In the aftermath of the COVID-19 pandemic many countries lack sufficient funds to attain the targets of Sustainable Development Goal 3 (SDG3). Therefore, it is high time to revisit the financing goal for a solidarity-based international contribution for health set in 2001. A new calculation is needed.
The COVID-19 pandemic not only triggered an unprecedented health crisis but also caused USD 13.8 trillion in economic damage, making it the most significant global economic crisis in a century. To address the health challenges and economic fallout, many countries incurred significant debt, compounding issues for those with already low incomes.
Post-pandemic, the situation has worsened “starting with supply-chain disruptions in the aftermath of the pandemic, a Russian-initiated war on Ukraine that triggered a global energy and food crisis, and a considerable surge in inflation, followed by a globally synchronized monetary policy tightening”. Low- and middle-income countries (LMICs), in particular, face severe challenges in meeting SDG3 targets by 2030, highlighting the need for increased health investments to build health systems resilient against future threats.
That is why the SDG-Monitoring Report finds that “…increased investment in health systems is needed to support countries in their recovery and build resilience against future health threats.” But can we know the financial amounts needed to successfully fund the accomplishment of SDG3 and its targets? To better understand this question, we must look back because a target for solidarity-based international health financing was indeed calculated more than 20 years ago, at the start of the MDG era.
Back in 2001, a WHO commission recommended OECD-DAC countries allocate 0.1% of their annual national economic output to support health in LMICs, but this target is utterly outdated. Neither the COVID-19 pandemic nor the broader SDG agenda established in 2015 were considered at the time. With the end of the global COVID-19 emergency in May 2023, it is essential to recalibrate this figure to reflect current realities. Even more so as the accelerating climate crisis is already having profound negative effects on global health and health care systems due to geographically expanding vector-borne infectious diseases and the growing frequency and severity of catastrophic natural disasters.
It is crucial that we recognize and address these challenges as part of the broader conversation on health-specific funding needs. Thus, WHO should be mandated to estimate the costs of achieving SDG3 globally, assessing how much each country can provide and identifying funding gaps for LMICs. High-income countries (HICs) should contribute to closing these gaps, with a newly calculated target ideally anchored at the UN level to ensure consistent implementation – as was the case with the United Nations ODA target of 0.7 percent. In the long-term, the recommended level of financial support should be regularly reviewed and adjusted depending on future developments.
A revised recommendation would bolster efforts to achieve SDG3, foster resilience against future pandemics, mitigate health impacts of climate change, and reduce global health inequities. It could also set a precedent for other SDGs, highlighting the interconnections between health (SDG3) and goals like poverty reduction (SDG1), education (SDG4), and gender equality (SDG5).
In the health sector, key organizations like Gavi, the Global Fund, and the Pandemic Fund are preparing for replenishment rounds in 2024 and 2025. WHO has launched an investment round seeking USD 7.1 billion, of which only USD 1.7 billion has been secured. Furthermore, the replenishments for the World Bank’s International Development Association (IDA) and the regional development banks are also on the agenda, with the IDA recently receiving donor commitments in the amount of 24 billion US dollars. Meanwhile, donor countries like Germany, France, and Sweden are cutting official development assistance (ODA), and the potential return of Donald Trump to the U.S. presidency could further reduce the largest donor country’s contributions. Amid this “replenishment crunch” and shrinking donor aid, it is critical to have a clear estimate of the total funding needed for SDG3 and the contributions required from HICs.
The world currently acts like a homeowner ignoring cracks in their foundation, avoiding the uncomfortable truth of necessary repairs. This denial is dangerous, as the system risks collapsing. Establishing a clear financial baseline will enable informed policymaking and better planning. Entering post-SDG deliberations with a rational understanding of funding gaps will make discussions more focused and productive.
Increased ODA for health must rest on a solid foundation. A recalculated target would remind donor countries of their obligations, while emphasizing the life-saving potential of adequate funding for SDG3. Steps to achieve this include initiating formal consultations among WHO member states and securing support from groups like the G7, G20, and UN organizations. A UN General Assembly resolution could mandate WHO to lead the recalculation, providing political legitimacy and ensuring results are widely adopted. Collaborations with the World Bank, IMF, and OECD would also be essential to develop realistic methodologies for assessing financial responsibilities and possibilities of both HICs and LMICs.
This approach is vital not only for achieving SDG3 but also for saving millions of lives, addressing health inequities, and enhancing resilience against pandemics and climate change. Sustainable health systems, universal health coverage, and global health equity depend on adequate funding. Because ultimately, we must remember that although sufficient financing contributions alone will not achieve the health-specific development goal and its targets, without the necessary funding SDG3 will be unattainable.
The proposal to update the 0,1% recommendation was developed in a position paper by the health working group of VENRO, the umbrella organisation of development and humanitarian NGOs in Germany (The position paper also emphasized the need for fair tax systems and a fair debt relief policy). The authors are part of this working group.