of Foreign Affairs on emergency health into two categories: health in conflict and fragile settings, and humanitarian assistance.
This graph shows a major difference between the two: investment in humanitarian assistance has decreased recently, but is still far greater than funding for health in conflict and fragile settings. The latter can be explained given the fact that the Dutch government does not mention conflict and fragile-settings as a policy priority.
For Dutch expenditure on emergency health, the bubble diagram shows that funding usually goes to a relatively large number of projects. In recent years, however, relatively large sums of money have been allocated to 'NRK Blokallocatie'tooltip::Dutch Red Cross Block Allocation, see <a href="https://zoek.officielebekendmakingen.nl/kst-34952-128.html" target="_blank">this link (Dutch)</a>., funds that can be used to respond rapidly to crises.
Who are the main implementing partnerstooltip:: The organisation that physically carries out the activity or intervention (source: IATI) of the Netherlands regarding emergency health?
In this graph, it becomes clear that the overall picture is to a large extent determined by the Dutch contribution to the Red Cross. Before 2021, the main implementing partners were Care International, Save the Children, and several other NGOs and international organisations.
Communicable diseases can be defined as illnesses caused by pathogens (like bacteria, viruses, parasites, or fungi) that can be spread from person to person, directly or indirectly (source: World Health Organization).
The Dutch government puts emphasis on addressing communicable diseases. In its Dutch Global Health Strategy - published right after the COVID-19 pandemic, the second policy priority is "Improving international pandemic preparedness and minimising cross-border health threats", with global access to medicines and health products and strengthened international action on AMRtooltip::Antimicrobial resistance; the situation where mutations occur in bacteria, viruses, fungi and parasites, causing them to no longer respond to medicines. and zoonotic diseasestooltip::Infections that are naturally transmissible directly or indirectly between animals and humans. as focus areas.
In sum, our analysis includes the following subthemes:
The theme communicable diseases had been categorised into four spending categories: HIV, Malaria, TB and others.
In this graph, it can be observed that funding by the Dutch Ministry of Foreign Affairs has decreased for all of these communicable disease in 2020, after which each increased again.
Expenditure on communicable diseases other than HIV, Malaria and TB took off in 2021; this is most likely related to spending on the COVID-19 pandemic.
In the area of communicable diseases; who are the main implementing partnerstooltip:: The organisation that physically carries out the activity or intervention (source: IATI)?
It can be observed in this graph that the World Bank, the Netherlands Enterprise Agency, and the larger donor organisations are the actors receiving most of the funding in this field.
Non-communicable diseases (NCDs) are medical conditions that are not caused by infectious agents and cannot be transmitted from one person to another. Common examples include cardiovascular diseases, diabetes and cancer. In its policy documents, the Netherlands does not place great emphasis on NCDs.
In sum, our analysis includes the following subthemes:
Note: this analysis does not include domestic health-related investments.
In this analysis, non-communicable diseases come in two categories: mental health & psychosocial support (MHPSS) and other non-communicable diseases.
This graph shows the amount of resources (both ODA and non-ODA) allocated by the Dutch government towards non-communicable diseases in low- and middle-income countries.
The overall picture is quite clear: data shows the Dutch government allocates relatively few resources to non-communicable diseases outside the Netherlands. A notable exception is the year 2020, when there was a sharp increase in expenditure on MHPSS.
For the theme of non-communicable diseases, we only have data for two years: 2020 and 2023.
In 2020, resources were allocated to a project by the Dutch Enterprise Agency, and the International Organisation for Migration (IOM).
In 2023, only a project by multiple parties has received funding.
Note that the general amount of Dutch budgets allocated to non-communicable diseases towards low- and middle-income countries is relatively low. While the SRHR and maternal & child health projects amount to a few hundred millions, the non-communicable diseases category only receives tens of thousands of euros/dollars.
