The French President Emmanuel Macron had, as one might expect, a busy end of the year 2017, full of visits and meetings with other heads of States to tackle global problems (and he still had time for some celebration for his 40th birthday at the Chambord castle – or was it an early Christmas celebration?). On November 28th 2017 he was in Ouagadougou, Burkina Faso, delivering a speech during his first African tour, followed by the European Union-African Union Summit in Abidjan, Ivory Coast ; on December 12th he welcomed a number of very important guests at the One Planet Summit in Paris, 2 years after the COP 21 and the signature of the Paris Agreement ; on December 13th he hosted a support meeting for the G5 Sahel, a joint force between Mali, Niger, Burkina Faso, Chad and Mauritania, to fight terrorism in the Sahel region ; and on December 22nd-23rd, he was in Niamey, Niger, to visit the French military forces deployed there and to support Niger – a key partner of the G5 Sahel and in the fight against illegal migration – with 400 million € in development aid.
Development, youth employment, climate change, security, the fight against terrorism, were all discussed. Sometimes, health issues were also mentioned. This was explicitly the case only during Macron’s speech in Burkina Faso, but ensuring good health is a multisectoral process. Is there a specific “Macronian global health vision” emerging from these meetings and especially from this new “Partnership with Africa” that Macron has been calling for? And can the “Macron momentum”, discerned by some for the European Union, bring out concrete health actions in 2018?
In his Ouagadougou speech, Emmanuel Macron pleaded for more efficient development aid, multilateral efforts, and coordination among donors. These three elements are also key to the Sahel Alliance (Alliance pour le Sahel), which the French President singled out. The Sahel is obviously an important region for French diplomacy for historic, economic and geostrategic reasons (for instance the French nuclear group Areva exploits uranium mines in Niger), and the Sahel Alliance was launched with the aim to complement the G5 Sahel force created three years before in order “to guarantee development and security conditions”. This nexus between security and development is nothing new. The emphasis is still put on security first with the G5 Sahel, which is currently looking for funds to expand and deploy the multi-country forces between the five Sahel countries to fight terrorist attacks by several armed groups (hence the meeting hosted in Paris and the visit to Niamey). The Sahel region is also a very poor one, with acute health problems and massive lack of access to health , thus the emphasis on development efforts. The French Development Agency (AFD) for instance has a 2015-2020 plan for the region (which is also funded by the European Union) focused on three priorities: youth employment, demographic challenges, food security and territorial development.
On health specifically, five points of the Ouagadougou speech can be underlined. First, Emmanuel Macron focused on “the challenge of population growth”, something that should be addressed by women empowerment (that would imply a focus on reproductive health, but the word was not pronounced). Second, he spoke of the need to improve access to health, and especially to provide better access to medicines to fight pandemics. He confirmed that France will remain the second donor to the Global Fund to fight Aids, Tuberculosis and Malaria, following the steps of Jacques Chirac, the first French President to commit to that institution. Third, he highlighted the need to build and strengthen health systems, by investing in health infrastructure, technologies and telemedicine. This task should be performed by the French private sector, namely French investment funds and insurance companies, which should invest in health systems and “build clinics” (a president never loses an opportunity for economic diplomacy). Fourth, he mentioned the importance of the fight against counterfeited drugs. And, fifth, he went on to climate change, which can amplify all threats, including health ones. In that regard, it was timely that, only two weeks later, Emmanuel Macron hosted the One Planet summit, two years after the signature of the Paris Agreement. Political actors were largely silent or absent, and the emphasis was put on financial actors, “green finance”, and how investments could be reoriented to support a low carbon economy, with the hope that their engagement would make up for the USA withdrawal (Axa for instance pledged to disinvest from the coal industry, the World Bank pledged not to finance projects exploiting fossil energy anymore after 2019).
What can we conclude from all this? A few priorities seem to emerge, which could still be better defined: a focus on the Sahel region with a “development-security nexus” approach (which could evolve into a “development-security-climate change” nexus approach?), a focus on access to medicines, health system strengthening (all this linked with the fight against counterfeited drugs), and support of multilateral funds (though rumor has it that France might cut its contribution to Unitaid by 20%). However, the preferred method to act on these priorities takes as much importance: a clear focus on aid efficiency and (multilateral) cooperation, and, maybe more striking, an emphasis on technologies and the role of the private sector, and especially the finance sector. This seems to be the current belief, one that was present in the Ouagadougou speech on health and one that also dominated at the One Planet Summit: when political will is lacking, there is a hope the private sector will jump in for the better…Who said “les promesses n’engagent que ceux qui y croient”? In the meantime, a crucial word for health and development failed to be pronounced: inequality. It is astonishing, although perhaps not surprising, that, for all the focus put on access to health, to medicines, to clinics-to-be-built-by-French-investors, and at a time when world income inequalities are rising, the issue was not even mentioned.
We might wish for 2018 that French global health actions take into consideration that, to “concretely deliver” on lofty goals, one not only has to build clinics equipped with technologies and telemedicine devices. Effective access also needs to be ensured, which requires an understanding and action on the reasons for unequal access to health. Because, even if Le Monde’s editorialists celebrate the fact that Emmanuel Macron has taught French people “patience”, global health can’t wait much longer.