Policy paper

2010 to 2015 government policy: health in developing countries

Updated 8 May 2015

This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government

This is a copy of a document that stated a policy of the 2010 to 2015 Conservative and Liberal Democrat coalition government. The previous URL of this page was https://www.gov.uk/government/policies/improving-the-health-of-poor-people-in-developing-countries. Current policies can be found at the GOV.UK policies list.

Issue

Globally, people’s health is improving. Since 1990, with a significant contribution from UK development programmes, the number of children dying from preventable causes has fallen from around 12.7 million a year to around 6.3 million about 17,000 fewer children died each day in 2012 than in 1990. In this period, the number of girls and women dying during pregnancy and childbirth has fallen from 543,000 a year to 289,000.

Yet there is still much to be done. The poorest people in the world’s poorest countries suffer the most from ill health, and women suffer more than men. Much of this suffering could be prevented by using existing treatments and by applying the latest knowledge about what works.

The challenge is to get these treatments to the people who need them the most - the poorest, the most marginalised, and those in fragile or post-conflict states. We want to speed up progress in improving people’s health.

Actions

We work with governments and health organisations to improve healthcare systems in the poorest countries, including supporting the development of drugs and vaccines.

We work to make it easier for poor people to get access to and use healthcare services when they need them.

We will improve children’s health, saving 250,000 newborn babies’ lives by 2015.

We will improve reproductive, maternal and newborn healthcare. From 2010 to 2015, we will spend an extra £2.1 billion on women’s and newborn health. We aim to save the lives of at least 50,000 women in pregnancy and childbirth.

We will help halve malaria deaths in at least 10 of the worst affected countries by 2015.

We will help halve the number of cases of and deaths from tuberculosis (TB) by 2015, compared to 1990 levels.

We are working with partners to immunise millions of children every year from killer diseases.

We will help control or eliminate 7 major neglected tropical diseases – improving the lives of 140 million people by 2015.

We are improving health services to prevent and treat non-communicable diseases, including heart disease, cancers, diabetes and mental health problems.

We will reduce new HIV infections; improve diagnosis, treatment and care of HIV and AIDS; and reduce stigma and discrimination towards people with HIV and AIDS.

We fund research to solve global health problems that threaten the lives of millions of people around the world.

Background

We have committed to reducing maternal mortality, improving maternal health and combating HIV and AIDS, malaria and other diseases in developing countries as part of the Millennium Development Goals, a series of targets agreed at the UN in 2000. 3 of these goals are about improving health by 2015.

The Millennium Development Goal to improve maternal health is one of the targets that is least likely to be achieved. Around 2.8 million babies still die every year before they are a month old, accounting for 44% of all deaths in children under 5 years of age. Three quarters of all newborn deaths occur in the first week of life.

In 2013/14 the UK spend on malaria was £536 million. This has been calculated using the methodology detailed in the Malaria Framework for Results.

Appendix 1: halving malaria related deaths in at least 10 of the world’s worst affected countries

This was a supporting detail page of the main policy document.

Malaria is a preventable and treatable disease. As a result of investing in malaria projects, the number of deaths fell from nearly a million in 2000 to 781,000 in 2009.

Yet more than half of the world’s population is still at risk of malaria and nearly 250 million people become severely ill with it each year.

1 in 5 child deaths in Africa is still caused by malaria. All of these are preventable. Where it doesn’t kill, it can have a long term impact on a child’s mental and physical development.

Malaria does not just affect children. The health of pregnant women and newborn children is put at risk. Men and women are unable to work for long periods when they become ill. Households can be thrown back into poverty when faced with the costs of saving a family member’s life. Whole nations suffer lost gross domestic product as a result of malaria.

What we are doing

We will help halve malaria deaths in at least 10 of the worst affected countries by 2015 and work to continue these reductions into the future.

We will do this by improving the quality and access of comprehensive health services, including malaria testing, treatment and prevention. UK aid will also fund research to develop new ways of preventing and dealing with malaria.

