Goal 3: Good Health and well-being
As reflected in the 2030 Agenda for Sustainable Development, health and development are inextricably linked. Healthy people are fundamental for happy, secure and prosperous societies. Between 2000 and 2011, improvements in health and healthcare helped to increase income growth by an estimated 24 percent across some of the world’s low-income and middle-income countries. The reverse is also true; more equitable societies are healthier ones. UNDP’s HIV, Health and Development Strategy 2016-2021 recognizes that health is both a driver and an outcome of sustainable development.
Achieving SDG 3 means ending AIDS, tuberculosis (TB), malaria, neglected tropical diseases (NTDs), and otherwise making the world safe from pandemic threats. It means ending preventable child deaths and ensuring that women have full access to sexual and reproductive healthcare. It means tackling the rapid rise of cancers, diabetes, heart disease and other non-communicable diseases (NCDs), strengthening implementation of the WHO Framework Convention on Tobacco Control, and addressing how the health of people and the planet intersect. SDG 3 also envisages the achievement of ambitious commitments to achieve universal health coverage (UHC), provide access to safe and affordable medicines and vaccines for all and to strengthen health systems.
Despite significant progress, much work remains to be done to achieve good health and well-being for all. In 2015 there were a quarter of a million new HIV infections among adolescents worldwide, two-thirds of which were among adolescent girls. Sub-Saharan Africa in particular remains devastated by the HIV epidemic. NTDs—such as leishmaniasis, Chagas, onchocerciasis and schistosomiasis—predominantly affect the world’s poorest and persist in part because of insufficient investment in research and development of new health technologies. More than six million children still die before their fifth birthday every year, many from diseases such as measles and TB, for which there are cost-effective solutions. Meanwhile, NCDs are expected to cost low- and middle-income countries more than US$ 20 trillion from 2011 to 2030 as a result of direct health costs and lost productive capacities. The cost of some medicines, vaccines and diagnostics renders them inaccessible to large segments of the population, in rich and poor countries alike. Anti-microbial resistance is a serious and growing threat and disruption of the planet’s natural ecosystems contributes to health emergencies such as Ebola and Zika.
Key to achieving and sustaining good health and well-being is an enabling legal, policy and regulatory environment. It is vital that governments work actively to improve the conditions in which people are born, grow, live, work and age; that stigma and discrimination are addressed at all levels; and that any conflicts between the right to health and commercial interests are managed. One way to accelerate health and development progress is to ensure adequate social protection and UHC. Each year 100 million people worldwide are driven into poverty by out-of-pocket health spending. UNDP’s Strategic Plan 2018-2021 recognizes that health shocks and catastrophic health expenditures impede poverty eradication efforts; it commits to supporting countries to scale up access to basic service, including health.
Financing good health and well-being
Transforming health systems to achieve the SDG 3 targets is estimated to require an additional US$371 billion per year by 2030, for 67 low- and middle-income countries (LMICs), which make up 95 percent of the total population in LMICs. Many of these countries, particularly middle-income countries, have the capacity to self-finance the needed investment. However, even with projected increases in domestic health spending, a US$20-US$54 billion annual funding gap would remain. This underscores the continued importance of international financial assistance, alongside domestic resource mobilization, as well as the need to pursue new approaches which increase efficiencies, reduce waste and unlock private capital. Blended financing, for example, can increase private sector investment in cutting-edge health solutions while supporting countries in the transition from traditional aid to nationally-funded health programmes and systems.
Increasing domestic funding for health is the most critical means of financing Goal 3. For instance, low-income countries in Africa undertook to increase health expenditures to 15 percent of government spending as agreed under the Abuja Declaration in 2001, yet few have achieved this to date. Diversifying sources of funding through taxes or compulsory national insurance are effective ways of raising needed revenue, while pooling and sharing the cost of healthcare across the population. The Addis Ababa Action Agenda on Financing for Development recognizes that taxes on tobacco “can be an effective and important means to reduce tobacco consumption and health-care costs, and represent a revenue stream for financing for development in many countries.” Such strategies often hinge on effective multi-sectoral governance and the development of national financing frameworks, which UNDP supports in partnership with WHO.
