Deep Dive Overview
The Global Fund facilitates the Debt-to-Health (D2H) program whose objective is to raise more funds for healthcare, prioritising the long-term impact on health outcomes over simple debt reduction. Like many low- and middle-income countries, Cameroon faced a 'crowding-out effect' where the requirement to service massive external debt forced the government to reduce allocations to essential sectors like healthcare.
Around the time of the project's inception, Cameroon had a generalised HIV/AIDS epidemic with an overall prevalence of 4.3% among those aged 15–44. Approximately 560,000 people were living with HIV, with the burden higher among women (5.9%) compared to men (2.9%). Only about half of those aware of their status were actually on treatment, and 25% of HIV-positive pregnant women were not receiving antiretroviral treatment. The D2H swap was considered a 'triple win': Cameroon strengthened its local health system, Spain converted a bilateral claim into a high-impact health contribution, and the Global Fund mobilised additional resources.
Policy Recommendations
Policymakers should move from discrete initiatives to comprehensive strategies that improve service delivery and health information systems. While early D2H projects focused on "vertical" programs like individual infectious diseases like HIV/AIDS, recent successful swaps show a shift toward "horizontal" Resilient and Sustainable Systems for Health (RSSH
Policymakers should actively ensure that aid projects are the result of fair consultations that align strictly with their national health policies
Policymakers must ensure that proceeds from programs such as D2H complement existing domestic resources for the health sector rather than replace them
Debt transparency is an essential prerequisite to prevent financial errors or the abuse of resources. Policymakers should be prepared to conduct initial evaluations to determine project feasibility, describe investment plans, and establish strong oversight systems
Key Numbers
in bilateral debt cancelled by Spain
invested in the Global Fund by Cameroon
additional patients placed on ART
HIV prevalence among ages 15–44
Deep Dive Summary
This deep dive reviews the Spain-Cameroon Debt2Health project, demonstrating how bilateral debt cancellation translates into Global Fund investments that strengthen local HIV and tuberculosis treatment systems.
Content Type
Case Study
Region
Central Africa
Author
Research Team
Read Time
10 min
Key Findings
Spain cancelled €24.1 million in bilateral debt claims, and Cameroon contributed approximately €9.3 million (40% of the cancelled amount) to the Global Fund.
D2H funding placed an additional 30,000 to 38,000 patients on life-saving antiretroviral therapy (ART) over three years.
The funding supported a shift toward an integrated, patient-centred approach utilising community-based organisations for HIV care.
A portion of the investment purchased new mobile digital X-ray machines for HIV care and supported multidrug-resistant tuberculosis treatments.