With only six years remaining to reach the 2030 Agenda, progress on the 169 targets under the 17 Sustainable Development Goals (SDGs) is disappointing. Just 17% of the targets are on track or have already been met, while 48% show only minimal or moderate progress. More than a third have stagnated or even regressed.

At the 2024 Future Summit, countries once again reaffirmed their commitment to the SDGs and the vision of a more sustainable and equitable future.

However, the stark gap between these pledges and the lack of meaningful action due to insufficient resource allocation and inconsistent policies reveals a major misalignment between words and action.

SDG 3, which aims to ensure healthy lives and promote well-being for all, has experienced setbacks even more severe than the overall SDGs. Only 10% of its targets have been achieved or are on track to be met. Meanwhile, 30% show moderate progress, 45% have made minimal strides and 15% have seen no improvement at all.

The figures are staggering: every two minutes, 18 children under five die; one woman dies from pregnancy and childbirth-related complications; two to three people die from tuberculosis or hepatitis; and 34 people from cardiovascular issues.

Additionally, 4.5 billion people lack access to essential health services, while 2 billion face financial hardship due to healthcare expenses.

The potential adoption of a Pandemic Treaty to safeguard against future pandemics like COVID-19 would be a significant step forward for global health. However, after more than two years of negotiations, approval has been delayed until the World Health Organization’s May 2025 Assembly.

There are key areas of contention, including resistance to integrating a gender perspective in the Treaty, reluctance to waive patents during crises and debates over the WHO’s future management of essential medical products and diagnostics. These issues remain some of the most controversial elements of the ongoing discussions.

This year marks the 30th anniversary of the International Conference on Population and Development (ICPD), which took place in Cairo in 1994.

There have been significant advancements over these past three decades, including expanded access to reproductive health services in many parts of the world and notable progress in gender equality and women’s empowerment, though these strides have been uneven. International standards for sexual education have also been developed.

However, key challenges persist. Gender inequality and disparities in access to health services and education remain deeply entrenched. In several regions, access to reproductive health services is still limited and maternal mortality remains high in some countries. Moreover, opposition movements targeting women’s health and rights are on the rise and funding for sexual and reproductive health is dwindling.

In 2023, official development assistance (ODA) from Development Assistance Committee (DAC) countries reached a record $223.61 billion, marking a 9.6% increase over the previous year.

However, when excluding the $31 billion spent on refugees in donor countries, the real increase in ODA is just 3.2%.

The performance among DAC countries has been uneven. While 14 countries increased their ODA, 17 countries saw reductions.

As a percentage of gross national income (GNI), ODA represents only 0.37%, just marginally higher than in 2022 and still far below the UN target of 0.7%.

Only five countries (Denmark, Germany, Luxembourg, Norway and Sweden) met the 0.7% target. Spain, contributing 0.24% of its GDP, ranked 22nd in ODA percentage and 12th in total ODA volume among 31 countries.

In 2022, DAC countries allocated $24.999 billion to health, representing 11.17% of total official development assistance (ODA), a 37% decrease from the previous year.

Of this amount, $11.236 billion (27.9%) was dedicated to controlling the EVD-19 pandemic. Vaccine donations remain a key element in global health efforts, accounting for 13.6% of the total, or $1.535 billion.

Además de recursos económicos, la defensa del derecho a la salud debe hacerse con el desarrollo de políticas y estrategias sólidas.

Beyond financial resources, the right to health must also be upheld through the development of robust policies and strategies. The setbacks in the progress of certain health rights, particularly in sexual and reproductive health, are deeply concerning.

In 2023, Spain’s ODA decreased by 12.7%, dropping to €3,595 million. This reduction of €526 million means that Spanish ODA now represents only 0.24% of gross national income (GNI).

his figure falls far short of the financial commitments made in recent years, making it unlikely that Spain will meet its target of 0.55% by 2027 or 0.7% by 2030, as outlined in the new Law on Cooperation for Development and Global Solidarity.

Furthermore, Spain’s ODA percentage is well below the EU average of 0.52% and the DAC average of 0.37%.

Trend in Spanish Gross ODA and as percentage of GNI, 2006-2023

ODA dedicated to health in Spain saw a significant decline of 38.3%, falling to €248.3 million. This reduction, which is three times greater than the cut to overall ODA, means that health cooperation now represents just 6.9% of total Spanish ODA, well below the DAC average of around 12%.

