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Fortunately, in spite of numerous challenges and setbacks, in recent years the health of many of the world’s people has improved tremendously, and these gains have persisted for decades. Thus, for example, child and maternal mortality decreased by 34% between 2000 and 2020. To be specific, inoculation programs, improvements in nutrition, and better access to health services – including professional care during pregnancy and birth − have contributed to that progress. Diseases like smallpox were eradicated while the spread of polio has fallen precipitously. Infectious diseases such as HIV/Aids, malaria, and tuberculosis have become more manageable due to global initiatives, notably the Global Fund to Fight Aids, Tuberculosis, and Malaria (GFATM).
»Fortunately, the health of many people around the world has improved tremendously.«
Moreover, the COVID-19 pandemic showed us how much progress in international cooperation is possible within a very short time. For instance, the COVID-19 Global Vaccine Access Facility (known as the Covax-Facility for short) supplied nearly two billion doses of vaccine to the world’s poorest countries, thereby saving more than 2.7 million lives.
Furthermore, the international Pandemic Fund was established in 2022 with the goal of closing a gap in international pandemic services by offering additional financial incentives to ongoing programs, intended to strengthen their laboratory facilities and enable them to invest in monitoring systems for the early detection of infectious diseases.
Germany has made important contributions to all of these initiatives and will continue to do so.
Without better and more equitable health care systems around the world, the human right to health will remain out of reach for many. In particular, infectious diseases may spread much more rapidly, and severe macroeconomic disruptions may occur due to the interruption of supply chains (e.g., because of border closures) and the higher number of staff members on sick leave.
»There is no one-size-fits-all model of functioning health care systems«
Many countries have invested successfully in the construction and expansion of their health care systems and in so doing were supported by the German Development Cooperation program. One example of this assistance is the introduction of health insurance schemes for poor people in India and Indonesia. Since 2000 the number of people who can take advantage of essential health services in those countries without impoverishing themselves has roughly doubled. Yet it is still true that there is no one-size-fits-all model of functioning health care systems. Instead, those systems must be adapted to the specific circumstances, needs, and cultural backgrounds of each country.
Current challenges
In spite of numerous advances, gaps continue to plague the provision of health care. In many countries health care systems continue to be underdeveloped, while failing to reach all groups within the population. Access to health services often remains limited for those who live in rural areas and for marginalized groups. Thus, in 2021 around 4.5 billion people lacked complete access to essential health services. Data from over 70 countries show that every fourth woman is prevented from making free decisions about her own health care, while every tenth woman lacks the power to decide whether to use contraceptives. Moreover, millions of human beings fall into poverty every year due to the costs of health care services. And in addition, the COVID-19 pandemic rolled back many advances. For example, because of lockdowns and limited access to health care institutions, routine immunizations of children could not be carried out as planned. Likewise, many women could not have preventive examinations during their pregnancies.
At the same time, wars and conflicts and the refugee movements and expulsions resulting from them increasingly hamper health care services in a number of regions. Thus, for example, the war in Ukraine and especially Russian attacks on the country’s medical institutions have drastically worsened the infrastructure of health care in that country. We still cannot get the horrible images of the Russian attack on Kyiv’s Children’s Hospital last July out of our minds.
At the same time, crisis and conflict situations increase the need for additional options for the treatment of psychological trauma. Last but not least, the rapidly rising number of non-infectious illnesses such as diabetes, cancer, or heart and circulatory diseases put extra stress on health care systems. In addition, rising temperatures and the increasing incidence of extreme weather events have heightened disease risks all over the world. So far, the increase in infectious diseases like malaria, zika, dengue, or cholera has shown up mainly in our partner countries. Yet almost two-thirds of the pathogens affecting humans and animals in Europe are climate-sensitive, so even countries like Germany, in addition to the measures they take to protect people against heat, must adjust to the burdens that the increasing numbers of climate-related infectious diseases will place on them. All of this is happening against a backdrop of dwindling financial resources, both those of donors and our partner-countries.
What are political actors doing?
Hence, our focus now more than ever is on coordination: cooperating with our international and bilateral partners. The World Health Organization plays a crucial role in coordinating global health measures. One example of that is the ongoing process of negotiating an international pandemic agreement which should improve the prevention of and responses to future pandemics as well as the care given to those who have been infected. Among other things, the accord should ensure stronger international cooperation when it comes to delivering vaccines as well as therapeutics and diagnostics.
»Multilateral funds constitute an essential instrument for the financing and support of global health projects«
Multilateral funds constitute an essential instrument for the financing and support of global health projects. The GFATM, mentioned above, invests in programs to combat the three infectious diseases noted in its acronym as well as others that strengthen health care systems and thus secure those investments over the long term. The vaccination alliance Gavi promotes inoculation programs in the world’s poorest countries in order to reduce child mortality and expand access to life-saving vaccines. Since their founding, the work of GFATM and Gavi has prevented approximately 76 million deaths. As one of the largest donors to both funds, Germany deserves a large share of the credit for these successes. Another example is the Global Financing Facility for Women, Children, and Adolescents (GFF). This NGO strives to reduce significantly avoidable deaths of mothers, newborns, children, and young people by 2030 through more sustainable financing.
If such efforts are to succeed, it is essential that partner countries assume direct responsibility. To encourage them to do so and ensure that funds are more efficiently allocated, two things need to happen: good coordination among the actors and adaptation to the systems existing in each country. As part of the effort to implement the Lusaka Agenda, concrete steps in that direction have been agreed upon.
At the European level, cooperation between the EU member states plays a vital role. As »Team Europe,« EU bodies, member states, and financial institutions bundle resources to provide coordinated responses to planet-wide challenges such as global health. Accordingly, Team Europe supports initiatives such as the production of and access to vaccines, medicines, and health technologies (MAV+), as well as the improved production and distribution of vaccines and drugs, and does so with a special focus on Africa.
The Federal Ministry for Economic Cooperation and Development (the »BMZ«) has a strategy for health, social security and population dynamics
In Germany too, health is a priority for policymaking in the field of development. In 2023 the Ministry published a »core issues« strategy that encompasses health, social security, and population dynamics. It demonstrates how partner countries can be supported as they try to strengthen health care systems and make them more resilient. The strategy emphasizes the significance of a comprehensive approach to health care provision, one that reaches all groups in the population, especially those that are marginalized and vulnerable.
»Special attention to gender equality and self-determination in family planning«
The BMZ strategy also pays special attention to gender equality and self-determination in family planning. Feminist development policy aims to reinforce the rights and health especially of women and girls all over the world. Among other things, that includes access to contraceptives, improvements in maternal health, and a campaign against gender-specific violence. For example, since 2011 bilateral measures in the context of the BMZ initiative »Self-determined family planning and reproductive health for all!« have helped 44 million couples to obtain and use contraceptives. In addition, more than 50,000 skilled personnel have been trained or retrained in obstetrics.
Trends in the area of global health demonstrate both impressive gains and serious challenges. Hence, international and German policymaking must continue to act decisively to guarantee equitable and sustainable health care provision for everyone—even when budgets are tight. At the same time, we need to take more advantage of innovative solutions and the potential inherent in digitalization to relieve the increasing burdens that have arisen from non-communicable diseases and the consequences of climate change. Only through a holistic and coordinated approach can we achieve the third of the UN’s sustainable development goals: health and well-being for all.