Unveiling the Illusion: Assessing the Global Struggle to Achieve Sustainable Development Goal 3

I am continuing with my series of articles dedicated to the global dynamics in meeting SDGs and why they are not as useful and effective as they are portrayed. Today I am talking about SDG3 - Ensure healthy lives and promote well-being for all at all ages.

There are 13 targets in this goal; however, results are only shown for 6, indicating that no or negligible progress has been made on more than half of the other targets.

One of the targets of Sustainable Development Goal 3 is universal health coverage, but progress has been slow since 2015. See more information on that further in the article.

From then on, on the official SDGs website, results are shown only for:

Target 3.1: The global maternal mortality ratio decreased slightly from 227 maternal deaths per 100,000 live births in 2015 to 223 in 2020, still significantly above the 2030 target of 70 maternal deaths. To meet this target, the annual rate of reduction needs to increase dramatically.

Target 3.2: The global under-5 mortality rate and neonatal mortality rate have declined, but the pace is insufficient to meet the 2030 target in many countries.

Target 3.3: Progress in combating communicable diseases like HIV, TB, and malaria varies, with some areas showing improvement but others, like TB incidence, worsening recently.

Target 3.7: There has been a slight increase in the use of modern contraceptive methods among women of reproductive age, but the pace must accelerate to achieve universal access to sexual and reproductive healthcare services by 2030.

Target 3.b: Childhood vaccinations have seen a significant decline, impacting essential immunization coverage globally.

Target 3.c: Although there has been an increase in the health workforce globally, the density of health workers remains critically low in regions with the highest disease burdens, particularly in sub-Saharan Africa.

Meaning, that we are not improving on more than half of the targets of SDG 3 shows a failure in the distribution and implementation of priorities.

Let's look at the Millennium Development Goals (MDGs) that I already mentioned in my previous article about the first two SDGs. The picture is not ideal; some of the targets have not been achieved, but there has been a significant improvement with hundreds of thousands of lives saved.

Millennium Development Goal 4:

• Target 4.A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate. Globally, significant progress has been made in reducing mortality in children under 5 years of age. In 2013, 6.3 million children under 5 died, compared with 12.7 million in 1990. Between 1990 and 2013, under-5 mortality declined by 49%, from an estimated rate of 90 deaths per 1,000 live births to 46. The global rate of decline has also accelerated in recent years – from 1.2% per annum during 1990–1995 to 4.0% during 2005–2013. Despite this improvement, the world was unlikely to achieve the MDG target of a two-thirds reduction in 1990 mortality levels by 2015.

More countries achieved high levels of immunization coverage; in 2013, 66% of Member States reached at least 90% coverage. In 2013, global measles immunization coverage was 84% among children aged 12–23 months. During 2000–2013, estimated measles deaths decreased by 74% from 481,000 to 124,000.

Millennium Development Goal 5:

• Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. Since 1990, the maternal mortality ratio has been cut nearly in half, and most of the reduction occurred since 2000. More than 71 per cent of births were assisted by skilled health personnel globally in 2014, an increase from 59 per cent in 1990.
• Target 5.B: Achieve, by 2015, universal access to reproductive health. Despite a significant reduction in the number of maternal deaths—from an estimated 523,000 in 1990 to 289,000 in 2013—the rate of decline is less than half of what is needed to achieve the MDG target of a three-quarters reduction in the mortality ratio between 1990 and 2015.

To reduce the number of maternal deaths, women needed access to good-quality reproductive health care and effective interventions. In 2012, 64% of women aged 15–49 years who were married or in a consensual union were using some form of contraception, while 12% wanted to stop or postpone childbearing but were not using contraception. The proportion of women receiving antenatal care at least once during pregnancy was about 83% for the period 2007–2014, but for the recommended minimum of four or more visits, the corresponding figure drops to around 64%.

The proportion of births attended by skilled personnel—crucial for reducing perinatal, neonatal, and maternal deaths—is above 90% in three of the six WHO regions. However, increased coverage is needed in certain regions, such as the WHO African Region, where the figure was still only 51%.

