Preventing premature deaths with improved health funding
*Why one in 10 infants worldwide did not receive any vaccinations in 2016, by WHO, UNICEF
Can improving domestic funding for health activities prevent premature deaths and increase life expectancy?
The SDG Health Price Tag, published Monday in The Lancet Global Health, shows that investments to expand services towards universal health coverage and the other Sustainable Development Goal (SDG) health targets could prevent 97 million premature deaths globally between now and 2030, and add as much as 8.4 years of life expectancy in some countries. While most countries can afford the investments needed, the poorest nations will need assistance to reach the targets.
The analysis estimates the costs and benefits of progressively expanding health services in order to reach 16 SDG health targets in 67 low- and middle-income countries that account for 75 per cent of the world’s population.
Also, worldwide, 12.9 million infants, nearly one in 10, did not receive any vaccinations in 2016, according to the most recent World Health Organisation (WHO) and United Nation Children Fund (UNICEF) immunization estimates. This means, critically, that these infants missed the first dose of diphtheria-tetanus-pertussis (DTP)-containing vaccine, putting them at serious risk of these potentially fatal diseases.
Additionally, an estimated 6.6 million infants who did receive their first dose of DTP-containing vaccine did not complete the full, three dose DTP immunization series (DTP3) in 2016. Since 2010, the percentage of children who received their full course of routine immunizations has stalled at 86 per cent (116.5 million infants), with no significant changes in any countries or regions during the past year. This falls short of the global immunization coverage target of 90 per cent.
WHO Director-General, Dr Tedros Adhanom Ghebreyesus, wrote in a commentary accompanying the paper in The Lancet Global Health: “Universal health coverage is ultimately a political choice. It is the responsibility of every country and national government to pursue it.”
The SDG Health Price Tag models two scenarios: an “ambitious” scenario in which investments are sufficient for countries to attain the health targets in the SDGs by 2030, and a “progress” scenario in which countries get two thirds or more of the way to the targets.
In both scenarios, health systems investments such as employing more health workers; building and operating new clinics, hospitals and laboratories; and buying medical equipment account for about 75 per cent of the total. The remaining costs are for medicines, vaccines, syringes and other commodities used to prevent or treat specific diseases, and for activities such as training, health campaigns and outreach to vulnerable communities.
Under the “ambitious” scenario, achieving the SDG health targets would require new investments increasing over time from an initial US$ 134 billion annually to $371 billion, or $58 per person, by 2030.
The analysis shows that 85 per cent of these costs can be met with domestic resources, although as many as 32 of the world’s poorest countries will face an annual gap of up to US$ 54 billion and will continue to need external assistance. High-income countries were not included in the analysis but other estimates show they can all afford to provide universal health coverage with essential health services to their citizens.
The ambitious scenario includes adding more than 23 million health workers, and building more than 415 000 new health facilities, 91 per cent of which would be primary health care centres.
These investments would boost health spending as a proportion of gross domestic product across all 67 countries from an average of 5.6 per cent to 7.5 per cent. The global average for health spending as a proportion of GDP is 9.9 per cent. Although higher spending does not necessarily translate to improved health, making the right investments at the right time can.
The investments could prevent 97 million premature deaths – one every five seconds over 15 years – including more than 50 million infants and children who are either stillborn or die before their fifth birthday, and 20 million deaths from non-communicable diseases such as cardiovascular disease, diabetes and cancer. Life expectancy would increase by between 3.1 and 8.4 years, and 535 million years of healthy living would be added across the 67 countries.
The “progress” scenario would require new investments increasing from an initial US$ 104 billion a year to $274 billion, or $41 per person, by 2030. These investments would prevent about 71 million premature deaths and boost health spending as a proportion of GDP to an average of 6.5 per cent. More than 14 million new health workers would be added, and nearly 378 000 new health facilities built, 93 per cent of which would be primary health care centres.
The analysis includes targets in Sustainable Development Goal 3 (health and well-being) as well as targets from Goal 2 (zero hunger), Goal 6 (clean water and sanitation) and Goal 7 (affordable and clean energy). Some targets and diseases were excluded because of the difficulty of estimating their associated costs and health impact, or a lack of robust data.
The SDG Health Price Tag does not prescribe what countries should spend on health, but is intended as a tool to inform further research. It also highlights that achieving universal health coverage and the other health targets requires not only funding but political will and respect for human rights.
WHO plans to update the estimates every five years and will include other health-related targets and diseases as more evidence becomes available.
Note to editors
The SDGs were adopted by the Member States of the United Nations in 2015 as the world’s to-do list for the next 15 years. They comprise 17 ambitious, interlinked goals and 169 targets for a healthier, safer and fairer world by 2030. While the SDGs are for all countries, the SDG Health Price Tag focused on 67 low- and middle-income countries that face the greatest challenges in terms of expanding health services.
The SDG Health Price Tag updates WHO estimates published in 2009 of the resources needed to strengthen health service delivery in low-income countries to reach the Millennium Development Goals.
Meanwhile, Director of Immunization, Vaccines and Biologicals at WHO, Dr. Jean-Marie Okwo-Bele, said: “Most of the children that remain un-immunized are the same ones missed by health systems.
“These children most likely have also not received any of the other basic health services. If we are to raise the bar on global immunization coverage, health services must reach the unreached. Every contact with the health system must be seen as an opportunity to immunize.”
Immunization currently prevents between two–three million deaths every year, from diphtheria, tetanus, whooping cough and measles. It is one of the most successful and cost-effective public health interventions.
According to the new data, 130 of the 194 WHO Member States have achieved and sustained at least 90 per cent coverage for DTP3 at the national level – one of the targets set out in the Global Vaccine Action Plan. However, an estimated 10 million additional infants need to be vaccinated in 64 countries, if all countries are to achieve at least 90 per cent coverage. Of these children, 7.3 million live in fragile or humanitarian settings, including countries affected by conflict. Four million of them also live in just three countries – Afghanistan, Nigeria and Pakistan – where access to routine immunization services is critical to achieving and sustaining polio eradication.
In 2016, eight countries had less than 50 per cent coverage with DTP3 in 2016, including Central African Republic, Chad, Equatorial Guinea, Nigeria, Somalia, South Sudan, Syrian Arab Republic and Ukraine.
Globally, 85 per cent of children have been vaccinated with the first dose of measles vaccine by their first birthday through routine health services, and 64 per cent with a second dose. Nevertheless, coverage levels remain well short of those required to prevent outbreaks, avert preventable deaths and achieve regional measles elimination goals.
152 countries now use rubella vaccines and global coverage increased from 35 per cent in 2010 to 47 per cent in 2016. This is a big step towards reducing the occurrence of congenital rubella syndrome, a devastating condition that results in hearing impairment, congenital heart defects and blindness, among other life-long disabilities.
Global coverage of more recently-recommended vaccines are yet to reach 50 per cent. These vaccines include vaccines against major killers of children such as rotavirus, a disease that causes severe childhood diarrhoea, and pneumonia. Vaccination against both these diseases has the potential to substantially reduce deaths of children under five years of age, a target of the SDGs.