SECTION III

Health in SDG Targets


Health is well placed in the SDGs. "Allow everyone to live in good health and promote well-being at all ages" is a very broad objective that affects all sectors. The SDG statement emphasizes that to achieve the overall health goal, “we must achieve universal health coverage (UHC) and access to quality health care.”

3.1 SDG 2 – No hunger

In 2019, nearly 690 million people were hungry, representing an increase of 10 million from the previous year. The number is rising in Africa, which is now the second most affected continent by hunger after Asia. People facing difficulties in accessing food that increased from 52% to 59% between 2015 and 2019 in sub-Saharan Africa.

Figure 3.1.1: Prevalence of wasting among children under 5 years of age in the WHO African Region, 2000–2021, WHO Figure 3.1.1: Prevalence of wasting among children under 5 years of age in the WHO African
                                Region, 2000–2021, WHO

In 2020, the African Region is the most affected by stunting with more than a quarter (28.2%) of African children under five affected. In contrast, only 4.2% of children are overweight, making Africa the second most overweight Region for children under five after South-East Asia. Since the beginning of the COVID–19 pandemic, an estimated 350 million more Africans have not had regular access to adequate food. Pregnant women and women of reproductive age are also affected by undernourishment, leading to a high prevalence of anemia in the Region (39,6%), with more than half of the countries having an anemia prevalence above 40%. However, some indicators show positive progress, such as the reduction of wasting among children under five to less than 5% by 2025 and maintain it at that level, for which the target could be reached if the current trend is preserved.

3.2 SDG 3 – Good health and well-being

Nearly 99% of maternal deaths occur in developing countries, with more than half in sub-Saharan Africa, which accounts for 525 deaths per 100 000 live births and 27 neonatal deaths per 1 000 live births. Only three countries, Cabo Verde, Mauritius and Seychelles, are below the internationally agreed target of 70 maternal deaths per 100 000 live births.

Current trend shows that by 2030 the Region will still record 390 maternal deaths per 100 000 live births, very far from the target.The factors contributing to these deaths are numerous and include shortage of qualified health workers contributing to the low rate of skilled births attendance (65%); high prevalence of women of reproductive age with unmet need for family planning (44%), and a high adolescent birth rate among women aged 10–14 which, at 102 births per 1 000 women aged 10–14, is the highest in the world.

Figure 3.2.1: Maternal mortality ratio (per 100 000 live births) in the WHO African Region in 2017, UN MMEIG Figure 3.2.1: Maternal mortality ratio (per 100 000 live births) in the WHO African Region in
                            2017, UN MMEIG
Figure 3.2.2: Prevalence of overweight among children under 5 years of age in the WHO African Region, 2000–2021, WHO Figure 3.2.2: Prevalence of overweight among children under 5 years of age in the WHO African
                            Region, 2000–2021, WHO

The continent remains subject to a number of threats such as tuberculosis, HIV, malaria, neglected tropical diseases, and non-communicable diseases, which, despite their decline, remain well above the global average. Lifestyle habits (diet, smoking, alcohol and drug consumption, violence, suicide, etc.), medication abuse (especially Antibiotics), and air pollution are also on the rise in this Region, and there is an increase in the mortality associated with them. Deaths due to road accidents, which was the target of SDG 3.6 to reduce by half by 2020, could not be achieved, While the goal of "reducing overweight in children under five to less than 5.6% by 2025" is achieved and need to be monitored. Following the COVID–19 pandemic, the WHO Africa Region is facing a re-emergence of certain vaccine-preventable diseases such as measles and polio, due to declining immunization coverage.

3.3 SDG 4 – Quality education

The African Region has 60% of children under five that are developmentally on track in health, learning and psychosocial well-being with 57% for boys and 62%. Measuring and monitoring ECD is critical to understanding what young children need and identifying those at risk of being left behind and not achieving their full developmental potential. Algeria has the most children with development on track with 77%, as opposed to the Central African Republic which has only 36%. In 2020, about 85% of countries in the African Region where data are available (27 countries) have more than 50% of their children under–5 who are developmentally on track in health, learning and psychosocial well-being.

