Nothing about us without us

The world’s children are facing deadly consequences from fragmented and failing health systems and a world at high risk of failing to meet SDG3: the right to Health For All. Only accelerated, concerted efforts can help

We are already at the halfway point to implementing the Sustainable Development Goals, and yet children across the world continue to face a multitude of crises. Those most affected by inequality and discrimination are disproportionately suffering from the debilitating consequences of continued conflict, economic instability and a deepening climate emergency.

SDG3 – the right to Health For All – builds on the adoption of the Universal Declaration of Human Rights by United Nations members 75 years ago and aims to achieve universal health coverage by 2030. Regrettably we are at very high risk of failing to reach this goal.

Not only is progress too slow, but we are also observing the reversal of some of the great gains made in recent decades in improving children’s health, nutrition and well-being. Globally, one in every 23 people needs humanitarian assistance to survive. Less than 20% of the humanitarian funding required to ensure children and communities can access life-saving health care is available. Healthcare workers take enormous risks to care for populations experiencing crisis, and routine health services including immunisation are far too often subject to disruption. Inequitable access to basic health and nutrition services makes achieving universal health coverage a far-off reality unless urgent efforts are undertaken to systematically address the challenges identified.

Health workers continue to face significant obstacles in reaching the most vulnerable children and communities. Weak health infrastructure means people and facilities are often far apart, and investment in supporting, training and retaining our health workforce is often lacking – yet health workers persevere under difficult circumstances. The global community must honour this dedication, and likewise go the last mile in delivering on commitments to achieve the right to Health For All.

A critical year

This year, 2023, is a critical one in this journey – as you read this, the second High Level Meeting for Universal Health Coverage will have taken place at the UN General Assembly in New York. We know that delivering on universal health coverage is essential for ending preventable childhood deaths and ensuring well-being so that children can thrive. Each year, more than 5 million children die before their fifth birthday from preventable and treatable causes, many of which result from a lack of access to affordable health, nutrition and sanitation. In 2021, 25 million children missed out entirely on routine vaccinations, a figure that is slowly recovering – 4 million more children were reached last year but 20.5 million children still missed out in 2022. Catching up on immunisations, building support for breastfeeding and addressing the 80% of malnourished children who lack access to treatment would go a long way in addressing these shortfalls and limit the 50% of under-five deaths attributable to malnutrition.

Achieving Health For All is complex in crisis contexts with collapsing or overwhelmed health systems – where the concept of achieving universal health coverage remains a distant vision. Save the Children sees this reality daily. As part of our efforts to support SDG3, we partner with health ministries, healthcare professionals and community-based health workers so that children can access primary health care. In countries around the world, our colleagues are supporting the expansion of immunisation campaigns in hard-to-reach locations, training community health workers and supporting health facilities to provide essential services that meet the specific needs of children.

Children have the right to survive, to thrive and to be protected. Yet in this perfect storm of multiple crises it has become increasingly difficult to address their immediate needs at the same time as investing in people, systems and structures that will protect against future shocks. The solutions are known, but access to health care remains a political choice – and requires leaders to sacrifice short-term political gain to achieve better outcomes for children.

Investing in primary health care

Major causes of child mortality can be addressed at the local level by working with communities, including community health workers. Promoting and implementing a comprehensive – and integrated – package of services across health, nutrition and water, sanitation and health can avert the deaths of millions of children each year. Primary health care is our biggest silver bullet – and yet implementing it remains a big challenge, due to high costs often paid directly by patients that put it further out of reach for the poorest families. 

So what does a resilient national health system that prioritises primary health care look like?

• It provides a comprehensive package of health and nutrition services that is available to all.
• It strengthens the health and care workforce by ensuring safe working environments and fair pay – which is, sadly, currently lacking.
• It invests in emergency preparedness and risk reduction strategies so that health systems can sense, prepare, react, adapt and learn.
• It builds child-sensitive social protection systems that are resilient and responsive to crises such as conflict, economic shocks, climate-related shocks or global health emergencies.

Grounding global processes

The world is vastly unequal, and the inclusion of under-represented voices is important – civil society, including children, can and must play a critical role in addressing health as a political choice. Progress at the global level can only be achieved if all of us enable and prioritise investment in national systems.

Rebeca, 18, who travelled from El Salvador to Geneva earlier this year, told member states at the World Health Assembly: “There are currently around 1.3 billion young people between the ages of 12 and 24 in the world, representing 16% of the world’s population, and our participation in efforts to achieve sustainable development is fundamental to achieving inclusive, democratic and just societies. Therefore, nothing about us without us.”

Governments, donors, international financial institutions, civil society and the private sector are all promising to invest in health systems, and deliver on universal health coverage, but these efforts must be accelerated. We must work better together if we are to meet our 2030 goals.

With an estimated 100 million people pushed into poverty each year due to healthcare costs, and only one in four children globally receiving some form of social protection benefit, we must not fail the world’s children.