Around 800 women per day around the world die during pregnancy or childbirth, or shortly afterwards. Most of these deaths could be prevented with a properly functioning basic healthcare system. The sharp fall in HIV globally is due largely to specific measures to combat HIV. In some cases, however, this has diverted attention from other diseases. It is therefore important that systems be strengthened across the entire spectrum, and to ensure that everyone who needs medical care receives it.
Strengthening health systems
Large global funds such as the Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM), the Vaccine Alliance Gavi and the Global Financing Facility (GFF) are making growing contributions to strengthening health systems through specific programmes. The United Nations Population Fund (UNFPA) and the World Health Organization (WHO) are also working on improving systems, for example by training health workers, drawing up guidelines, conducting research into new or better medicines and other interventions.
Healthcare during pregnancy and childbirth
The United States’ Mexico City Policy (MCP) has put further pressure on the financing of SRHR services, including safe abortion. Dutch support for organisations that provide these services is now even more important, to continue guaranteeing good abortion- related services.
Health among vulnerable groups and in humanitarian situations
An estimated 60% of preventable maternal deaths occur in fragile and humanitarian settings. Access to safe abortion is often even more difficult in such circumstances, because of limited resources or social stigma for example. The Netherlands has ensured that sexual health is included in programmes being implemented in these difficult circumstances.
Progress in result area Quality of health care
Strengthening health systems
Although most of the GFATM and Gavi budgets is spent on specific programmes, these investments also help strengthen basic healthcare. The Netherlands believes that these initiatives should make even more use of national systems. This is particularly important in countries whose income status means they can no longer expect financial support from GFATM and/or Gavi. In 2018 12 health funds agreed to improve their coordination and focus more on the needs of countries. This was set out in the Global Action Plan for Healthy Lives and Well-being for All, adopted at the UN General Assembly in September 2019 and coordinated by WHO.
Through its country programmes, the Netherlands helps governments make their health systems stronger and better. This is going well in Ethiopia and Bangladesh, for example. Political tensions in Mali have kept progress behind schedule there, however. In Francophone countries in West Africa, in particular, many women still have no access to contraception. The Netherlands therefore supports the Ouagadougou Partnership, which contributes to better donor coordination and family planning services in nine West African countries.
Pregnancy- and childbirth-related healthcare services
In 2018 the Netherlands helped, via the International Planned Parenthood Federation (IPPF), with the provision of healthcare for almost 68 million people, and the prevention of over three million unsafe abortions. More than two million women were supplied with contraceptives via the reproductive health services organisation IPAS and over 600,000 women received support with safe abortions.
Role of the private sector
The efforts of the international business community to help achieve health-related SDGs are falling short of expectations. The Netherlands encourages entrepreneurship among private healthcare providers and promotes the role of the private sector in global organisations, for example through the Gavi Matching Fund.
Health among vulnerable groups and in humanitarian situations
The Netherlands continued to focus on healthcare and the provision of SRHR products and services among vulnerable groups and in humanitarian situations. For example, the Safe Abortion Action Fund provided services in camps housing refugees and displaced persons in Iraqi Kurdistan and Nigeria, and for exceptionally vulnerable groups in Haiti and Uganda.
Performance-based Financing (CORDAID)
CORDAID is an international NGO that is working to improve healthcare in Ethiopia through Performance-based Financing (PBF). PBF directly links payment to objectively determined results. Clinics and hospitals receive quarterly payments after achieving the results. Payment on this basis also gives them scope to invest in healthcare improvements as they see fit.
In Borana CORDAID successfully supported 23 clinics and two hospitals. Compared with 2015, this meant eight times more children aged five and under received primary healthcare. The programme was expanded to a further 65 clinics and five hospitals in Jimma, with funding from the Dutch embassy. After just one quarter, visible results were achieved in the form of improved quality scores in all districts. Starting in 2020, a total of 2.3 million people will benefit from the programme.
Photo credits: Petterik Wiggers
Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)
The Netherlands is a major donor to GFATM. With a total contribution of €919 million up to and including 2019, we are its tenth largest public donor. The Netherlands has always championed a human rights approach. Working with Dutch civil society, we have enabled vulnerable groups to take part in decision-making on GFATM policy, and sexual and reproductive rights are included in country programmes.
GFATM not only contributes to the fight against HIV, tuberculosis and malaria, it also increasingly helps strengthen basic healthcare, not only by supplying medicines, but also by strengthening countries’ own purchasing and distribution policies.
The Netherlands is calling for the careful phasing out of aid to countries that are no longer eligible for support, and for the further strengthening of national systems and better coordination with other health organisations.
Photo credit: Global Fund / Nana Kofi Acquah