3.4 SDG 5 – Gender equality

Women suffer the most from gender inequality and marginalization on the continent. Indeed, in the African Region, 34% of girls are forced into marriage before the age of 18, compared to 4% of boys. In addition, 33% of women are victims of partner violence, and 36% of women aged 15–49 are still victims of genital mutilation/cutting, almost 1 in 3 girls in 2017. Many countries in the Region still do not have laws to guarantee the rights of these women. Although there has been a decline in this marginalization, the COVID–19 pandemic has slowed actions against these practices over the past two years.

3.5 SDG 6 – Clean water and sanitation

The African population using basic drinking water services in 2020 is 32%, far from the 80% target to be reached by 2030 which is becoming more unlikely to be achieved. The situation is similar for the use of basic sanitation services, for which only 23% of the population is covered. These water and sanitation shortfalls, in addition to poverty, are high risk factors for the fecal peril diseases that prevail in the Region.

3.6 SDG 7 – Affordable and clean energy

The quality of energy and technologies used are not modern and sustainable in the Region, especially in rural areas. This constitutes a challenge to ensure a living environment that meets the requirements of a healthy environment. Only 20% of the African population use as first resort, clean fuels and technologies, which is the lowest rate among all WHO regions. The consumption of these energy sources is 39% in urban areas and 6% in rural areas.

3.7 SDG 8 – Decent work and economic growth

Most of fatal injuries due to work accidents are in Asia (65%) and Africa (17%). Men are more exposed than women to work accidents regardless of whether they result in fatal or non-fatal injuries.

3.8 SDG 11 – Sustainable cities and communities

Sub-Saharan Africa's urban population is the fastest urbanizing in the world. In the Region, 25 countries have a concentration of fine particulate matter (PM2.5) over 40 μg/m3. Ambient air pollution related deaths have been increasing from 361 000 in 2015, to 383 000 in 2019, mainly in most highly developed countries. PM2.5 pollution was estimated to be responsible for 1.96 billion lost Intelligence Quotient points in African children in 2019.

3.9 SDG 13 – Climate action

The African Region is prone to natural disasters and is the second most affected region by disasters (622) after Asia (1 305) during the period 2010–2020. In 2019, most disasters in the last ten years (83% were triggered by natural hazards) were caused by extreme weather and climate events such as floods, storms, and heat waves. In 2019, 20 million people were affected by disasters in Africa: Cyclone Idai in Mozambique, Zimbabwe and Malawi affected 2.8 million people; Drought in Southern and Eastern Africa (12 countries) affected 9.3 million people; Cyclone Kenneth in Mozambique and Comoros, affected 2.7 million people.

3.10 SDG 16 – Peace, justice and strong institutions

Africa is one of the most fragile and insecure regions in the world, with several conflicts. One-third (35%) of the 464 000 homicides committed worldwide are from the region, the majority of which are committed by men. Approximately 7 500 people lost their lives in armed conflicts in the Sub-Saharan Africa region in 2020. These conflicts promote violence of all forms (sexual, physical, psychological). Studies shows that more than half of African children are physically abused, and in some parts of the continent, four out of ten girls are sexually abused before the age of 15. The civil registration in African countries is still a big challenge: 49% of children under five (nearly 89.5 million children) in sub-Saharan Africa remain unregistered, a 2% decrease since 2008. If nothing is done, trends shows that the number of unregistered children in Africa will continue to rise.

3.11 SDG 17 – Partnerships for the goals

Similarly, many countries do not perform well in terms of completeness of death registration and medical certification of causes of death, making data availability in this area a major challenge for civil registration and vital statistics systems. For both vital events (births and deaths), only 7 AFRO-Region’s countries reached 90% completeness, which is a satisfactory level. Many countries have obsolete or inaccurate population data, only 20 countries have been able to conduct population censuses in the past 10 years. These data are essential for the development of policies.

Countries need to make additional efforts and adopt new strategies and laws to improve indicators for achieving the health-related SDGs by 2030. While most of the goals are still underway, some have reached deadlines or are close to reaching them. Almost none of the latter indicators have reached their target and need to be updated. Experiences from other Regions with significant progress or successful achievements can also be capitalized on and adapted to the AFRO Region to preserve gains and to guarantee further significant progress.