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Where is the World Heading to?

This year, we are experiencing the biggest crisis of global health and economy since World War II. The COVID-19 pandemic has not only changed our daily routines and work, impacted society and the economy, but also put everyone’s health and life at risk. In July, United Nations Secretary-General António Guterres warned that the world is facing many challenges. In addition to unacceptably high levels of poverty, a rapidly worsening climate emergency, persistent gender inequality, and massive gaps in financing, we now find ourselves confronting another massive global challenge in COVID-19, which, according to Mr. Guterres, “is taking us further away from the Sustainable Development Goals (SDGs)”. He further pointed out that COVID-19 could set the world back years and even decades, leaving countries with massive fiscal and growth challenges.

The 17 SDGs, launched in 2015 to follow up on the Millennium Development Goals set in 2000, should have been better suited to the global pace of development and are practical long-term goals and plans that ensure the well-being of all people in the world. However, during this COVID-19 pandemic, we have seen that global efforts have not been sufficient to deliver change. As Mr. Guterres says, “We haven’t invested adequately in resilience – in universal health coverage, quality education, social protection, safe water and sanitation.”

The Progress in Ensuring Healthy Lives and Promoting Well-being

According to The Sustainable Development Goals Report 2020 released in July this year, progress had been recorded in improving health and well-being around the world before the COVID-19 pandemic. For instance, child mortality has been significantly reduced in the past two decades. The global under-5 mortality rate fell from 76 deaths per 1,000 live births in 2000 to 42 in 2015, and to 39 in 2018. By 2018, 121 countries had already met the SDG target on under-5 mortality, and 21 countries were expected to achieve it by 2030. The progress may be encouraging, but there are still signs of concern. In 2018 alone, some 5.3 million children died before reaching their fifth birthday, and almost half of those deaths occurred within the first 28 days of life. By citing a recent study, the above report also points out that if routine health care is disrupted and access to food is decreased, there could be a devastating increase in child and maternal deaths: 118 low- and middle-income countries could see an increase of 9.8 to 44.8% in under-5 deaths per month over a period of six months.

The report also hails the coverage of immunisation, which has saved millions of lives, as a major progress in ensuring healthy lives. The impact has been remarkable: coverage of the required three doses of diphtheria-tetanus-pertussis (DTP3) vaccine increased from 72% in 2000 to 86% in 2018, while that of the second dose of measles‑containing vaccine (MVC2) increased from 19% in 2000 to 69% in 2018. However, when COVID-19 broke out, childhood immunisation efforts globally were severely interrupted. 53% of the 129 countries where data are available reported moderate-to-severe disruptions or a total suspension of vaccination services during March and April 2020, which has put the lives of many children in great danger.

In terms of coverage of basic health service, it is estimated that between 2.5 billion and 3.7 billion people – about one third to one half of the global population, were covered by essential health services in 2017. If current trends continue, 39 to 63% of the global population will be covered by such services by 2030. However, the COVID-19 pandemic has created an unprecedented burden on hospitals and health facilities, and is disrupting essential health services around the world. If the world is to turn universal health coverage into a reality by 2030, growth in the provision and use of essential health services must greatly accelerate.

The rapid spread of COVID-19 has highlighted the shortage of medical personnel in many countries, especially in regions most affected by the disease. Over 40% of all countries have fewer than 10 medical doctors per 10,000 people; over 55% of countries have fewer than 40 nursing and midwifery personnel per 10,000 people. In order to achieve the goal of universal health coverage by 2030, an additional 18 million health workers are needed, primarily in low- and lower-middle-income countries.

