Spain’s Debt Swap Programs Have Improved Health Indicators in Cameroon, Ethiopia and DRC

06 November 2023

In 2017, Spain, together with the Global Fund to Fight AIDS, Tuberculosis and Malaria, signed debt swap programs with Cameroon, Ethiopia and the Democratic Republic of the Congo (DRC) to support human development and the improvement of health indicators in these African countries. These programs form part of the Global Fund’s Debt2Health program [ download in English | Español | Français ] .

The Debt2Health program converts debt repayments into lifesaving investments in health. Under individually negotiated “debt swap” agreements, an implementing country agrees to invest in programs to fight the three diseases or strengthen health systems through the Global Fund. In return, a creditor country cancels debt owed by the implementing country.

On 29 September 2023, Spain announced it had successfully closed the debt swap programs signed with Cameroon, Ethiopia and the DRC, which have led to improvements in health indicators in the three countries.

The program signed with Cameroon has led to the cancellation by Spain of debts amounting to €9.2 million and US$16.7 million. In return for the debt relief, Cameroon made a contribution of €9.3 million to the Global Fund, which has been earmarked for the fight against AIDS. Program funds have enabled a total of 30,000 people to receive antiretroviral therapy, and together with additional resources mobilized by the Global Fund, have helped raise the treatment coverage rate for people living with this disease from 50% to 70%.

In the case of Ethiopia, the program has involved the cancellation by Spain of a debt of US$8.7 million. In return, Ethiopia made a contribution of €3.2 million to the Global Fund, which has been allocated to the fight against AIDS, tuberculosis and malaria. Program funds have contributed to the diagnosis and treatment of more than 4,800 cases of multidrug-resistant tuberculosis, and increased access to HIV testing with the aim of achieving 90% viral suppression among HIV-positive people currently receiving antiretroviral therapy. In addition, investments in laboratory equipment have improved overall health care delivery through better access to anatomic pathology, biochemistry and microbiology services.

As for the program signed with the DRC, Spain canceled US$8.3 million in debt relief. In return, the DRC made a contribution equivalent to US$3.4 million to the Global Fund, which has been earmarked for the fight against malaria in the country. The program funds have enabled the distribution of 2.2 million long-lasting insecticide-treated mosquito nets in the province of Tschopo in the northeast of the country. The program has also contributed to a 52.3% reduction in malaria mortality in the DRC, which, since 2015, has had one of the highest malaria mortality rates in the world.


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