As can also be distilled from the previous section, the only implementing partnerstooltip:: The organisation that physically carries out the activity or intervention (source: IATI) found in our data are the Netherlands Enterprise Agency and the International Organisation for Migration (IOM).
There is also a project featuring multiple parties.
Where does the money that is spent on non-communicable diseases go to, geographically?
In 2020, funding was relatively equally distributed among a larger list of countries, with South Sudan at the top. In 2023, expenditure was limited to Burkina Faso.
Not all global health issues can be categorised under a clear, overarching theme. This section captures these other, often cross-cutting subjects. It includes investments in gender, key populations, community engagement, environmental health and climate change, and pandemic preparedness and response (PPR).
Gender equality, in its broad sense, is mentioned by the Dutch government as a foreign affairs policy priority. It is currently working on the establishment of a Feminist Foreign Policy, which intends for gender to "become the main focus of all aspects of Dutch foreign policy."
Key populations are most often mentioned in the context of SRHR by the Dutch government. The Netherlands donates resources to protect the rights of groups that are marginalised, including sex workers and people identifying as LGBTQI+. The government also works on preventing sexual violence, child prostitution and sexual abuse.
Climate change and health is another focus area of Dutch global health policy, as can be read in the Dutch Global Health Strategy. "Addressing the impact of climate change on public health, and vice versa" is is the third priority of this strategy, and consists of two focus areas: making healthcare more sustainable and resilient to climate change, and international action on climate, water and food.
PPR is also a theme prioritised by the Dutch government. In the Dutch Global Health Strategy - published a short time after the COVID-19 pandemic, PPR is captured by the second Dutch policy priority: "Improving international pandemic preparedness and minimising cross-border health threats". The focus areas under this priority are global access to medicines and health products and strengthened international action on AMRtooltip::Antimicrobial resistance; the situation where mutations occur in bacteria, viruses, fungi and parasites, causing them to no longer respond to medicines. and zoonotic diseasestooltip::Infections that are naturally transmissible directly or indirectly between animals and humans..
In sum, our analysis includes the following subthemes:
In our analysis, cross-cutting issues encompass the following subthemes gender; key populations, community engagement, environmental health and climate change, and pandemic preparedness and response (PPR).
Over the last few years, attention for these themes has been relatively stable. Environmental health and climate change has received most funding, with most investments going towards WASH project. Gender and community engagement follows in second.
There has been no investment in PPR over the last five years.
Who are the main implementing partnerstooltip:: The organisation that physically carries out the activity or intervention (source: IATI) when it comes to these cross-cutting issues?
An interesting picture emerges in this graph. While many usual names such as UNICEF and a number of the above-mentioned NGOs occur, there are also many water-related actors. Examples include Vitens International, Aqua for All and Simavi.
The list with countries receiving funding related to these cross-cutting themes is relatively similar to the more general list of countries receiving funding from the Dutch Ministry of Foreign Affairs, with a greater focus on African countries.
This tool is an initiative of Cordaid, a Dutch emergency relief and development organisation. Its goal is to further the public’s understanding of the role of the Netherlands in global health. Cordaid worked together with Fyris Research & Data, the agency responsible for document reviewing, data processing and design. The development of this tool was a collaborative effort, combining the expertise and dedication of external researchers, advocates from NGOs, financial specialists from international organisations, data scientists and Cordaid staff. The process of arriving at this platform involved extensive research, co-creation sessions, and iterative design sprints.
In this section, you can discover more about the data we have used, the novel methodology we have developed and the limitations we have encountered.
The initial research objective was to create a platform that:
In a collaborative effort with professionals from the global health field, we have worked out what this would look like in terms of data. It was established that generic, comparable data was needed to compare across themes and countries.