We also work through international institutions and partnerships to improve the global response to this preventable disease. Read our framework for results: Breaking the cycle: Saving lives and protecting the future (December 2010).

Appendix 2: supporting research to improve health in developing countries

This was a supporting detail page of the main policy document.

For many of the diseases that affect people in poor countries there is only a small number of drugs available, and many of those are out of date and may be toxic. Global policies and national health practices need to be based on the best possible information, and the latest evidence.

What we are doing

We fund research to solve health problems such as malaria, HIV and AIDS, and TB as well as neglected diseases that threaten the lives of millions of people around the world.

We will carry out research with others, such as the Bill and Melinda Gates Foundation and other governments as well as innovative alliances with the private sector. We will continue to work with both the UK Medical Research Council and the Wellcome Trust.

Our research investigates new solutions to existing health problems delivering existing solutions in a more effective way, and to more people.

Our experience in health research has produced important results, including the following.

Malaria is an entirely preventable and curable disease but the parasite has become resistant to older medicines, and it is estimated that a child dies of malaria every 30 seconds. The Medicines for Malaria Venture, a not-for-profit foundation funded by UK aid, has brought out a new antimalarial treatment, dispersible Coartem, especially formulated for children. The new drug is safe, effective, easier for children to absorb, and provides a malarial cure rate of 97%.

The Drugs for Neglected Diseases initiative, also funded by UK aid, developed the first new combination drug in 25 years for the treatment of sleeping sickness (trypanosomiasis). Despite the fact that roughly 60 million people are at risk of being infected sleeping sickness is one of the most neglected tropical diseases. As the drug is more convenient for patients, it lifts the burden on health staff and cuts the costs of medicine, transport and hospitalisation.

It is important to know how many women are dying in childbirth as many deaths could be avoided with the right medical support. We funded the Measuring Maternal Mortality Programme which has developed new, low cost methods of calculating maternal mortality by interviewing members of the community, and avoiding the need for expensive surveys in areas where there is poor registration of births and deaths.

Appendix 3: improving access to health services

This was a supporting detail page of the main policy document.

Up to 90% of people in developing countries pay for medicines themselves, making medicines the largest family cost after food.

The World Health Organization reports that over a billion of the world’s poorest people miss out on the health care they need each year because they cannot afford to pay for it. An estimated 100 million more people are pushed below the poverty line simply because they need to use health services and have to pay for them on the spot.

Health services also need to be properly staffed; improving access means that skilled and motivated health workers need to be in the right place at the right time.

Girls and women often face particular problems in getting healthcare. Some find their health is not prioritised by family members and limited household funds are used elsewhere. For others, the wider community has more of a say over their bodies than they do. For instance, girls and women have little choice over when to have children and how many to have.

What we are doing

We support international efforts to help countries move towards providing basic health services to everyone.

We work to overcome the problems that stop poor people using healthcare. This includes making sure good quality essential services are available free of charge when people need them, that facilities are properly staffed, and that people are not prevented from using them by transport difficulties or the attitudes of staff.

For example, we help to make sure that young people have access to family planning services.

Appendix 4: preventing and treating tuberculosis (TB)

This was a supporting detail page of the main policy document.

Tuberculosis (TB) is a bacterial infection spread from person to person through the air. It mainly affects the lungs but it can also affect other parts of the body, such as the brain, kidneys or spine.

TB is a disease of poverty, affecting mainly young adults in some of the poorest parts of the world. In recent years there has been significant global progress in reducing deaths and illness due to TB, with an estimated 6 million lives saved since 1990.

But the global burden of TB remains huge - more than 2 billion people, equal to a third of the world’s population, are infected with latent TB and one in ten will develop active TB at some point in their lives. In 2009, TB caused the deaths of 1.7 million people - nearly 5,000 people every day.

