The “Sustainable Development Goals (SDGs) Health Price Tag”, published recently in The Lancet Global Health, has provided some useful information in relation to 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.
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.
According to the report’s summary, the analysis shows that investments to expand services towards universal health coverage and the other 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.
The report’s summary explains that 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.
The report explains that in both scenarios, investing in 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.
According to the World Health Organisation (WHO), under the “ambitious” scenario, achieving the SDG health targets would require new investments increasing over time from an initial US$134 billion annually to US$371 billion, or US$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.
The “progress” scenario would require new investments increasing from an initial US$104 billion a year to US$274 billion, or US$41 per person, by 2030. These investments would prevent about 71 million premature deaths and boost health spending as a proportion of Gross Domestic Product (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, according to the report’s summary.
Delivering adequate health care and providing the key elements of Universal Health Care (UHC) to all has always been a challenge for developing countries with limited resources and underdeveloped systems. The “SDG Health Price Tag” does not prescribe what countries should spend on health, but is intended as a tool to inform further research.
Public Health Minister Volda Lawrence, at a round-table discussion on sustainable financing of UHC, earlier this year, had recommended that stronger efforts be made by developing countries to revise financing at national levels, so that health could be positioned as a top priority for funding. At the forum, she pressed the need for targeted allocation of resources to address the growing shortage of health workers. She had also noted the need for management of resources in both the public and private health sectors efficiently, as countries move towards achieving the goal of UHC by 2030.
As stated by Lawrence, it is known that creating awareness with regard to social determinants of health, promoting health at all levels of the community; ensuring that healthy public policies are in place; and developing and implementing innovative approaches that work, along with a public/private mix that address the high-end needs can arrest the escalating demands faced by countries.
That said, achieving universal health coverage and the other health targets requires not only funding but political will. We support the view of Dr Tedros Adhanom Ghebreyesus, WHO Director General, who stated that “UHC is ultimately a political choice. It is the responsibility of every country and national government to pursue it”.