The IATI-data catered to these needs, as can be read in the next section. This also contributed to the scope we eventually chose for, as IATI data only includes the Ministry of Foreign Affairs as contributing actor. The Ministry of Health, for example, does contribute ODAtooltip::Official Development Assistance (ODA) is an internationally agreed indicator of government aid provided to developing countries. It refers to money, goods or services that promote the economic development and welfare of such countries (source: <a href="https://www.government.nl/topics/development-cooperation/the-development-policy-of-the-netherlands" target="_blank">Government of the Netherlands</a>). to global health (for example to the WHO), but these data are not included in the IATI database. They have, however been added manually.
We have selected the International Aid Transparency Initiative (IATI) Datastore on global aid activities as our main source of data. We did so for the following reasons:
Our final subset from this data includes activities reported by the Ministry of Foreign Affairs, the Dutch Enterprise Agency (RVO), and the Dutch Development Bank (FMO), from 2018 up until 2023. This results in a sum of 636 global health-related projects that have had at least one budget transaction during this time.
The Ministry of Health is not listed, despite the fact that ODAtooltip::Official Development Assistance (ODA) is an internationally agreed indicator of government aid provided to developing countries. It refers to money, goods or services that promote the economic development and welfare of such countries (source: <a href="https://www.government.nl/topics/development-cooperation/the-development-policy-of-the-netherlands" target="_blank">Government of the Netherlands</a>). contributions to the WHO are reported in the HGIS-nota. These figures have been separately added to our totals.
We acquired programmatic access to the IATI data via its Datastore API and wrote Python code to make the data retrieved from the API easier to work with given our goals.
First, organisational identifiers for governmental organisations associated with the Netherlands were collected from publishers listed here. We included types “Government” and “Other Public Sector”. This leads to eleven different organisations to query.
Second, after an extensive document review and an elaborate focus group discussion with professionals from the field, we defined our Themes of global health, and associated DAC 5 digit sector codes with each of them by carefully considering each of their descriptions. Please see the translation table provided here. This enabled us to filter the data into a manageable set of projects, and group the IATI data into our own categories. 72 projects (12 per cent) were assigned to multiple of our themes.
The Ministry of Foreign Affairs reports data online at nlontwikkelingssamenwerking.nl (henceforth referred to as ‘NLOS’). Figures reported under Global Health and SRHR here correspond to the totals of the allocated budgets and disbursements found in IATI’s Datastore. On closer inspection we however found projects that we would not have filtered given our selection of sector codes, and vice versa, we were able to find projects we deemed relevant to global health that were not reported on this website.
Given the above, we decided that to be more complete and also at least minimally in line with the ministry’s own reporting with respect to spending on global health, the IATI project identifiers listed yearly on this website should all be included in our raw data as well, and assumed to be about global health. We then extended this data with whatever else we can find in the IATI database that is reported by the Ministry and is associated with global health according to our coding rules.
The data at this stage has:
To interpret our potential data and make a final judgment of each project’s relevance to global health, we made use of OpenAI’s generative pre-trained transformer (GPT 3.5), to the wider public better known by its chatbot version ChatGPT. Given the wide variety of textual data and associated parameters this model has been trained on, it generally shows a good conceptual understanding of what global health means. It also understands most of the world's languages, which means we don't have to translate inputs into one common language as a pre-processing step.
Every project in our potential data was fed to the AI via the OpenAI API, and evaluated based on its description text. That is, for each text we asked it the following prompt: "Does the following text describe an aid activity that is considered to be part of global health and directly addresses people's health? Answer with yes if it does, answer with no if it does not."
The answers were then parsed and used as a final filter to arrive at our final selection of IATI data.
The IATI data holds many different variables. To produce the visuals for this website, the data had to be reshaped in various ways. Additionally, we converted all data to be available both in EUR and USD, when relevant. We used the Python package CurrencyConverter for this, which sources the European Central Bank for historical rates.
An initial prototype of the tool was established during the spring of 2023. Vertical scrolling was recommended to facilitate an optimal user experience, allowing information assimilation in a gradual manner as opposed to overwhelming the user with excessive figures and numbers.