The end of the COVID-19 health emergency partially explains this steep decline in health funding from Spain. The Ministry of Foreign Affairs, EU and Cooperation now leads in funding health cooperation, contributing 45.8% of the total.

Notably, the Ministry of Health is no longer one of the primary health donors, a shift that indicates that occasional funding boosts do not necessarily set a lasting trend.

Trend in Spanish Gross health ODA, 2006-2023

Millions of people remain trapped in ongoing crises marked by long-standing conflicts, violence, the impacts of the climate crisis, economic instability and extreme poverty. From Ukraine and the Occupied Palestinian Territory to Afghanistan, Sudan, Yemen, Burkina Faso, Myanmar, Haiti and the Democratic Republic of Congo, countless people live in states of permanent crisis and extreme fragility.

By the end of 2023, there were 117.3 million forcibly displaced people, marking an 8% increase from the end of 2022. Additionally, 281.6 million people in 59 countries and territories faced severe acute food insecurity.

In this context, it is unsurprising that the UN increased its 2023 assistance target by 7%, now aiming to reach 245 million people.

As the scale and complexity of crises intensify, humanitarian space is increasingly restricted. In conflict zones, food is often used as a weapon of war and attacks on civilians, infrastructure and humanitarian workers are becoming more frequent.

The situation in Gaza is a recent example, but it is far from isolated. Humanitarian access is being obstructed in several ways, whether through administrative hurdles, restrictive laws, harassment, or direct violence against aid personnel.

n 2022, the UN documented 3,931 incidents where humanitarian access was denied, mostly by governments. The highest number of such incidents occurred in the Occupied Palestinian Territory, Yemen, Afghanistan and Mali.

In addition, attacks on humanitarian workers have escalated, with serious attacks almost doubling between 2015 (150 attacks) and 2023 (281 attacks), resulting in 280 workers killed and 224 injured.

In countries affected by crisis and conflict, millions of people face severe health threats, including disease outbreaks, malnutrition and limited access to essential health services. This is exacerbated by an increasing number of attacks on health infrastructure and workers, making it even more difficult for people to receive care.

According to the UN, at least 19 countries with a Humanitarian Response Plan experienced outbreaks in 2023. For example, Chad reported a dengue fever outbreak, while Burundi, Cameroon, the Democratic Republic of Congo, Ethiopia, Haiti, Kenya, Lebanon, Malawi, Mozambique, Nigeria, Somalia, South Sudan, Sudan, Syria and Yemen reported outbreaks of cholera and/or acute diarrhoea.

Moreover, countries facing humanitarian crises often have fragile health systems, limited resources, and consequently, high rates of maternal and neonatal mortality. In 2023, the Inter-Agency Working Group on Reproductive Health in Crises reported that 64% of global maternal deaths, 50% of neonatal deaths and 51% of foetal deaths occurred in countries with humanitarian response plans.

In 2023, the humanitarian system faced a severe funding crisis. For the first time, there was a significant decrease in humanitarian aid funding compared to the previous year, with $7.5 billion less allocated than in 2022. This reduction is evident both globally and within the UN system.

Funding for UN appeals, for example, has been cut by 25%, dropping from $30.409 billion in 2022 to $24.234 billion in 2023. By the end of the year, only 43.2% of the $56.1 billion requested had been received—the worst funding shortfall in years.

In 2023, Spanish Development Cooperation allocated €213,777,954 to humanitarian action, marking a 65% increase compared to 2022. This increase, amounting to €55,297,502 more than in the previous year, also represents a 2% rise, surpassing the 5% threshold of total ODA allocated to humanitarian action, something that has not been achieved since 2011. While this is a positive development, it remains far below Spain’s commitment to allocate 10% of ODA to humanitarian action.

Although the €158 million increase is substantial in absolute terms, in percentage terms it represents only a modest rise of 0.3% compared to 2021, bringing the total to 3.88%. This figure still falls short of the 10% target for humanitarian action and also lags behind the DAC countries' average allocation of 10.93% in 2022.

Trend in Spanish Gross ODA devoted to HA, 2005-2023