TB infection in people living with HIV is now one of the most worrying features of the epidemic, as these diseases can work together to shorten life-span.

What we are doing

We will help halve the number of deaths and cases of TB by 2015, compared to 1990 levels. We will also work to halve the number of TB deaths among people living with HIV by 2015.

We will do this by increasing access to diagnosis and treatment of TB.

We’re investing more than £34.5 million in research and work to develop more effective vaccines and treatment for TB and TB-HIV. Read our position paper on HIV: Towards Zero Infections (May 2011).

Appendix 5: preventing and treating non-communicable diseases

This was a supporting detail page of the main policy document.

Non-communicable diseases (NCDs) are increasing in all countries and currently account for 3 in 5 deaths worldwide.

Most of this mortality is caused by 4 groups of NCDs: cardiovascular disease (which include strokes and heart disease), cancers, chronic respiratory disease (asthma and emphysema) and diabetes. Mental health and injuries are also classed as NCDs.

NCDs are to a large extent caused by common preventable risk factors like tobacco, unhealthy diet, insufficient physical activity and the harmful use of alcohol.

Although NCDs have been associated with wealthy people and countries, they are increasingly becoming diseases of poverty. NCDs are likely to become a leading cause of poverty and death in the world.

What we are doing

We are improving basic health services for the poorest, including improving:

• health systems
• the ability of health workers to deliver services
• the access of the poor to essential medicines.

This will enable health services to deal with all priority health problems including NCDs.

The UK funds research into the feasibility, acceptability and impact of mental health care for mental disorders.

We also support hepatitis B immunisation (that prevents liver cancer) through the Global Alliance for Vaccines and Immunisation (GAVI).

We work on the underlying determinants of ill health. This work includes poverty reduction, education and work on climate change. For example, we support the Safe Cookstoves Initiative which seeks to reduce indoor air pollution, estimated by the health metrics group to be one of the top 5 contributors to diseases worldwide. Moving to safer indoor cooking methods could save 2 million lives.

Appendix 6: improving reproductive, maternal and newborn healthcare

This was a supporting detail page of the main policy document.

Globally, 215 million women who want to delay or avoid pregnancy are not able to use an effective method of family planning. Each year there are 75 million unintended pregnancies and 22 million girls and women have unsafe abortions.

Most deaths in pregnancy or childbirth in developing countries are entirely avoidable, yet about 300,000 women and girls die every year, and for every woman who dies, up to 30 more suffer a debilitating illness or permanent disability.

Investing in reproductive, maternal and newborn health saves lives and is highly cost effective. Simply meeting the need for family planning could prevent around a third of maternal deaths and a fifth of newborn deaths.

We believe we should give girls and women the ability to choose whether and when to have children and how many children to have, and we need to make sure pregnancy and child birth are safe.

What we are doing

From 2010 to 2015 we will spend an additional £2.1 billion on women’s and newborn health. This will include working to:

• save the lives of at least 50,000 women in pregnancy and childbirth and 250,000 newborn babies by 2015
• help at least 24 million girls and women to use modern methods of family planning (including 1 million young women)
• prevent more than 20 million unintended pregnancies
• support at least 2 million safe deliveries providing long lasting improvements to maternity services, for example by training more doctors and midwives.

Read our framework for results: Choices for women: Planned pregnancies, safe births and healthy newborns (December 2010).

Appendix 7: improving health systems

This was a supporting detail page of the main policy document.

In many low income countries, the poorest people do not have access to health services.

When people are ill with malaria, tuberculosis, HIV or pneumonia they are unable to get the lifesaving medication they need.

A lack of access to family planning services, safe childbirth and vaccinations also mean that the poorest cannot plan for the future, and mothers and babies are at greater risk of death in childbirth. As a result many people die from easily treatable or preventable conditions.

By strengthening the whole health system (by managing it well, staffing it with well trained and motivated health workers and making sure that there are reliable supplies of medicines), countries can help to make sure that the basic health needs of their populations can be met.