Subsequently, an additional focus group discussion was held, comprising the same set of global health professionals. We collaboratively worked on the preliminary prototype setup, discussing its content, visual elements, and overall aesthetics.
Drawing insights from this second focus group discussion, coupled with ongoing rounds of review, the current version of the tool was established.
The approach chosen and the data associated with this project have their limitations:
Research lead
Adriana Parejo Pagador
Programmes Communication Officer
app@cordaid.org
Address
Grote Marktstraat 45
2511 BH The Hague
www.cordaid.org
Below, you can find the resources to this project. Missing something? Let us know!
Explore data sources relevant to the role of the Netherlands in global health
These data are the key source for our analysis of key global health themes given its high level of detail and coverage of ODA projects over time. It includes global health spending in all sectors and allows for easy comparison (e.g. between countries). The information stored in this database is updated daily and can be accessed automatically using an API. The data can also be queried online via Datastore Search and D-Portal. |
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Budget, commitment and disbursement by DAC sector codes, as reported to IATI. The website also adds information from budget documents and an impression of results by theme (see navigation). The raw IATI data for the Netherlands can be manually downloaded by year (updated every month) |
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A secondary source based on project-level data reported by OECD member states. Concerns commitments and disbursements up to 2021 and is updated fully at the end of the year, up until the prior year. Accessible through the Query Wizard and OECD Statistics. |
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A secondary source containing estimates for 1990 to 2021 of development assistance for health projects based on various sources at a disaggregated level of detail. |
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Platform created by the Global Fund providing free and open access to the Global Fund Data. |
There are many global health trackers out there. You can find some useful ones here.
The University of Washington's Institute for Health Metrics and Evaluation created a platform for exploring global health funding data, enabling diverse expenditure analyses across distribution channels. |
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In-depth tracker of the Dutch efforts in development. It includes trend analyses, political analyses and issue deep-dives. |
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OECD profiling of the Netherlands with regard to development cooperation spending. |
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ODA by country and sector up to 2020, including multilateral flows imputed for specific sectors. Higher-level aggregations. |
Several qualitative resources describe the global health architecture and the role of the Netherlands
Koplan, J.P et al. (2009) Towards a common definition of global health. |
Global health is a field that is rarely clearly defined. This article discusses why, and provides a new way of defining global health. |
Financing Global Health 2021: Global Health Priorities in a Time of Change |
The Institute for Health Metrics and Evaluation's report offers policymakers essential insights into present and future health finance. The latest edition, Financing Global Health 2021, delves into pandemic preparedness, future spending, and development assistance for health. |
The article compares initial COVID-19-era health spending, assesses aid for pandemic preparedness, and contextualises future health investment needs, all by the Institute for Health Metrics and Evaluation. |
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The Global Health Policies of the EU and its Member States: A Common Vision? |
Published in 2018, this article contends that European nations and the European Commission hold divergent perspectives on global health, with varying views on social justice, security, and investment, challenging the notion of a unified 'EU' vision. |
Why the Netherlands should step up its ambitions on global health |
This article (2017) examines Dutch global health efforts, highlighting the Netherlands' robust governance system as a foundation for comprehensive, collaborative policy-making. Drawing from Germany's G7 and G20 influence, the article suggests the Netherlands could lead by example, fostering collective European expertise. |
Primary health care on the road to universal health coverage: 2019 monitoring report |
A WHO monitoring report that, among other things, argues the Netherlands has been a strong advocate for universal health coverage (UHC) and primary health care (PHC), which are seen as critical components of achieving sustainable development and addressing global health inequities. |
The Dutch Global Health Strategy, a vision document for 2023-2030 brought forward by the Dutch ministries of Foreign Affairs and Health. |
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Do what we do best – policy document for foreign trade and development cooperation |
In this document, the Dutch government describes its strategy for Foreign Trade and Development Cooperation. It elaborates on the coalition agreement (see above), and it is supplemented in the coming years by targeted strategies (such as the already published Dutch Global Health Strategy). |
In its Africa Strategy, the Netherlands aims to enhance ties with states on the African continent by strategic and sustainable investments, fostering EU partnerships. This approach aims to tackle migration, trade, energy transition, security, and food security challenges collaboratively. |
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The Netherlands is currently working on a Feminist Foreign Policy. |
Other resources related to the role of the Netherlands in global health
MOPAN is an internationally recognised platform for assessing the performance of international organisations. |
Explore data sources relevant to the role of the Netherlands in global health
These data are the key source for our analysis of key global health themes given its high level of detail and coverage of ODA projects over time. It includes global health spending in all sectors and allows for easy comparison (e.g. between countries). The information stored in this database is updated daily and can be accessed automatically using an API. The data can also be queried online via Datastore Search and D-Portal.
