June 09, 2020
“Ensuring healthy lives and promoting well-being at all ages”. That is the formulation of SDG 3 which, given the current crisis, exposes all the problems posed by the implementation of the 2030 Agenda.
Stating that it was difficult to imagine this situation in 2015, when the 2030 Agenda was adopted, is half true: in 2009, the World Health Organization had described the influenza A H1N1 (known as swine flu) caused by a Polio outbreak of the coronavirus family, and just one year before the adoption of the Sustainable Development Goals (SDGs), outbreaks of Polio (believed to be eradicated) had been declared as international health emergencies in 2014 in the Middle East, and Ebola outbreaks in West Africa. This means that two international health emergencies were declared in the months immediately before the intergovernmental process of negotiations that ended with the adoption of the 2030 Agenda.
It is also true that no progress was made towards achieving some of the SDG 3 targets, and that data available is insufficient. Let’s see some examples:
🔸Indicator 3.1.2 refers to the proportion of attended births by specialized health personnel. Since 2015 there is only one data source at the global level (2016; 81%). The previous one is from 2010 (71%). If we measure the level of progress it is still insufficient (source: World Health Organization).
🔸Indicators 3.3.1 to 3.3.5 refer to specific diseases: regarding HIV, in 2018 the HIV incidence rate was 0.24% of uninfected people, a smaller change from 0.26% in 2015. Also in 2018, the incidence rate of Tuberculosis fell from 132 new cases per 100,000 inhabitants from 141 in 2015. The incidence of malaria has stagnated at around 57% since 2015. The number of people needing treatment for non-communicable diseases fell from 1.8 to 1.76 billion between 2015 and 2018. All of this progress puts us out off track to reach the goal of eradicating these diseases by 2030 (data from the United Nations Secretary-General’s Report on progress towards achieving the 2020 SDGs).
This insufficient progress can be explained by the same reasons that also help to understand the deficiencies shown to respond to the pressures introduced into national health systems by the COVID-19 pandemic. Whoever approaches the SDGs for the first time and observes their goals can be surprised to see that some of them are indicated with numbers and others alphanumerically. This distinction occurs because there are “achievement” targets (purely numerical ones), while another set of targets are “progress targets” (the alphanumeric ones), which must be met in order to achieve the first ones. The thing is that if progress targets are not promoted, achievement goals become unattainable.
SDG 3 (Health and Well-Being) includes nine achievement targets and four progress targets. On the latter we find references to support the affordability of access to medicines and vaccines; Increasing health financing and the development, training and retention of health personnel in developing countries; And strengthening the capacity of all countries in risk reduction and risk management for national and global health.
Indicators associated with these goals show that, on a global level, newborn vaccination coverage went from 85% in 2015 to 86% in 2018. Measles vaccination, a highly contagious disease, showed a 69% coverage of the population in 2018, insufficient to prevent outbreaks. Likewise, between 33% and 50% of the population had basic health coverage services and the percentage of families that dedicate more than 10% of their income to pay for health services increased from 9.4 to 12.7% between 2015 and 2018. “If current trends continue, only 39% to 63% of the world’s population will be covered by essential health services by 2030,” states the UN Secretary General´s report. All this occurs within the framework of an increase in official development aid for basic health between 2010 and 2018 of 41% in real terms.
Other data that allows us to better monitor it, and which we disaggregate at a regional level, are the number of doctors per 1,000 inhabitants, the number of hospital beds per 1,000 inhabitants, health spending as a GDP percentage and family spending in private health care as % of total health cost.
The results are repeated, always placing the European zone or the OECD countries among the best positioned, while Sub-Saharan Africa and South Asia with the worst results, with marked differences between one and the other, in some cases exceeding 100%.
In the face of a global threat to health, the above table shows the factual impossibility of adequate global responses due to differences in resources. And the weakness of an integral system is always the same as the expressed by its weakest part.
When building strategies and plans for the post-pandemic world, we have lessons to learn in this matter, which would be essential to keep in mind to avoid making the same mistakes and to be better prepared for a common next challenge.
“An additional 60,254 cases and 2,584 deaths were reported in the past 24 hours, representing a 2% relative increase for cases and deaths respectively, compared to the previous day.“PAHO, May 27, 2020.
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