What we are doing

We provide high quality technical advice to help countries improve their healthcare systems. This includes providing policy advice about how to reach the poorest people with the health services they need. UK aid helps to support the delivery of these services, and our advisers work with governments and health providers to make the best use of scarce resources.

We work with global health organisations and donors to improve health, for example the World Health Organization, Global Alliance for Vaccines and Immunisation (GAVI), and the Bill and Melinda Gates Foundation.

This work includes supporting research to develop new medicines and services, such as drugs and vaccines. Read our publication: ‘Health is global: an outcomes framework for global health 2011-2015’.

In some contexts we are also working with non-state actors to improve health services for the poor, women and girls.

Appendix 8: preventing and treating HIV and AIDS

This was a supporting detail page of the main policy document.

The world has made huge progress against the HIV epidemic in the 30 years since AIDS was first identified. New infections have fallen by 19% since 1999 and over 8 million people are on anti-retroviral treatment, more than a tenfold increase over 5 years.

Around 34 million people are living with HIV – more than ever before due to the life prolonging effects of antiretroviral therapy – but half of those people do not know they have HIV and 7 million people needing treatment are still not getting it.

Stigma and discrimination against people with HIV can make it difficult for people to get access to information, support and treatment.

In June 2011, countries meeting at the United Nations in New York adopted ambitious new targets to defeat HIV and AIDS, including providing universal access to treatment, care and support and doing more to prevent new infections.

What we are doing

We are helping to reduce new HIV infections where the need is greatest, particularly in Africa, where we are helping reduce new infections among women by at least 500,000 by 2015.

The leading cause of death among people living with HIV is tuberculosis (TB) so we are improving access to HIV and TB diagnosis and increasing treatment and care.

Our financial support to the Global Fund to Fight AIDS, Tuberculosis and Malaria will enable 37,000 HIV-positive women to prevent transmission to their babies and will also 268,000 people to access life-saving treatment.

We will reduce costs for medicines from pharmaceutical companies, securing lower prices and better value for money. For example, our work with the Clinton Health Access Initiative has lowered the price of life-saving HIV treatment generating enough cost-savings to buy medicines for an additional 500,000 people by 2015.

The UK works to stop stigma towards people with HIV and AIDS and invest in research to understand the causes of HIV and find innovative solutions. For more information read our position paper: Towards zero infections (May 2011) and for information on what has been achieved in the last two years read the position paper: Towards zero infections - two years on.

Appendix 9: increasing the number of people receiving immunisations

This was a supporting detail page of the main policy document.

Every year, about 2 million children die of diseases that could be prevented by immunisation. That’s one child every 20 seconds.

Vaccines offer a simple, cost-effective solution to this problem. For the price of a cup of coffee a child can be vaccinated against 5 of the major childhood killers, including haemophilus influenzae B, diphtheria and tetanus.

What we are doing

UK aid will fund the Global Alliance for Vaccines and Immunisation (GAVI) to help vaccinate over 80 million children and save 1.4 million lives. That’s 1 child vaccinated every 2 seconds for 5 years.

We fund the Measles and Rubella Initiative to vaccinate 45 million children against measles between 2011 and 2015, preventing 5 million cases of measles and 100,000 deaths.

We fund the Global Polio Eradication Initiative which has immunised 2.5 billion children against polio since it was set up in 1988, resulting in a more than 99% fall in cases worldwide, and we will support them to rid the world of the final 1%.

We manage a number of partnerships to research vaccines for TB, AIDS and diarrhoeal disease. UK aid funds global agencies such as the World Health Organization (WHO) and UNICEF to help set international immunisation policy and guidance and vaccinate children.

Advanced Market Commitment

An Advanced Market Commitment (AMC) is a donor commitment to subsidise the future purchase of a vaccine that is not yet available. It is an innovative mechanism to incentivise private manufacturers to invest in research and development and to build manufacturing capacity to supply vaccines to developing countries. The aim is to accelerate the availability of effective vaccines at cost-effective and sustainable prices.

