SDG 3 – Good Health and Well-Being

In addition to medical care, a healthcare system also includes specialised staff, medical goods and technologies, information, communication and management systems as well as financing and control.

On behalf of the German Federal Government, KfW Development Bank is helping partner countries to modernise their existing health facilities and build new ones. It is also about ensuring that logistical processes operate effectively and cold chains can be maintained, for example to transport and store vaccines and other medical products and consumables safely and quickly. Laboratories must be comprehensively equipped in order to be able to diagnose human and animal diseases safely and at an early stage. This is the first step towards appropriate treatment for patients and a realistic assessment of disease burden and potential epidemics.

Advancing digitalisation is a prerequisite for better and more efficient care. It enables access to information, products, services and expertise, e.g. through online platforms. KfW also promotes the use of telemedicine or electronic vouchers. In this way, healthcare provision can be noticeably improved, especially in remote areas and crisis regions.

The supply of vaccines against COVID-19 was extremely unevenly distributed globally. African countries in particular – partly because they lacked their own production capacities – had hardly any opportunities to protect their populations through vaccination. Since the lack of pharmaceutical production is a fundamental problem in Africa, KfW is supporting the development of local vaccine production and the pharmaceutical sector in three countries: South Africa, Senegal and Rwanda.

Now that attention for COVID-19 has decreased, the focus is shifting to the already known and still challenging infectious diseases. KfW supports its partners in preventing their spread. For instance, in collaboration with the Bernhard Nocht Institute for Tropical Medicine in Hamburg, early warning system for epidemics and pandemics are being set up in the six partner states of the East African Community. The Community's network of mobile laboratories have already been used to control outbreaks of Ebola, dengue, COVID-19 and, most recently, Tanzania's response to the Marburg virus.

Those suffering from both poverty and ill health have no voice and, crucially, no purchasing power. This is why most pharmaceutical companies do very little to incorporate poverty-related diseases into their research and development. Since 2012, KfW has been involved in investing in a number of funds that promote research and development into such diseases on behalf of the German Federal Government, including the Global Health Investment Fund, the successor, the Adjuvant Global Health Technology Fund, and the Women's and Children's Health Technology Fund. In addition, various product development partnerships are funded for the research and development of pharmaceutical products and their market launch for poverty-related diseases.

Chronic diseases are no longer limited to rich industrialised countries. They are spreading worldwide; 80% of these non-communicable diseases now occur in emerging and developing countries, where they cause 73% of all related deaths. These include metabolic, respiratory, cardiovascular diseases, mental disorders and cancer. Chronic diseases lead to high economic costs, for example through production losses, but also through expenditure on diagnostics and treatment.

The care of chronically ill people often requires lifelong care, medication and services. In rural areas and fragile contexts, however, there is often a lack of diagnostic equipment, medicines and expertise; in addition, hospitals in developing countries often concentrate on treating infectious diseases.

In Cambodia, for example, KfW is participating in a national health fund to provide social protection for those affected by chronic diseases. This enables the Asian country's public healthcare system to cover services for the poor, for example in the treatment of high blood pressure, diabetes and cervical cancer.

Health needs to be affordable. According to World Bank estimates from the end of 2024, almost 2 billion people have fallen into financial hardship due to the high cost of healthcare. This is a vicious circle, as poverty in turn increases the risk of falling ill.

As a result, the aim of development cooperation is to help partner countries move towards universal health coverage (UHC). All people should have access to necessary healthcare services without becoming impoverished as a result. The basic prerequisites for this are the provision of adequate health services and a stable system for funding them. For this reason, KfW is assisting its partner countries with developing a sustainable and properly funded healthcare sector. This can either be done via results-based and demand-orientated financing or within the framework of programme-based approaches. KfW also supports the establishment and expansion of health insurance and other types of insurance in the event of illness. Involving private service providers in this process can prove effective, as in some contexts this enables more poor people to receive important medical services.

In Tanzania, more than one million women and their babies have been insured through a KfW-supported project. This has enabled them to receive professional care before, during and after childbirth. More than a thousand healthcare facilities have been able to improve their performance by participating in the project. The approach is currently being extended from women and children to the entire population and supplemented with IT components to increase efficiency. In Pakistan, KfW is supporting the Social Health Protection Initiative (SHPI) on behalf of the BMZ, which helps poorer sections of the population to access high-quality healthcare without falling into even deeper poverty as a result of high healthcare expenditure.

Although significant progress has been made in recent decades in terms of sexual and reproductive health and rights (SRHR), which are an integral part of the SDGs, major challenges to gender equality still remain. For example, almost 260 million of women worldwide cannot use contraception, even though they wish to do so, and lack access to modern methods of family planning. As a result, more than 21 million girls aged 15 to 19 become pregnant every year – and every two minutes, a woman dies during pregnancy or childbirth. Globally, almost 50% of all pregnancies are unplanned.

Over the years, KfW has developed a wide range of support measures and bespoke solutions to these challenges. Its approaches to improving perinatal care, modern family planning, education and youth services also help to enhance autonomy and gender equality. In the family planning field, strategies have proven successful in which the strengths of the private sector – such as reliable supply chains and marketing and communication methods – complement government services in a targeted manner, thus improving demand and supply nationwide and for all population groups equally. For example, this may involve advertising contraceptives and health services. KfW is already supporting this approach in seven countries including Nigeria and Côte d’Ivoire, as well as through regional projects.

In Kenya and South Africa, young people can use their smartphones to earn bonus points when using reproductive health services, which they can then redeem in local shops.

Voucher programmes have proven to be an effective method of reaching socially vulnerable groups. Vouchers are distributed in a targeted manner or sold at heavily subsidised prices. They give poor women access to professionally supervised births, expensive long-acting family planning methods such as IUDs or hormone implants or the use of pre- and post-natal care for mothers and newborns. However, it is also important to expand modern infrastructure for mothers and children as well as providing the necessary equipment – especially against the backdrop of population growth.