Far too many people around the world – especially the poor – don’t have access to even basic healthcare. Preventable diseases like HIV, tuberculosis, and malaria still claim millions of lives every year, and recent outbreaks of diseases like Ebola and Zika show how weak many countries’ health systems are.
The good news is that investment in health makes a massive difference and life-changing progress happens every day. The world has cut under-5 child deaths in half since 1990. Since the turn of the century, the annual number of new HIV infections are down by more than a third and malaria deaths have been halved.
We need to accelerate this incredible progress by ensuring that life-saving medicines and supplies reach the people who need them most, and that all people have access to safe and reliable health services.
Good health is vital to success. Millions die from preventable illness each year, affecting families, communities, and the advancement of entire nations.
However, poor health doesn’t affect us equally. Infectious diseases and preventable maternal and child deaths disproportionately impact the world’s poor — and Africa is the hardest-hit region.
Though the resources for global disease control have increased dramatically since 2000, funding remains drastically insufficient and funding has started to flatline in the last few years. If global efforts to fight infectious diseases stagnate or stop, these diseases will quickly rebound and progress will be lost.
Many health systems in low- and middle-income countries lack essential components needed to prevent and treat diseases. Strengthening the health workforce, infrastructure, and access to basic life-saving prevention and treatment tools will be crucial to achieving healthy lives for all.
Ensuring healthy lives for all is achievable in our lifetime. In many cases, we already have the tools we need to save millions more lives.
We need to better deploy supplies that can treat and prevent the world’s most deadly diseases, and better equip health systems to respond to health emergencies. If we improve global vaccination coverage, we could save the lives of an additional 1.5 million children each year. It’s also within possible to treat all people living with AIDS, TB, and malaria so they can live full and healthy lives.
To accelerate progress and end preventable diseases in our lifetime, we also need to scale up domestic and donor resources. As low- and middle-income countries’ economies grow, so should the proportion of spending on health. Additionally, donors must continue their support, including full funding for the Global Fund and Gavi that together can save nearly 15 million lives by 2020.
The world has a plan and the tools needed to end AIDS as a public health threat by 2030. But achieving this is not a foregone conclusion.
In the more than three decades since HIV/AIDS was first discovered, the disease has taken the lives of 35 million people around the world. In 2016 alone, AIDS killed 1 million people, 720,000 of whom were living in Africa. These deaths have an impact on the countries and communities that are hardest hit by the disease, especially for the 16.5 million children around the world who have become orphans because of AIDS. Life-saving antiretroviral treatment is available and affordable, yet millions of people still do not have access.
People often become infected with HIV during their most productive years (15-49 years old), making the disease – if untreated – a threat to development progress in the poorest and hardest hit countries. Within countries, HIV is increasingly concentrated among the most vulnerable populations, including men who have sex with men, female sex workers, injection drug users, and adolescent girls. In many countries, political dynamics and legislation have made it increasingly difficult to reach them.
Young women aged 15 – 24 are also at particularly high risk of infection. An average of 986 young women were infected with HIV every day in 2016; most of these women live in sub-Saharan Africa. AIDS remains the leading cause of death for women of reproductive age (15–49 years) globally, and new infections among young women (aged 15–24 years) were 44% higher than they were among men in the same age group
Worryingly, funding available for the global fight against AIDS has started to flat line. In 2016, funding disbursed by donor governments for HIV fell for the second year in a row. This happened at a time when there is still over a $7 billion gap in funding to reach the UNAIDS estimated $26.2 billion needed annually by 2020 to end AIDS as a global public health threat by 2030.
In 2016, world leaders pledged to end the AIDS epidemic by 2030, but greater levels of funding, used more strategically, are needed to deliver on this commitment.
Thanks to investments and innovation over the last 15 years, we have made remarkable progress against AIDS. As a result of this progress, we know what is needed to accelerate efforts in the decade to come. Today, 20.9 million people are on lifesaving AIDS treatment, up from just 685,000 in 2000. Since 2000, new HIV infections have fallen by more than one third, infections among children have dropped by 65%, and AIDS-related deaths have decreased by nearly half since their peak in 2005.