Millennium Development Goal 6:

Targets 6.A, 6.B, and 6.C of the Millennium Development Goals (MDGs) aimed to combat HIV/AIDS, malaria, and other diseases by specific deadlines. Here's a concise summary of the progress made:

• Target 6.A (HIV/AIDS): By the end of 2013, approximately 12.9 million people globally were receiving antiretroviral therapy (ART), surpassing the target of placing 15 million people on ART by 2015. The decrease in new HIV infections, along with increased ART availability, contributed to a significant decline in HIV mortality levels, from 2.4 million in 2005 to an estimated 1.5 million in 2013.
• Target 6.B (Malaria): In 2013, an estimated 198 million cases of malaria occurred globally, leading to approximately 584,000 deaths, with most fatalities among children under 5 in Africa. However, the period from 2000 to 2013 witnessed a global decline in both malaria incidence and mortality rates among the population at risk by 30% and 47%, respectively. Interventions like insecticide-treated nets and indoor residual spraying have expanded, meeting the MDG target of halting malaria incidence by 2015.
• Target 6.C (Tuberculosis and Other Diseases): The global incidence of tuberculosis has been slowly declining, achieving the MDG target to reverse its spread by 2015. In 2013, there were an estimated 9 million new cases and 1.5 million deaths globally, with sustained treatment success rates at or above the target of 85%. Challenges remain, particularly with multi-drug resistant tuberculosis. Additionally, efforts to combat neglected tropical diseases have shown progress. Cases of diseases like human African trypanosomiasis and dracunculiasis have reached historic lows, and plans are in place to eliminate leprosy, visceral leishmaniasis, and lymphatic filariasis as public health problems by 2020, with significant reductions in incident cases recorded since the launch of respective programs.

Let's return to the SDGs and their results in the present time. In 2021, 4.5 billion people—more than half the world’s population—were not covered by essential health services, says a report from the World Health Organization and World Bank.

Since the Sustainable Development Goals were set in 2015, progress towards achieving universal health coverage (UHC), one of the targets set in Goal 3: Good Health and Well-being, has stagnated according to a new report "Tracking universal health coverage 2023 global monitoring report" from the World Health Organization (WHO) and the World Bank.

Trends in Global UHC Service Coverage:

Although the journey toward achieving Universal Health Coverage (UHC) has seen considerable progress from 2000 to 2021, as evidenced by the population-weighted global UHC Service Coverage Index (SCI) which increased from 45 to 68, a closer inspection of the progress post-2015 reveals a deceleration in the gains compared to the pre-2015 era. While the index saw an encouraging rise in the first 15 years, the period between 2015 and 2021 only witnessed a marginal increase of three index points. This slowdown is particularly notable in the context of the Sustainable Development Goals (SDGs), which aim for substantial improvements across various health indicators.

The COVID-19 pandemic further complicated the global health landscape, exerting unprecedented pressures on health systems worldwide. Despite the overall stagnation of the UHC Service Coverage Index (SCI) on a global scale during the pandemic, the impact varied significantly across different regions and countries. Some regions reported acute disruptions in the coverage of essential health services throughout 2020 and 2021. However, due to the relatively short duration of these disruptions, they were not consistently captured in the annual estimations of the SCI, complicating efforts to fully assess the pandemic's impact.

Key Insights from the first part:

• Data Timeline: Observations for the years 2000, 2015, and 2019 provide a timeline that illustrates the transition from the MDG to the SDG era.
• Improvements During MDGs: There was a notable rise in the UHC Service Coverage Index during the MDGs, signalling enhanced accessibility and quality of health services.
• Stagnation in SDGs: Post-2015, the rate of improvement in health service coverage has noticeably slowed. Moreover, the proportion of the population experiencing catastrophic health spending has risen, indicating an increase in financial hardship due to health expenses.
• MDG vs. SDG Performance: The graphical analysis from the report demonstrates that during the MDGs, there was a clear upward trajectory in improving health service coverage, with an approximate annual increase of 1.4%. However, during the SDGs, this progress has stalled significantly, with an increase of only about 1.5-2% over four years (0,4-0,5% annually), roughly 3.5 to 3.7 times slower than during the MDGs.

