Embracing change, empowering communities: Unlimit Health's journey to universal health

The environment in which we operate is changing at an unprecedented rate, and this rate of change is set to increase fourfold in the next two decades. Over the last five years, geopolitical events have impacted priorities for overseas assistance and development aid; the long-term effects of the COVID-19 pandemic continue to be felt; a quarter of the world’s population now resides in conflict-affected countries; adverse effects of climate change continue to exacerbate humanitarian crises, fuel displacement, food insecurity, and resource scarcity, particularly in vulnerable regions and straining already fragile health systems. These global events have compounded health inequities and have led us to reflect on our purpose and place in this rapidly changing environment.  

What a change in landscape means for ending parasitic disease 

As outlined in Action for Global Health’s latest Stocktake Review, global progress towards sustainable development goal (SDG) 3, which aims to ensure healthy lives and promote well-being for all at every stage of life, has been dramatically impacted by COVID-19, climate change and conflict. Compared to gains made before 2015, expanding access to essential health services, such as reproductive, maternal, newborn and child health, has slowed. In 2021, almost half the world’s population wasn’t covered by essential health services, according to the Tracking Universal Health Coverage: 2023 Global Monitoring Report.  

Growing inequalities and structural barriers, including access to safe water and improved sanitation facilities, have also increased people’s vulnerability to neglected tropical diseases (NTD) and limited their access to health and other services. These climatic shifts affect disease distribution and transmission. For example, changes in precipitation and temperature have enabled endemic transmission of dengue, leishmaniasis and schistosomiasis in Europe and the USA. Climate change can impact further at-risk populations, increasing their exposure to parasitic infections and reducing resilience to other emerging threats that affect health, livelihoods, and the health system.   

A shift in the UK political environment in the last decade has also impacted UK official development assistance (ODA), with more ODA being allocated to domestic spending following similar trends in the USA, Germany and other high-income donor governments. 2021 saw the first year since 2013 of a reduced budget from 0.7% of gross national income to 0.5%. Paired with waning interest and investment in multilateral mechanisms for international cooperation, these obstacles are deterring the world from solving complex global challenges, with the most vulnerable and marginalised of populations within low and middle-income countries the hardest hit, many of those in countries endemic for parasitic infections. 

A crossroad that presents an opportunity for positive outcomes 

The socio-political and funding landscape is bleak. But at the halfway point to the SDGs, and with only 15% of the indicators due to be met, as an organisation, we must identify opportunities that might also emerge from these challenges. The shrinking fiscal space in which global health efforts are being implemented requires rethinking the global health funding architecture and how international organisations such as ours operate. Momentum for a change in the funding architecture coincides with increased recognition of the need for a shift in power dynamics that currently undermine locally-led development and health systems resilience, further embedding inequalities. This means moving away from a funder-led agenda to one championed by local ownership, sustainability considerations and a partnership of mutual respect. It also means supporting different sectors to work together so that health systems can provide quality health services for everyone who needs them.  

In 2021, the World Health Organization (WHO) released its NTD road map for 2030 setting global targets and milestones for the control, elimination and eradication of these diseases, in parallel with the SDGs. We chose to respond to the challenges of the changing external environment by aligning our work and 2023-28 organisational strategy with the road map pillars. This strategic shift, which reflects the views of our ministry of health partners and has at its core the ambition to end preventable parasitic infections, also corresponded with a new identity for the organisation. But it wasn’t just a name change, we intend to do things differently, too.  

Time for a temperature check 

Lately, the UK international development agenda has been re-energised with the Foreign, Commonwealth and Development Office’s release of a white paper emphasising the need to go beyond traditional aid to meet the scale of the challenges facing us. With 50% of the global population voting in 2024, it has been dubbed a ‘super election year’, offering the potential for significant change around the world, impacting on international coordination and collaboration. Furthermore, the WHO just published its global report on NTDs, including quantitative information on the progress towards the 2030 targets of the road map.  

It’s also been one year since launching our 2023-28 strategy and new brand, and we believe in holding ourselves to account. As such, it’s time for a temperature check. In the next article of this series, we’ll share how our context differs from a year ago, delving into our approach and progress in adapting to this new reality and how we are fostering and deepening relationships, evidence and approaches to sustainable development.  

Ending parasitic disease, together.