As we continue to improve access to treatment, we must also improve prevention by deploying existing and new tools more effectively. For example, we know that treatment is an effective form of prevention; if a person living with AIDS takes their treatment regularly, they can reduce the likelihood of passing HIV on to others by up to 96%. Additionally, voluntary medical male circumcision, another powerful tool, was shown to reduce the likelihood of HIV infection in men by up to 60%.
We also know that funding for HIV works. Investments in the fight against AIDS – channelled through governments and programs such as the Global Fund and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) – have helped save millions of lives and started to bend the curve of the pandemic. The Global Fund’s grants currently support more than half the world’s people on treatment – 11 million people – and since its inception, the Global Fund has provided 579 million HIV counselling and testing sessions. PEPFAR is providing treatment support for over 14 million people, including 1.1 million children. In 2016, PEPFAR reached more than 85.5million people with HIV testing and counselling and 1 million adolescent girls and young women with comprehensive HIV prevention interventions through the DREAMS Partnership.
The world must build on this progress and accelerate the response in the next four years – particularly among women and girls and the world’s most marginalised and difficult-to-reach populations. We have the tools to finish the job of virtual elimination of mother-to-child transmission, to dramatically scale up treatment, and to deploy smarter prevention strategies. To be effective, these goals cannot be achieved in isolation from one another, nor can they be the sole responsibility of a small number of donor countries. Only when donors, African governments, international organisations, and the private sector work together will the end of AIDS become a reality.
For millions of people around the world, a simple mosquito bite can have deadly consequences. Malaria is a tropical disease caused by parasites and transmitted through the bite of an infected Anopheles mosquito.
In 2016, malaria killed approximately 445,000 people. That is 50 people every hour who die of something completely preventable – almost two-thirds of whom are children under five.
One half of the world’s population lives in areas at risk of malaria. But about 90% of malaria cases and deaths globally occur in sub-Saharan Africa; just 15 countries accounted for nearly 4 out of every 5 malaria cases and deaths in 2016. Since 2000, the decline in malaria incidence in these 15 countries has dropped just 32% compared to 54% in other countries globally.
Control measures such as indoor residual spraying (IRS) with insecticides and insecticide-treated bed nets (ITNs), and antimalarial drugs such as artemisinin-combination therapy (ACT) have successfully reduced malaria cases and deaths. However,insecticide- and drug-resistance is a growing threat as these interventions continue to be scaled up.
Not only does malaria cause illness and deaths around the world; it decreases productivity and increases the risk of poverty for the communities and countries affected. For example, infection rates are highest during the rainy season, often resulting in decreased agricultural production. In total, malaria directly costs sub-Saharan Africa an estimated $12 billion a year . The total economic loss, however, are estimated to be far greater. Economists believe that malaria may slow economic growth by up to 1.3% per year. Malaria also puts a serious strain on public health systems. In heavily affected sub-Saharan African countries, malaria accounts for as much as 40% of public health spending.
Increased funding for malaria control and treatment is still needed to build on the progress made in the last few years. In 2015, funding for malaria control and elimination totalled $2.9 billion. Although this was one of the highest funding totals to date, it was less than half the estimated $6.4 billion needed by 2020.
Malaria is an entirely preventable and treatable disease. For just $10, a bed net treated with insecticide can be bought and distributed, with training given on how best to use it. Combining bed nets with other simple actions such as spraying homes with insecticides could prevent millions of people from getting sick. For those who do become infected with malaria, treatments costing $2 each are highly effective and can dramatically cut deaths.
Significant increases in the resources available to fight malaria have had huge positive health impacts. Initiatives, such as the Global Malaria Action Plan (GMAP), the Global Fund to Fight AIDS, Tuberculosis and Malaria, the US President’s Malaria Initiative (PMI), and the World Bank’s Malaria Booster Program, have significantly expanded coverage of bed nets and access to malaria treatment globally. Since 2000, one billion insecticide-treated mosquito nets have been distributed in Africa and today an estimated 68% of children under-five in sub-Saharan Africa are sleeping under insecticide-treated nets, compared to less than 2% in 2000. The Global Fund alone has distributed a total of 795 million bed nets and treated 668 million malaria cases since its inception.
This support is producing results. Between 2000 and 2015, global malaria death rates fell by 60% and global malaria incidence decreased by 37%. In 2014, 16 countries reported no cases of the disease and in 2015 33 countries reported fewer than 1,000 cases.