Moving forward to the next category of Global Health Measurement. The '2023 UHC Global Monitoring Report', serves as a critical barometer for the state of global health, focusing on two pivotal SDG indicators from 2000 onwards for 138 countries:

What's Happening: The cold, hard truth is only 42 countries managed to make the picture look good—they made health services better and kept health costs from slamming families. But, for most countries, the news isn't so great. Since the world kicked off the SDGs in 2015, many countries haven't really moved up the chart. They're stuck or even losing ground, which is a big worry because it means despite all the big plans, getting good health services to everyone and keeping costs fair is still a massive challenge. This implies that 96 countries either experienced worsening conditions or no significant change in either health service coverage, catastrophic health spending, or both.

Therefore, the report takes a closer look at the slice of the global population that isn't getting the essential health services they need. When you translate the UHC SCI scores to reflect the percentage of people receiving essential health services, the numbers begin to tell a story. (See the Fig. 1.4 in the report summary)

From the year 2000 to 2021, there's been a decrease of about 15% in the number of people not covered by these vital health services, which sounds like good news. However, zoom in on the timeline. You'll see that the line depicting this improvement begins to flatten out post-2015—that's when the Sustainable Development Goals (SDGs) took the steering wheel from the Millennium Development Goals (MDGs).

What does a flatter line mean? Simply put, it shows that the progress made under the MDGs started to lose its momentum once the SDGs came into play.

To sum up, here is the succinct data representation:

Categories That Worsened After SDGs:

• Catastrophic Out-of-Pocket Health Spending (SDG 3.8.2): The global percentage of people living in households spending more than 10% of their household budget on health expenses has continuously increased, reflecting a deterioration in financial protection.
• Financial Hardship Due to Health Spending: The number of people facing financial hardship due to health spending increased, particularly those affected by catastrophic health spending.
• Rate of Progress in Health Service Coverage: Progress in expanding health service coverage has significantly slowed or stagnated since the SDGs were introduced, with very few countries continuing to see improvements akin to the MDG era.

Categories That Stayed Stable or Did Not Change Significantly After SDGs:

• Impoverishing Health Spending at the Extreme Poverty Line: Despite an overall decrease from 2000 to 2019, the rate of reduction in impoverishing health spending at this poverty line has remained steady post-2015, not showing significant change.
• UHC Service Coverage Index (SDG 3.8.1): While there was a slight increase post-2015, the overall global index showed very limited improvement, suggesting a near stagnation in the expansion of essential health services.
• Access to Essential Health Services: The proportion of the global population not covered by essential health services saw only minimal, much slower progress after 2015, indicating a stagnation in expanding access.
• Impoverishing Health Spending at the Relative Poverty Line: Increased from 11.8% in 2000 to 16.7% in 2019, indicating more people are experiencing financial hardship above the extreme poverty line. However, by doing some math we can see that the percentage of increase has slowed by 15% from SDG takeover.

This detailed assessment paints a stark picture of the current challenges in meeting the health-related SDGs. While the early years of the SDGs showed some promise, recent years have highlighted the need for renewed focus (or abolishment of half of the targets?) and increased efforts to re-focus our efforts on targets that are working and provide benefits for society.

1.?https://sdgs.un.org/goals/goal3#progress_and_info

2.?https://www.who.int/news-room/fact-sheets/detail/millennium-development-goals-(mdgs)

3.?https://thedocs.worldbank.org/en/doc/274691605003514448-0050022020/original/12ISSMEASURINGPROGRESSINSDG3HEALTH.pdf

4.?https://www.un.org/millenniumgoals/maternal.shtml#:~:text=Target%205.,the%20reduction%20occurred%20since%202000.