World leaders gathering in New York this week could set the course of human health for a generation
The promise of health for all
September 18, 2023
At the UN General Assembly, through the High-Level Meetings on pandemics, tuberculosis (TB) and universal health coverage and gatherings to advance the Sustainable Development Goals (SDGs), climate action and development financing, leaders have an opportunity to address crises threatening people and planet.
These crises are interconnected, with health at the centre. Extreme poverty rose for the first time in a generation after COVID-19, with women bearing the brunt of job losses during the pandemic. Even as COVID-19 appears to recede for some, it continues to have damaging effects on health responses, while conflict and climate-driven infectious diseases like malaria threaten more people and increase epidemic risks.
Absent ambitious acceleration, the world will miss the health-related SDG targets and be even more inadequately prepared for future pandemics.
Keeping the promise of the SDGs—including health for all—requires building health systems that leave no one behind and reach the furthest behind first.
When health programmes and policies are guided by science, equity and access for all, we can end pandemics—today and tomorrow.
Our experience responding to HIV and TB through UNDP’s partnership with the Global Fund provides valuable lessons. In Angola, Cuba and Sudan, health programmes aim to improve equitable access to innovations and care and build resilient and sustainable health systems that help mitigate risk and respond to pandemics, the climate crisis and other development challenges.
Innovations in HIV testing
Progress against HIV is still uneven worldwide. In Cuba, new infections have declined by 13 percent since 2010, but increased to almost 6 percent for men who have sex with men and nearly 20 percent for transgender people in 2017. And nearly a third of people living with HIV countrywide are not receiving treatment, which saves lives and prevents new infections.
Accessing treatment starts with people knowing if they have HIV. In 2022, an estimated quarter of people living with HIV in Cuba did not know their status. Closing this gap requires ready access to testing, including among transgender people and men who have sex with men who may be deterred from accessing services because of HIV-related stigma and discrimination.
In October 2022, UNDP and Cuba’s Ministry of Public Health rolled out HIV self-testing for transgender people and men who have sex with men through 30 clinics in Havana and main provincial cities. Self-testing is fast and private, enabling people who may have delayed testing due to fear of stigma and discrimination to access other HIV services sooner.
Beyond clinics, UNDP supports the MSM-Cuba Network and TransCuba Network to provide counselling and sexual health services, including rapid HIV testing. The NGOs conduct outreach in social spaces, such as parties and community centres, to encourage HIV testing, prevention and treatment. Since the COVID-19 pandemic, MSM-Cuba Network has offered rapid testing from its leaders' homes to protect confidentiality and increase access.
In 2022, over 43,000 men who have sex with men and 1,010 transgender women accessed HIV testing through the two organizations, reaching 15 percent and 28 percent of their estimated populations, respectively. Increased testing is enabling more people to access treatment and prevention services, which reached 88 percent of men who have sex with men living with HIV and 92 percent of transgender people living with HIV in 2022.
MSM-Cuba Network is now piloting HIV self-testing at Havana’s Prosalud health unit to further promote community-led approaches. Self-testing's privacy and convenience could reach more partners of people living with HIV and other contacts who do not frequent clinics.
Following WHO recommendations, self-testing will be offered countrywide through clinics and key population-led organizations in 2024. This approach empowers affected communities and community networks to prevent the spread of HIV. It expands health service coverage to reach Cuba’s goal of having 95 percent of people living with HIV know their status, as part of the United Nations’ partnership with Cuba and key population organizations to end HIV since 1998.
Equity to end TB
Global progress against TB, an airborne disease deadlier than AIDS, was reversed by COVID-19 and its disruptions to health services and impact on livelihoods. In Angola, TB remains the third leading cause of death among people aged 15-49, putting it among countries with the most TB cases annually.
Health service coverage is low, especially among lower income people, with 60 percent of TB services located in Luanda, the capital. In 2018, more than 12 percent of Angolan households spent over a quarter of their budgets on healthcare, which pushed 1.6 million people into extreme poverty.
With the Government of Angola and Development Aid from People to People, UNDP supports TB education in remote areas of Benguela and Cuanza Sul through the deployment of community health workers, who challenge stigma and misconceptions that can delay diagnosis and disrupt treatment. With each TB case, they visit patients, deliver medicines and encourage people to complete treatment, which helps prevent new infections and the emergence of drug resistance.
Community health workers connect remote communities with health facilities, providing a vital link to prevent and respond to TB. They reach people who might remain undiagnosed and untreated due to their location and inability to cover health expenses. They were integral to improving TB case reporting following the onset of COVID-19 which had a negative impact on TB testing.
In the first half of 2023, the partnership found 97 percent of expected TB cases, an increase of nine percent from the previous six months. Of the people that started treatment, provided and delivered free of charge, 83 percent were cured—a strong sign that more underserved people are accessing healthcare without additional financial hardship, a key condition for achieving universal health coverage.
Health care in crisis
Sudan’s crisis has left tens of millions of people in need of assistance in a country severely exposed to climate change. Over 5 million people have fled violence, including a million to neighbouring countries. Sudan’s health system is under exceptional pressure, with over two thirds of hospitals, primarily in Khartoum, out of service.
Restricted health access has far-reaching consequences. Globally, more than 70 percent of cases of epidemic-prone infectious diseases are found in conflict-affected, fragile and vulnerable settings. Interruptions to HIV and TB treatment increase the risk of death, drug resistance and disease transmission.
UNDP is supporting health workers, facilities and supplies to continue life-saving medical treatments in Sudan. With the National Medical Supplies Fund and World Food Programme, UNDP is delivering medicines to health facilities that remain operational. The supplies will cover Sudan’s immediate needs to ensure continuity of treatment for 11,000 people living with HIV and keep the national TB programme on track to treat an expected 21,000 cases.
UNDP is working with the National HIV and TB Programme to map operational health facilities and trace all patients requiring HIV and TB treatment. UNDP is supporting staffing, communications, fuel and operational costs in state health facilities and community-based programmes to for continuity of TB and HIV services. In addition, UNDP is deploying nine mobile primary healthcare centres in remote, hard-to-reach areas, including for internally displaced people, with the Federal Ministry of Health, WHO and humanitarian NGOs.
UNDP is further supporting the rehabilitation of the health system. Supplies and equipment for laboratory diagnostics, solar energy installations at 110 health facilities, oxygen supplied by seven pressure swing adsorption (PSA) plants and cylinders and two large-volume biomedical waste incinerators are keeping health services operational.
This support will contribute to averting a wider humanitarian catastrophe, while enhancing health systems to prevent a wider HIV and TB outbreak. They are part of UNDP’s Sudan Emergency Community Stabilization Offer, which is also supporting emergency employment, continued agricultural production and essential services such as clean energy access and solar-powered water systems. Together, these programmes help safeguard socioeconomic progress and address underlying development deficits that cause conflict, which can further drive pandemic risk.
Keeping our promise
In Angola, Cuba, Sudan and beyond, UNDP is accelerating progress towards the SDGs to deliver the promise of health for all on a thriving planet. In health, we are partnering with countries and communities to build resilient and inclusive health systems that finish the job on existing pandemics like TB, achieve universal health coverage and prepare for future pandemics—driven by climate change and conflict alike.
For world leaders gathering in New York, complacency, the status quo and tinkering around the edges will not suffice. We must have the necessary ambition to mobilize action and investment in health systems that deliver health services to everyone, everywhere, today and tomorrow.
We must keep our promise. For healthy lives and well-being on a thriving planet.
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