Health care is a human right. But it is also a key element in the fight against poverty and a prerequisite for economic growth. That is why the international community of nations has dedicated several Sustainable Development Goals (SDGs) as before Millennium Development Goals (MDGs) to health.The projects of KfW Development Bank are part of this international framework. KfW provides a total of EUR 2.87 billion in funding for the health sector in 41 countries. Stable health care systems – which also incorporate the private sector – are particularly important to ensure that more people can benefit from good medical care.
In developing countries, illnesses often plunge entire families into crisis because they usually have to pay most the costs on their own. And every year, around 100 million people fall into poverty because they have to spend what little money they have on medical care or medicine. Illnesses and the high costs of treatment are one of the most common causes of poverty worldwide.
Consequently, the goal of development cooperation is to contribute to universal health coverage (UHC) in the event of illness. A sustainable financial system that generates sufficient funds through tax revenue, contributions and supplementary payments is needed along with suitable health care services. The costs of treatment may not exclude the poor.
KfW Development Bank supports its partner countries with various measures to organise the healthcare sector in such a way that it is sustainable and has solid financing. It promotes, for example, results and demand-oriented approaches in addition to funding for medicine, equipment and infrastructure ("inputs"). One example is voucher systems which provide good and affordable care to pregnant women and their newborns before, during and after childbirth. Furthermore, KfW supports the setup and expansion of health insurances as well as other health protection approaches. An effective approach proved to be including private health care providers so that more poor people can take advantage of medical services.
Healthcare financing is also an important aspect under what are known as programme-based approaches. In these models, KfW supports partner countries in structuring, budgeting and implementing their healthcare policy and thus strengthening the healthcare system overall.
A well-functioning healthcare system also needs the right infrastructure, equipment and logistics. People in developing countries often live hours or days away from the next medical facility. And, if they do make it to a health centre, it is usually not even close to meeting the highest standards in modern medicine. As a result, KfW Development Bank not only builds new hospitals and health centres, it also modernises existing ones on behalf of the German Federal Government.
One of KfW's priorities in the construction of new hospitals is sustainability. Under the heading "Green Hospital", processes and medical equipment as well as the building's shell and heating technology are optimised to use resources efficiently. Sustainable use of the new infrastructure also requires a sufficient budget, regular maintenance and enough staff with the right training.
In addition, KfW helps its partner countries set up cold chains to supply medicine or outfit labs with special equipment, for example, to diagnose tuberculosis. These are very often lacking particularly in poor areas. Innovative technologies like e-health create new opportunities in the healthcare sector: more and more people in developing countries use modern means of communication such as mobile phones and Internet that give them access to health information and services. Healthcare has been noticeably improved in remote areas and crisis regions as a result. KfW is also active here.
Around the world, some 15,000 infants die each day from malaria, AIDS, tuberculosis, diarrhoea or childhood diseases that could easily be prevented by vaccines. About one-sixth of the world's population suffers from tropical diseases that have been difficult to treat so far, such as dengue fever or sleeping sickness. The healthcare systems in many of our partner countries cannot cope with these illnesses on their own. In addition, pandemics like the Ebola crisis in West Africa and the growing number of resistant germs contribute to new challenges of both a therapeutic and systemic nature.
As a result, KfW Development Bank has provided support in the fight against tuberculosis and polio at national and international level for many years by financing vaccines, cold chains, supply systems and laboratories for diagnostics and to control epidemics. India, for example, has been supported in its efforts to contain polio by KfW. In the meantime, the World Health Organisation has certified India as polio-free. In Nigeria, KfW also promotes intensive vaccine measures, even though polio is currently not endemic. This also applies to Pakistan and Afghanistan. It is therefore necessary to continue vaccination programmes in these countries. The plan is to vaccinate around 30 million children against polio every year.