The AMC for pneumococcal vaccine provides manufacturers with incentives to develop products suitable for developing countries and to commit to long term supply of the vaccine at an affordable price. Pneumococcus causes meningitis and pneumonia and is responsible for 1.6 million deaths each year – half are children under age 5. With GAVI and support from donor countries, 17 countries have already introduced this vaccine using AMC, with a further 41 scheduled to do so by the end of 2015.

Two manufacturers are currently supplying GAVI countries with vaccines tailored for developing country needs, at a price more than 90% lower than the vaccine is sold for in developed countries.

A comparable vaccine without donor support could be distributed to developing countries a full 9 years after its introduction in the industrialised world. In contrast, the AMC-backed vaccine can be introduced in low-income countries almost at the same time (just a year between rollouts).

The pilot scheme aims to purchase 2 billion doses and save 7 million lives by 2030. This intervention could make a huge contribution to reducing the 800,000 deaths in children under 5 that occur annually due to pneumococcal disease.

The UK has committed US$485 million to the pilot AMC for pneumococcal vaccine, out of a donor-funded total of US$1.5 billion.

International Finance Facility for Immunisation

The International Finance Facility for Immunisation was set up in 2006 to rapidly accelerate the availability and predictability of funds for Gavi’s immunisation programmes.

The International Finance Facility for Immunisation (IFFIm) uses long-term pledges from donor governments to sell ‘vaccine bonds’ in the capital markets, making large volumes of funds immediately available for Gavi programmes.

IFFIm was the first aid-financing entity in history to attract legally-binding commitments of up to 20 years from donors and offers the predictability that developing countries need to make long-term budget and planning decisions about immunisation programmes.

The World Bank acts as financial adviser and treasury manager to IFFIm. So far IFFIm bonds have raised more than US$3 billion in immediately available cash resources for Gavi immunisation programmes.

Appendix 10: preventing and treating neglected tropical diseases

This was a supporting detail page of the main policy document.

More than 1 billion people are affected by neglected tropical diseases (NTDs). This is the term given to a number of different parasitic and bacterial infections.

NTDs lead to disability and disfigurement, with some patients suffering from stigma. Collectively they cause half a million deaths every year worldwide.

They tend to affect the poorest people located in the hardest to reach areas, often in remote or conflict areas, where there is little or no access to health services, clean water and sanitation.

Many NTDs can be prevented or even eliminated with proven, highly cost effective interventions costing as little as $0.40 per person per year in Africa.

What we are doing

The UK expanded its NTD programmes in 2009:

• backing the Guinea Worm Eradication Programme (GWEP) through the Carter Center and WHO.
• to help control Lymphatic Filariasis (elephantiasis) through the Global Alliance based at the Liverpool School of Tropical Medicine.
• to help control onchocerciasis (river blindness) through the African Programme for Onchocerciasis Control - APOC
• Schistosomiasis (Bilharzia) / helminth (worm) control managed by the Schistosomiasis Control Initiative (SCI) at Imperial College.
• research support to the Drugs for Neglected Diseases initiative (DNDi) and the Tropical Disease Research (TDR) Special Programme at WHO.

In mid 2011 the UK agreed to step up its support. This was announced at the the London Declaration meeting on NTDs in 2012 with the expectation that the UK’s NTD support would eventually help reach more than 140 million people by mid-decade.

In November 2012 stakeholders met in Washington DC to review progress since the January meeting.

Besides expanding our support for the UK programmes started around 2009, we have increased our commitment to:

• support tackling trachoma
• strengthening global technical capacity through WHO.
• developing integrated country approaches in Nigeria and South Sudan
• support to Kala-azar control.

Overall our strategy is to help control or eliminate seven major neglected tropical diseases.