Apart from a lack of basic health service and medical personnel, whether people can afford medical services will also become a challenge in achieving universal health coverage. With the current pandemic spreading around the world, the efforts made towards eradicating poverty are expected to be seriously undermined. The report projects that an additional 71 million people will be living in extreme poverty due to COVID-19. Southern Asia and sub-Saharan Africa are expected to see the largest increases in extreme poverty, with an additional 32 million and 26 million people, respectively, living below the international poverty line as a result of the pandemic. Unemployment has caused families to experience economic hardships, which may lead them to cut down on spending on food. Children may therefore experience hunger and this will take a toll on their health in the long run. If governments are unable to address the basic and urgent needs of their people by enacting comprehensive health policies and increasing public expenditure, impoverished families will not be able to afford medical costs, thereby exposing their children to greater health risks.

What is Next for the World?

The current pandemic has shown that countries are not making equal strides in ensuring healthy lives and promoting well-being. The lack of synchronisation means that when the current health crisis occurred, both developed and developing countries failed to respond quickly enough by adopting appropriate measures in maintaining early warning systems, mitigating health risks and containing the spread, not to mention initiating international collaboration to support vulnerable countries and communities in need. Instead, this pandemic will inevitably reverse years of progress made in achieving this SDG.

To respond to the needs of the most vulnerable, World Vision has begun a global response in over 70 countries around the world, which includes promotion of preventive measures, support for health systems and care for affected children. A report titled Unmasking the Impact of COVID-19 on Asia’s Most Vulnerable Children was published in June and detailed the results of our assessment in nine countries in the Asia Pacific region. The report shows that livelihoods of more than 60% of families were fully or severely affected by the COVID-19 pandemic. With the economy worsening, 17% of caregivers are reducing their food intake to provide for their children (29% for Sri Lanka and 21% for Bangladesh), putting their own health at risk.

At the time that this article was being written, the pandemic showed no sign of slowing down. Living in such extraordinary times, we are certain that the world’s progress, especially that of health and well-being, will be hugely hampered and delayed by the COVID-19 pandemic, with vulnerable children and families being the most affected. It is down to us to show them the concern that they deserve.

The New Normal (India)

When India’s countrywide lockdown began on 25 March 2020, Shiv Kumari’s role as a community health worker and World Vision volunteer changed. Life came to a halt in Delhi and World Vision staff members were barred from visiting the communities we serve. However, as a government-appointed community health caregiver, Shiv Kumari has the license to visit and sensitise the community even during lockdown. She carried out surveys for World Vision and has been our hands and eyes in the community. Through Shiv Kumari and other volunteers, World Vision has been able to continue relief distribution in the communities.

Shiv Kumari has always been on the forefront and a beacon of light in these dark times. She was the helpline that connected people to the government and World Vision, and she made sure that people had access to all government facilities from cooked food to free COVID-19 tests. Pearls of sweat roll down Shiv Kumari’s forehead as she navigates the alleys of her community, with her face covered with a mask. Delhi’s weather in summer can be quite extreme: the temperature that day reads 40°C. “It’s so hot I don’t want to wear a mask, but my work is such that I have to wear a mask throughout the day,” she says. This is the predicament she has to live with during this time of pandemic: the new normal.

Shiva Kumari, 42, is an accredited social health activist (ASHA), a community health worker instituted by the Government of India's Ministry of Health and Family Welfare as a part of the National Rural Health Mission. As an ASHA worker, her job is to educate the community about safe child birth, timely immunisation of children, looking after pregnant women and informing on general health. She has also been a World Vision India volunteer for eight years.

Shiv Kumari’s locality is an impoverished slum in North Delhi. Here houses are stacked up like shipping containers, with no courtyards and the main doors connected to a small lane just big enough for one person to walk at a time. “Families of 4-5 live in a small one-room house. Since they have limited space inside the house, they spend a lot of time outside in the small lane. This makes social distancing almost impossible in the community. People don’t listen. So I have to do a lot of house visits to sensitise about the safe practices,” says Shiv Kumari.

