SDG 3 – Good Health and Well-Being

The coronavirus pandemic showed only too clearly how inadequate the healthcare systems in many developing countries are. Hospitals and test laboratories were overwhelmed. As well as infrastructure, healthcare systems include many other aspects such as staffing, medical supplies and information systems, as well as financing and logistics.

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. Laboratories must be fully equipped so that they can reliably detect coronaviruses and other pathogens like tuberculosis and its resistant strains. This is the first step towards appropriate treatment for patients and a realistic assessment of disease burden and potential epidemics.

And with the advance of digital technology, online platforms are more readily available so that even remote regions can access specialist knowledge. This is why telemedicine is one of the solutions promoted by KfW. Telemedicine can noticeably improve healthcare, especially in remote areas and crisis-struck regions.

As part of its rapid response to COVID-19, KfW is promoting the construction of new hospitals and expansion of existing hospitals, particularly with a view to increasing ventilator capacity. With respect to new hospitals, KfW is focusing on sustainability. In the longer term, resources will be used for buildings, technology and processes under the umbrella of “green hospitals”, for example in Serbia. Sustainable use of the new infrastructure also requires adequate funding, regular maintenance, and a sufficiently large, skilled and qualified workforce.

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 in three countries: South Africa, Senegal and Rwanda.

Now that the focus on COVID-19 has diminished again, the existing and still challenging infectious diseases are coming back into focus. 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 have long since ceased to be “diseases of affluence”. The diseases widespread in industrialised countries are becoming more and more prevalent all over the world, with 80% of these non-communicable diseases now occurring in emerging and developing countries. They cause 74% of all deaths worldwide. The changing lifestyles and eating habits brought about by industrialisation and urbanisation are contributing factors to the increasing levels of diabetes, respiratory and cardiovascular diseases, mental illnesses and cancer. Climate change is also having an increasingly important impact on human health in this context. Chronic diseases incur a high economic cost; for instance, due to production downtimes as well as expenditure on diagnostics and treatment.

This is because chronically ill patients often require lifelong care, medication and services. In rural areas and fragile conditions, these are often unavailable. Hospitals in developing countries often focus on the treatment of infectious diseases. They lack the diagnostic equipment and knowledge to identify non-communicable diseases as well as the drugs to treat them.

KfW is therefore participating in a national health fund to provide a safety net for those affected by chronic diseases in Cambodia(PDF, 136 KB, non-accessible), for example. With assistance from the fund, the Asian country’s public healthcare system can cover services for the poor, providing treatment for medical conditions such as high blood pressure, diabetes and cervical cancer.

Health needs to be affordable. At the individual level, diseases – whether acute or chronic – cause more than suffering. In many cases, they also impose a huge financial burden, which often plunges entire families into poverty. Every year, around 100 million people are impoverished due to the costs associated with medication or medical care. This is a vicious circle because poverty, in turn, increases the risk of becoming ill.

As a result, the aim of development cooperation is to help partner countries move towards universal health coverage (UHC). This involves giving more and more people access to the necessary services without them falling into financial hardship. 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 has proven to be effective in bringing important medical services to more people living in poverty.

In Tanzania, for example, more than 1 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.

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 (roughly 13%) 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. The situation is particularly grave in the poorest and most fragile countries, and universal access to the relevant information, products and services is a long way off. Globally, 50% of all pregnancies are unplanned.

During its many years of activity, KfW has developed a wide range of support measures and bespoke solutions for these issues. 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 that combine the strengths of the private sector (in terms of reliable supply chains, for example) with marketing and communication methods have proven to be successful, consequently improving both supply and demand. 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.

Many of those involved in providing these private services are women. In Pakistan, for example, trained midwives operate small healthcare facilities. KfW is helping them to improve their business skills and quality management. In Kenya and South Africa, young people can earn bonus points from 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. These vouchers are distributed in a targeted manner or sold at heavily subsidised prices so that poor women can receive services such as professionally attended births or long-acting family planning methods such as IUDs or hormone implants, as well as ensuring that mothers and newborn babies can receive prenatal and postnatal care. 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.