Together with the GAVI Alliance, KfW also supports vaccine programmes in the East African Community including the respective supply chains and helps prevent serious respiratory infections and diarrhoea which are two of the most common causes of death among children there. Overall, KfW supports programmes to fight diseases at a volume of more than EUR 546 million (without HIV/AIDS).
In the ECOWAS region as well as in the East African Community, KfW supports the development of laboratory capacities to prevent pandemics and thus contributes to improving the capacities of the pandemic early warning systems in the regions.
On behalf of the German Federal Ministry of Education and Research, KfW Development Bank has also fostered what are known as since 2011. Since then, EUR 76 million has been dedicated to the development of medicines, vaccines and diagnostics for neglected infectious diseases. This includes the fight against sleeping disease transmitted by the tse-tse fly or dengue fever, widespread mainly in tropical regions, which still affects millions of people every year.
Non-communicable diseases (NCDs) already account for 70 % of deaths around the world. These include many chronic diseases such as diabetes, cardiovascular diseases, cancer, chronic respiratory diseases and mental disorders. The economic losses (disease-related production downtime and treatment costs) in developing countries alone will amount to an estimated USD 47 billion by 2030.
NCDs are a burden in many respects – for the people affected as well as for the healthcare system, the economy and the development of the respective country. The growing number of chronically ill people not only means human suffering, it also represents an enormous burden on the respective healthcare systems because the care of chronically ill patients requires medical staff, medication and services, often for their entire lives. Particularly in rural areas and fragile contexts in low-income countries, the population has little access to diagnostic procedures and high-quality therapies; there is not enough equipment or qualified personnel.
The healthcare systems in developing countries, which are often specialised in the treatment of infectious diseases as a result of their current focus, must adapt to the requirements of early detection and treatment of NCDs. This applies to the provision of diagnostic equipment as well as the ongoing training of healthcare personnel. At the same time, in order to ensure coverage of the foreseeable and long-term costs of treatment, national security schemes must be set up to finance illness.
As part of the Health Equity Fund in Cambodia, a national fund for subsidising the medical costs of the poorest section of the population, KfW promotes the early detection and treatment of NCDs using an integrated approach that strengthens both the demand and the supply side of the healthcare system. In addition to other healthcare services, a voucher system offers diagnostic services for cervical cancer and diagnostic and treatment services for cataracts.
The concept of sexual and reproductive health was conceived at the 1994 International Conference on Population and Development and means comprehensive well-being in all areas of human sexuality and reproduction. Sexual and reproductive rights are inextricably linked to the recognition and respect of universal human rights such as the right to healthcare, physical well-being and non-discrimination. They include, for example, the right to full information, access to safe contraception and comprehensive healthcare, but also to protection against sexual violence, sexually transmitted infections and harmful traditional practices.
Although maternal mortality has been almost cut in half over the past 25 years, around 830 women die every day from preventable complications during pregnancy and childbirth. Approximately 214 million women in developing countries who do not want to become pregnant do not use modern contraceptive methods. The main reasons are fear of side effects and health risks, no sexual intercourse or irregular sexual intercourse, resistance from the immediate environment and a short period of time since giving birth.
This is why one of KfW's priorities in the health care sector is sexual and reproductive health, which makes up 35 % of the projects in this sector. These projects include measures for safe pregnancy and motherhood, medically supervised childbirth, self-determined family planning and the prevention of female circumcision, HIV/AIDS and other sexually transmitted diseases. KfW, for example, supports projects that combine HIV prevention and family planning because the two are closely linked.
To this end, KfW Development Bank relies on proven instruments such as "social marketing" or "social franchising" that complement public family planning programmes and effectively help prevent HIV/AIDS on a wide scale. Both approaches make use of modern marketing and communication methods to promote healthy habits among the population. This includes the use of contraceptives and condoms, as well as taking advantage of health services. These services are offered to be easily accessible and affordable. "Voucher programmes", which entitle holders to supervised births and pre- and post-childbirth care for mothers and newborns, have also proven successful.