The costs of reaching the health-related SDGs
Authors: Kunhee Park, Katherine Gilbert, Peter L Annear
Journal: The Lancet Global Health (2017)

Karin Stenberg and colleagues1Stenberg K Hanssen O Tan-Torres Edejer T et al.Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries.Lancet Glob Health. 2017; 5: e875-e887Summary Full Text Full Text PDF PubMed Scopus (216) Google Scholar estimate the resources needed at both country and global levels to progress towards the health-related Sustainable Development Goals (SDGs). Their analysis included 67 low-income and middle-income countries, selected on the basis of income and population, which account for 95% of the population in all low-income and middle-income countries. No Pacific Island countries (PIC), and only four of 33 small island developing states, were included in the analysis.2United NationsSustainable development knowledge platform. Small island developing states.https://sustainabledevelopment.un.org/topics/sids/listGoogle Scholar Although leaving out the PIC does not affect the global cost estimates—the Pacific has a relatively small population (just over 11 million) spread across 22 countries and territories—this omission matters for two reasons. First, in the era of leaving no one behind, it is important that the PIC and other, less populous countries are not disadvantaged in the distribution of global resources that will be required to meet the SDGs. Second, realistic estimates of the costs to deliver a health service at the national level are needed in the PIC. As noted by the authors, “contexts are diverse, and spending a specific amount per person will not necessarily produce a specific outcome”. There is a paucity of cost data in the Pacific that leaves many questions regarding the health system unanswered. What might be the best delivery models of a health service in PIC, given their challenges of geography and scale? What would they cost? How do these costs compare with other contexts? What can PIC achieve with the resources at hand, and what could be achieved with additional resources? These questions are arguably more relevant than ever. Most PIC health systems are founded upon progressive taxation and have performed relatively well to date.3World Health OrganizationUniversal health coverage on the journey towards healthy islands in the Pacific.http://www.wpro.who.int/southpacific/pic_meeting/2017/documents/12thphmm_session02_uhc_16august.pdfDate: June, 2017Google Scholar However, some PIC have experienced a recent stagnation in improvements to key health outcomes, partly due to the increasing burden of non-communicable diseases.3World Health OrganizationUniversal health coverage on the journey towards healthy islands in the Pacific.http://www.wpro.who.int/southpacific/pic_meeting/2017/documents/12thphmm_session02_uhc_16august.pdfDate: June, 2017Google Scholar Decreasing and less predictable external funding, combined with negative effects from climate change, are further challenges to realising the health-related SDGs in the region. We have much to learn from PIC about the association between health systems and sustainable development, which is deeply embedded within Pacific culture.4World Health Organization. Yanuca Island declaration. Conference of the Ministers of Health of the Pacific Islands, Yanuca Island, Fiji. March 10, 1995.Google Scholar In turn, Stenberg and colleagues1Stenberg K Hanssen O Tan-Torres Edejer T et al.Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries.Lancet Glob Health. 2017; 5: e875-e887Summary Full Text Full Text PDF PubMed Scopus (216) Google Scholar provide a framework for global health partners to help estimate the level of investment needed to achieve the health-related SDGs in PIC, and other less populous countries, and to assess how this investment might be achieved through better use of existing resources and novel funding mechanisms. We declare no competing interests. Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countriesAll countries will need to strengthen investments in health systems to expand service provision in order to reach SDG 3 health targets, but even the poorest can reach some level of universality. In view of anticipated resource constraints, each country will need to prioritise equitably, plan strategically, and cost realistically its own path towards SDG 3 and universal health coverage. Full-Text PDF Open AccessThe costs of reaching the health-related SDGsThe estimated additional US$274–$371 billion needed annually until 2030 to achieve the targets of Sustainable Development Goal 3 (SDG3) in low-income and middle-income countries (September issue, p e875)1 may seem like a high price tag—it is. But these costs account almost exclusively for downstream health-system investments. The donor community can perhaps help relieve this cost burden through concurrent investments in comparatively smaller, upstream, and targeted global functions. Full-Text PDF Open Access