A range of new tools and promising malaria vaccines currently in development will be critical to counter threats like the growing insecticide resistance and the drop in external funding for public health. With a coordinated global effort, we can continue to make progress and ultimately ensure the virtual elimination of malaria deaths.
In a 2017 Huffington Post article, Dr. Tedros Adhanom, now WHO Director-General, wrote: “Defeating malaria is absolutely critical to ending poverty, improving the health of millions and enabling future generations to reach their full potential. Today, and every day, let us recommit to ending malaria for good.”
Maternal and Child Health
The rapid drop in global child deaths in the last 20 years is one of the world’s most spectacular, and most hopeful, success stories. Since 1990, the number of child deaths globally has been cut in half and maternal mortality worldwide dropped by about 44%.
Yet in many of the world’s poorest countries, ensuring that mothers stay alive and healthy and that their children can survive and thrive still represents a significant challenge. In 2015, 303,000 mothers died from pregnancy-related causes and millions more suffered from complications related to pregnancy or childbirth, including hemorrhage, infection, hypertensive disorders and obstructed labour.
Women in the poorest countries are most at risk of dying from pregnancy and childbirth. A woman’s lifetime risk of maternal death is 1 in 180 in developing countries compared to 1 in 4900 in developed countries. In countries designated as fragile states, the risk is 1 in 54.
Maternal health is deeply intertwined with child health, which also remains a significant global challenge. In2015, 5.6 million children died before their fifth birthday, and only 62 countries had reached the Millennium Development Goals (MDG) 4 target of a two thirds reduction in under-five mortality since 1990. If levels of under-five mortality for each country remain at today’s levels, 84 million children under the age of 5 will die between 2016 and 2030.
More than any other region, Africa is home to the highest number of child deaths – 2.7 million in 2016. Despite some countries making improvements – and in some cases, dramatic gains – in child health in recent years, sub-Saharan Africa’s average child mortality rate is almost 14 times the average of high-income countries. Many of these deaths are from entirely preventable and treatable causes, such as pneumonia, diarrhoea, malnutrition and malaria.
With proper care and treatment, nearly all of these deaths could be avoided. However, many health systems in low- and middle-income countries have a shortage of health-care workers, a lack of basic equipment, inadequate access to basic life-saving prevention and treatment tools, and poor infrastructure. Improving health systems is essential to saving the lives of mothers and children in the developing world.
Simple, cost-effective solutions to improve maternal and child health exist. Enabling women to plan and space births, treating infectious diseases and improving nutrition can help women stay healthy during pregnancy. Additionally, efforts to educate women – both in general and specifically during and immediately following their pregnancies – help ensure that mothers know how and when to seek health care services for themselves and their children.
Skilled care by a birth attendant during pregnancy and labour, emergency obstetric care, and immediate postnatal care all help reduce maternal mortality. These kinds of basic maternal health services before and after delivery could prevent up to 80% of maternal deaths, 99% of which occur in developing countries.
It is also possible to save many more children’s lives with low-cost interventions. Vaccinations against diseases like hepatitis B, Haemophilus influenzae type b (Hib), pertussis, measles, and yellow fever can save millions of lives each year. Since 2000, Gavi, the vaccine alliance, has supported the immunisation of 640 million children and has helped save 9 million lives. An increase in measles vaccination alone resulted in a 84% drop in measles deaths between 2000 and 2016 worldwide. Other interventions like Vitamin A supplements, which cost as low as $1 per child per year, could save over a quarter of a million young lives annually by reducing the risk and severity of diarrhoea and infections.
Treatment to prevent mother-to-child transmission of HIV, anti-malaria bed nets and the promotion of breastfeeding and proper nutrition can also guard against infectious diseases and ensure good health in the early stages of childhood.
Thanks to strong financing, programs, and political will over the last fifteen years, we know we can end maternal and child deaths from preventable causes. However, we have a long way to go before achieving the Sustainable Development Goals (SDG) targets to substantially reduce global maternal mortality, neonatal mortality, and under-5 mortality.
Health Systems Strengthening
Strong health systems are integral to treating and preventing infectious diseases and delivering life-saving services to children and mothers. A strong health system provides care to people who need it, regardless of where they live and their ability to pay, and consists of a well-trained health workforce, strong infrastructure, a reliable supply of medicines and equipment, and the capacity to quickly detect and respond to health emergencies.
