The COVID-19 pandemic has affected progress for all health indicators.

Global deaths resulting from the collapse of health systems because of the pandemic are 32% higher than those directly caused by the disease, estimated at 6.4 million as of October 2022.

Childhood vaccination rates have declined for the first time in 10 years and, for the first time since 2005, TB deaths have increased. These impacts are most significant among the most vulnerable populations, which are those with the most serious health issues.

Estos efectos tienen más relevancia en las poblaciones más vulnerables, que son aquellas que tienen los mayores problemas de salud.

The global response, which prioritised local solutions to an international problem, has proven ineffective in reducing these inequalities, be they internal inequalities within each country or those between the different countries of the world.

Over the past 20 years, many health indicators have improved and, with them, global health. However, the lack of progress as regards some of these indicators remains unacceptable.

Maternal mortality has fallen by 37%, yet 810 women still die every day from complications in pregnancy and childbirth.

Despite improving every year, the global under-five mortality rate is 37 deaths per 1,000 live births, 13,700 per day.

Moreover, some indicators are getting worse, such as that related to Non-Communicable Diseases, which kill 41 million people every year, accounting for 75% of the world's deaths.

Universal health coverage, the overarching target encompassing the other objectives under SDG3, is increasingly far from being achieved.

In addition to the weaknesses of many health systems in responding to the health needs of their populations, individual health expenditure is increasing.

As a result, the number of people who spend more than 10% of their household budget on health, i.e., catastrophic health expenditure, rose from 940 million to 996 million a year.

The digitalization of health represents both an opportunity and a threat when it comes to improving access to health and reducing inequality across the globe.

The use of new technologies can ensure that people living in inaccessible areas receive the health services they need and to the extent required.

It also facilitates the flow of information, both information concerning patients between the different levels of care and information that can be used to train healthcare staff, which will even change people's habits in terms of the way they receive care.

However, there are also certain shortcomings involved with the digital transformation in health that need to be mentioned. These relate to the digital divide, the use of communication in health, and the use of people's personal health data and the question of who owns it.

Official Development Assistance (ODA) from Development Assistance Committee (DAC) countries reached an all-time high of USD 178.9 billion, 4.4% more than in 2020.

However, while ODA increased in 23 of the 29 DAC countries, the increase was not as large as expected, given the global crisis resulting from the pandemic.

In fact, if we remove contributions for donated COVID-19 vaccines, the increase would have only been 0.6% in real terms.

In addition, USD 1.7 billion was redirected to the fight against COVID-19 from other programmes, but, obviously, these other health issues had not gone away.

ODA represents 0.33% of the Gross National Income (GNI) of these countries, a percentage that falls far short of the 0.7% commitment, which only five DAC countries met in 2021.

In the first year of the pandemic, the pool of donors increased their allocations to the health sector considerably, allocating USD 28.5 billion, USD 7.2 billion more than in 2019, an increase of 33.6%.

This increase bucks the downward trend regarding the importance of the health sector in the ODA of the DAC countries as a whole, reaching 17.54% in 2020, five and a half points more than in 2019.

We do not yet know the total ODA allocated to health in 2021, but we do know how much was allocated to measures related to COVID-19, i.e., USD 18.8 billion, which represents 10.5% of its total ODA.

USD 6.3 billion was spent on providing vaccines against COVID-19, 36.6% of which were donated doses left over from batches procured by DAC countries, raising questions as to whether or not they can be counted as ODA.

In 2021, Spanish ODA amounted to EUR 3.1 million, an increase of 15.2% compared to the previous year, reaching 0.25% of Gross National Income (GNI).

This figure is a far cry from the 0.5% committed for the end of the legislature, the average of 0.33% for all DAC donors, 0.49% for EU countries and the 0.7% commitment made more than 50 years ago at the United Nations (UN).

Trend in Spanish Gross ODA and as percentage of GNI, 2006-2021

The increase in funds of EUR 324.7 million brings the total allocated to health to EUR 526.6 million, the highest amount allocated by Spanish cooperation to health in its history.

Although Spanish Cooperation has significantly increased its contribution to health, it is essential that a Global Health strategy be drawn up in the short term, including the strengthening of public health systems, with sufficient resources and personnel

The COVID-19 pandemic clearly affected the sectoral distribution of aid in 2021, prioritising the health sector, where ODA increased from 7.5% in 2020 to 16.8% in 2021.<7p>

Two milestones to highlight: (i) The increase of funding by 9.3 points to EUR 324.7 million brings the total allocated to the health sector to EUR 526.6 million, the largest amount allocated by Spanish Cooperation to health in its history. Of the total allocated to health, EUR 312 million (59%) went directly to the fight against COVID-19. For the first time since this report has been drawn up, the Ministry of Health is the largest contributor to health cooperation, accounting for 56.5% of the total.<7p>

Trend in Spanish Gross health ODA, 2006-2021

Humanitarian crises are increasingly characterised by the multi-dimensional nature of the factors that generate and perpetuate them.

In this context, the effects of the climate crisis have a particular impact on populations who are in a situation of greater structural vulnerability, as they directly affect the availability of basic resources such as drinking water and food security.

This, coupled with the discrepancy between humanitarian needs and the funds allocated to HA in 2021, is pushing millions of people around the world to the brink.

In contexts of humanitarian crises, health is affected by a number of factors including sexual violence, which is widespread and systematic in situations of conflict or forced displacement.

The impact that this type of violence can have on the physical and mental health of those who it is inflicted upon can be devastating.

This is compounded by the scarcity of services for the care and treatment of victims of sexual violence, as well as for prevention and protection.

Humanitarian crises have a significant impact on the mental health of people who experience them.

What's more, mental health and psychosocial well-being are necessary in order to strengthen community resilience and for the recovery of communities in crisis situations.

However, the mental health and psychosocial support response during a humanitarian crisis can often be hampered by fragile health systems, disruption of services and staff shortages, among other factors.

Spanish Cooperation's HA continued to grow significantly in 2021, standing at EUR 107 million, 11 million more than in 2020, which represents 3.5% of its total ODA

A percentage that it is also still far from the 10.53% average for countries on the Development Assistance Committee (DAC).

Trend in Spanish Gross ODA devoted to HA, 2005-2021