Budget, commitment and disbursement by DAC sector codes, as reported to IATI. The website also adds information from budget documents and an impression of results by theme (see navigation). The raw IATI data for the Netherlands can be manually downloaded by year (updated every month)
A secondary source based on project-level data reported by OECD member states. Concerns commitments and disbursements up to 2021 and is updated fully at the end of the year, up until the prior year. Accessible through the Query Wizard and OECD Statistics.
A secondary source containing estimates for 1990 to 2021 of development assistance for health projects based on various sources at a disaggregated level of detail.
Platform created by the Global Fund providing free and open access to the Global Fund Data.
There are many global health trackers out there. You can find some useful ones here.
The University of Washington's Institute for Health Metrics and Evaluation created a platform for exploring global health funding data, enabling diverse expenditure analyses across distribution channels.
In-depth tracker of the Dutch efforts in development. It includes trend analyses, political analyses and issue deep-dives.
OECD profiling of the Netherlands with regard to development cooperation spending.
ODA by country and sector up to 2020, including multilateral flows imputed for specific sectors. Higher-level aggregations.
Several qualitative resources describe the global health architecture and the role of the Netherlands
Global health is a field that is rarely clearly defined. This article discusses why, and provides a new way of defining global health.
The Institute for Health Metrics and Evaluation's report offers policymakers essential insights into present and future health finance. The latest edition, Financing Global Health 2021, delves into pandemic preparedness, future spending, and development assistance for health.
The article compares initial COVID-19-era health spending, assesses aid for pandemic preparedness, and contextualises future health investment needs, all by the Institute for Health Metrics and Evaluation.
Published in 2018, this article contends that European nations and the European Commission hold divergent perspectives on global health, with varying views on social justice, security, and investment, challenging the notion of a unified 'EU' vision.
This article (2017) examines Dutch global health efforts, highlighting the Netherlands' robust governance system as a foundation for comprehensive, collaborative policy-making. Drawing from Germany's G7 and G20 influence, the article suggests the Netherlands could lead by example, fostering collective European expertise.
A WHO monitoring report that, among other things, argues the Netherlands has been a strong advocate for universal health coverage (UHC) and primary health care (PHC), which are seen as critical components of achieving sustainable development and addressing global health inequities.
The Dutch Global Health Strategy, a vision document for 2023-2030 brought forward by the Dutch ministries of Foreign Affairs and Health.
In this document, the Dutch government describes its strategy for Foreign Trade and Development Cooperation. It elaborates on the coalition agreement (see above), and it is supplemented in the coming years by targeted strategies (such as the already published Dutch Global Health Strategy).
In its Africa Strategy, the Netherlands aims to enhance ties with states on the African continent by strategic and sustainable investments, fostering EU partnerships. This approach aims to tackle migration, trade, energy transition, security, and food security challenges collaboratively.
The Netherlands is currently working on a Feminist Foreign Policy.
Other resources related to the role of the Netherlands in global health
MOPAN is an internationally recognised platform for assessing the performance of international organisations.