Yet the 2014-16 Ebola outbreak in West Africa, the widespread Zika epidemic, and the reemergence of polio in Nigeria’s Lake Chad region demonstrate the need to put health system strengthening at the center of the global health agenda if we want to achieve SDG3.
The shortage of health workers is a major hurdle in expanding health care. The WHO estimates that to achieve SDG3, there should be 4.45 physicians, nurses and midwives per 1,000 people. Yet based on the current pace of progress, the global deficit of health workers based on needs will be 17.4 million doctors, nurses, and midwives. This severe shortage of health workers will hit African countries the hardest: 68% – of the global disease burden from HIV, TB, and malaria is accounted for by Africa, which has only 4% of the world’s health workforce[ii].
Additionally, many health systems in low- and middle-income countries lack basic equipment, face inadequate access to basic life-saving prevention and treatment tools and poor infrastructure. In total, half of the world’s population does not have access to essential health services.
The health care the poor do receive is oftentimes prohibitively expensive. In low- and middle-income countries, over one-third of spending on health comes out of people’s’ pockets and 6% of people are tipped into or pushed further into extreme poverty because of health spending.[iv]
An investment in health systems is an investment in the fight against AIDS, TB and malaria and an investment in ending preventable deaths among children and mothers. Health Systems Strengthening is also at the crux of achieving Universal Health Coverage (UHC), in which all people can afford and have access to needed, quality health services without suffering financial hardship.
Thanks largely to stronger health systems, more people are on lifesaving AIDS treatment now than ever before, and effective TB diagnosis and treatment saved 54 million lives between 2000 and 2016.[v] Providing basic health services before and after delivery could prevent most maternal deaths, and have already helped cut the maternal mortality rate by 44% since 1990. The coverage of infants worldwide receiving the DTP3 vaccine rose from just 21% in 1980 to 86% in 2015[vi] – an amazing health systems achievement as it requires 3 contacts with the health system at appropriate times, yet progress has stalled in the past 3 years.
Beyond SDG 3, health systems strengthening can help achieve other sustainable development goals. Achieving UHC means people will not face financial hardship when accessing quality health care, which contributes to SDG 1, no poverty. Further, women make up 67% of employment in the health and social sectors compared with 41% of total employment. This means that investing in the health workforce – unlike investments in other sectors – will contribute to SDG 5, gender equality, by investing in women’s empowerment and economic opportunity.
Health systems strengthening is also key to achieving global health security – countries’ ability to anticipate and respond to public health emergencies that could affect regional or global populations. Small investments in health systems now can pay enormous dividends in global health security. For example, the infrastructure developed to support polio immunizations in Nigeria was used to quickly put a halt to the Ebola epidemic in Africa’s most populous country.
The path forward is as intricate as it is integral – needing support from sectors like health, labor and infrastructure to strengthen our data, build capacity and put us on the right track. The WHO’s Global strategy on human resources for health offers policy options and recommendations to address the global shortage of health workers and the government signatories of UHC2030’s Global Compact demonstrate commitment to achieving UHC.
ONE’s Policy Position
ONE is calling for strong funding and smart investments to accelerate the fight against HIV, TB and malaria and end preventable childhood deaths by 2030. In particular:
- Increase ambition and diversify sources of external funding, including through strong Official Development Assistance (ODA) for bilateral programs like PEPFAR, and for international organizations like the Global Fund to Fight AIDS, TB & Malaria and Gavi, the Vaccine Alliance.
- Increase the share of domestic financing for health, with a specific focus on strengthening primary health care and health workforce in the poorest countries.
[i] Calculation using IHME data. Sum of DALY, Deaths, YLD and YLL figures for 2015 in WHO African Region vs Global.
[ii] Calculation using IHME data. Sum of DALY, Deaths, YLD and YLL figures for 2015 in WHO African Region vs Global.
[iii] WHO, 2015. http://www.who.int/mediacentre/news/releases/2015/uhc-report/en/
[Iv] WHO, 2015. http://www.who.int/mediacentre/news/releases/2015/uhc-report/en/
[v] WHO, 2017. http://www.who.int/mediacentre/factsheets/fs104/en/
[vi] UNICEF, 2016. https://data.unicef.org/topic/child-health/immunization/