“My workload has definitely increased because of COVID-19. I do house-to-house survey and tell the community about the disease. We take body temperatures and send people for testing if we find that their temperatures are high. We also make sure that no one is starving in the community,” she adds. However, they are still a long way from the normalcy that they used to know. Schools have been closed since the lockdown began and there is little hope of reopening them in the near future.

COVID-19 hit the community hard when members of four families tested positive. Shabnam, 35, was tested positive and had to move into a government quarantine centre. She was most worried about leaving her two-and-a-half-year-old son, but the separation is also tough for her family members who had to remain in the house. The people who have tested positive have a stigma attached to them and it has been difficult for these families. Shiv Kumari and other World Vision volunteers, along with members of the Child Protection Unit set up by World Vision, stepped up and worked together to help meet the needs of these families. “We faced discrimination even from our relatives and the community. Shiv Kumari and the World Vision volunteers took care of us during that time. They delivered food to our doorstep,” says a grateful Shabnam who has fully recovered and returned home.

The community has no drainage and therefore no toilets at home. Everybody uses the public toilets, even families who have tested positive. Therefore, it has become a responsibility for Shiv Kumari and other volunteers to make sure that social distancing is maintained and hygiene practised. “Now people clean their vegetables properly before cooking. They wash their hands and shower regularly. General hygiene has improved because of COVID-19,” observes Shiv Kumari. Washing hands has become a matter of life and death.

As a mother of three adult children, Shiv Kumari cherishes the extra workload in the pandemic despite also having responsibilities at home. Her spirit remains high even after four months of service and that energy is drawn from deep within. “God has sent me here to serve. My destiny is to serve others,” says Shiv Kumari.

“I know my job is risky, but I will do my best and I believe that God will protect me.”

The Pandemic Has Made My Dream Come True (Afghanistan)

The work at the freight yard was very hard, so Masoud only had two wishes - being able to sleep in the morning and pursuing an education in order to become a doctor. Never had he thought that the current pandemic would have helped his wish come true.

Masoud is just 13 years old, but he has been working since he was just six. “When my friends and I are working, most children are still asleep,” he explains. Until recently, he worked with his father in a freight yard, and they would arrive early each morning before the first call to prayer, just as the sun was peeking over the horizon. “If I’m late, others will carry the items and there will be no work left for me,” Masoud explains. “I have to be at the yard before the trucks arrive in order to get work.”

Two years ago, Masoud started his education when he was enrolled in a World Vision programme that helps street children through a local enrichment centre. Masoud used to study part time after work, but, unexpectedly, the coronavirus pandemic has now made his first wish come true.

“One early morning I went to work with my father. The roads were blocked by the police, but we used other ways to get there. The door of the freight yard was also closed, and we got hopeless and sad. We asked the people what is going on, and they said ‘corona’ had come. I didn’t understand what was happening, but finally we came home. My father and I lost our jobs at the freight yard, but I achieved my dream of sleeping till six in the morning.”

One day soon after he lost his job, Masoud went to the enrichment centre, but things were a bit different when he arrived. “As soon as I entered, I was given a mask and gloves. Instead of how we sat normally, now we sat in chairs placed far apart.”

“We received an information sheet, and the teachers explained about the coronavirus and the hygiene practices we needed to fight with this virus.” Masoud also left the enrichment centre that day with a new mission. “The teachers asked us to pass these learnings onto others, and I’ve played my role,” Masoud added proudly.

Before, Masoud didn’t know what coronavirus was and believed his father when he told him it did not exist. But now, Masoud has been able to share his knowledge and help his father and friends stay safe from the virus. Although Masoud and other child labourers are some of the most vulnerable to being exposed to the virus, many do not have access to television and other media where awareness messages are typically shared. However, now equipped with the knowledge from the enrichment centre, Masoud is able to share information to stop the spread of the virus.

Masoud is still working, this time as a rubbish collector, but he is hopeful that his new awareness will help keep him safe as he works to support his family. And maybe one day, his other dream of graduating from school and becoming a doctor might still come true.