Many countries, especially least developed countries (LDCs), will continue to rely upon international financial assistance to reach the health-related SDGs. Such resources are available through philanthropic foundations with a strong focus on health such as the Bill and Melinda Gates Foundation, alongside traditional ODA providers and NGOs. The International Finance Facility for Immunization (IFFIm) demonstrates how donor funds are being used to leverage larger-scale private finance for health through sales of “vaccine bonds”. Other important funds include the Global Fund to Fight AIDS, Tuberculosis and Malaria, GAVI (the Vaccine Alliance) and the new Global Financing Facility for Women, Children and Adolescents’ Health (the GFF). UNDP’s partnership with the Global Fund has saved 3.1 million lives to date.
Innovations in public-private partnerships offer unique opportunities for health financing. In partnership with GAVI, UNDP is supporting India’s Ministry of Health and Family Welfare to roll out an innovative mobile application that provides real-time information on vaccine stocks. This work supports India’s progress towards universal vaccine coverage by increasing efficiency, reducing waste and saving money. Another example is UNDP’s Solar for Health initiative, which assists national governments to work with communities, local authorities and industry to increase access to quality health services by equipping health centres with solar panels. Such efforts ensure sustainable access to basic electricity, eliminate the use of less reliable and environmentally harmful energy sources and provide private sector partners with a socially conscious investment opportunity. Other powerful innovations include the use of social impact bonds for health, for example in the area of maternal and newborn health, and encouraging the private sector to support the health of its workers directly. This would not only enhance profits through a more productive workforce but also fill gaps in public service coverage.
Financing SDG 3 will depend on other ways to increase efficiencies, including in existing resource allocation. Around 20—40 percent of current health spending is “wasted”, for example through the use of expensive medicines where cheaper, equally effective options are available. High-value interventions that can advance multiple SDG targets, across different sectors, should be costed and co-financed accordingly. More broadly, the SDGs require identifying and implementing financing policies that advance health and development together, as an investment that will enhance human capital and contribute across the 2030 Agenda.
Financing Solutions for SDG 3
The solutions listed below provide a wide range of finance options to significantly increase resources to promote good health and wellbeing. These options do not however constitute an exhaustive or comprehensive list of financing options for SDG 3.
Systematic search for biochemical and genetic information in nature in order to develop commercially-valuable products and applications.
Approach for projects, organizations, entrepreneurs, and startups to raise money for their causes from multiple individual donors or investors.
Legal entity and investment vehicle to help mobilizing, blending, and overseeing the collection and allocation of financial resources for environmental purposes.
Investments made with the intention to generate a measurable social and environmental impact alongside a financial return.
Governments and civil society use lotteries to raise funds for benevolent purposes such as education, health, and nature conservation.
Payments for ecosystem services (PES) occur when a beneficiary or user of an ecosystem service makes a direct or indirect payment to the provider of that service.
Private unrequited transfers sent from abroad to families and communities in a worker's country of origin.
A public-private partnership that allows private (impact) investors to upfront capital for public projects that deliver social and environmental outcomes in exchange for a financial interest.
The sale tax any individual or firm who purchases fuel for his/her automobile or home heating pays. Fuel taxes can reduce the consumption of fossil fuels and greenhouse gas emissions while generating public revenues.
Taxes on certain pesticides and chemical fertilizers can mobilize fiscal revenues while mitigating the negative effects associated with pesticide/fertilizers application and promoting sustainable agriculture practices.
Excise taxes on tobacco products can raise fiscal revenues, improve health and well-being, and address market failures.
Standards applicable to the financial sector that capture good practices and encourage the achievement and monitoring of social and environmental outcomes.