As globalization advances, the international community has been confronted with various challenges such as disparity and poverty, terrorism, refugees and displaced persons, climate change, and marine plastic litter. These social, economic, and environmental issues are intertwined with one another, and are linked across national boundaries. In order to resolve such transboundary global issues, it is necessary for the international community to move beyond the conventional concept of developed and developing countries, and to work together to address the issues.

The Sustainable Development Goals (SDGs) are 17 international targets to be achieved by 2030, which were agreed upon by all UN member states at the UN Summit held in September 2015 as a successor of the Millennium Development Goals (MDGs). While the MDGs were targets established for developing countries, the SDGs represent a commitment by the entire international community including developed countries, and therefore could be described as a “compass” providing the direction toward the simultaneous and fundamental resolution of global issues that concern all these countries.

This section features Japan’s initiatives aimed at achieving the SDGs through the resolution of global issues, from the perspective of various fields including health, water and sanitation, education, gender, environment, and climate change.

(1) Health and Medical Care

Many people in developing countries do not have access to basic health services that are available in many developed countries. Even today, more than 5.4 million children under the age of five die annually due to infectious diseases, malnutrition, diarrhea, and other preventable causes. Over 303,000 women die during and following pregnancy and childbirth per year; lack of emergency obstetric care provided by skilled health professionals such as obstetricians, gynecologists, and/or midwives is a leading cause of these deaths. Furthermore, rapid population growth has made poor countries suffer from further poverty, unemployment, hunger, poor access/quality of education, and environmental deterioration. This led to SDGs Goal 3, set as “Ensure healthy lives and promote well-being for all at all ages.” In addition, we must respond to various health issues which differ across countries and regions, and ensure that all people have access to basic health services at an affordable cost when needed. To that end, it is important to achieve “Universal Health Coverage (UHC).”

■Japan’s Efforts

●Promotion of UHC

Japan has attached importance to measures to improve healthcare that is directly linked to human security. In light of the establishment of the “Development Cooperation Charter” in February 2015, the Government of Japan established the “Basic Design for Peace and Health” as a theme-based guideline for global health policy in September the same year. This policy aims to utilize Japan’s expertise, technologies, medical devices, and services in order to achieve the following: (i) establish a system to respond to public health emergencies such as Ebola virus disease, and (ii) provide basic health services for all people throughout their lifetimes. These efforts are also important for tackling challenges in global health identified in the SDGs.

Universal Health Coverage (UHC) means everyone has access to basic health services at an affordable cost when needed. The achievement of UHC is important for narrowing disparities in healthcare services, meeting basic health needs of all people, and enabling aid recipient countries to consider and solve their own health challenges. The Government of Japan has actively taken the lead in promoting UHC as a “Japan Brand” in international discussions, such as the G7, TICAD, and UN General Assembly. Thanks to these efforts by Japan, the Sustainable Development Goals (SDGs) adopted in 2015 included the achievement of UHC as one of its global goals.

At the G7 Ise-Shima Summit held in 2016, the leaders agreed to strengthen the capabilities of the international community to cope with public health crises such as infectious diseases, as well as promote UHC, which is key toward resolving a wide range of health issues, better preparedness for crises, and strengthen efforts to deal with antimicrobial resistance (AMR). Reflecting these points, the “G7 Ise-Shima Vision for Global Health” was issued. In December 2017, the “UHC Forum 2017” was held, wherein Japan announced its commitment of a total of $2.9 billion to boost UHC initiatives to support efforts by various countries and organizations to achieve UHC. Furthermore, Japan has proactively raised the importance of sharing knowhow on promoting UHC with international organizations and donor countries, as well as enhancing cooperation toward strengthening health systems in developing countries at fora such as the UN General Assembly and G7 Ise-Shima Summit. As such, Japan has played a leading role in establishing the “International Health Partnership (IHP) for UHC 2030” (commonly known as UHC2030), which has been developing aid coordination frameworks for healthcare.

With regard to Africa, Japan positioned the promotion of UHC as one of the priorities of TICAD VI held in 2016, and has actively provided assistance to Africa through policy yen loans to Kenya and Senegal, toward the achievement of UHC. Furthermore, at the TICAD Ministerial Meeting held in October 2018, Ministers reaffirmed the necessity of promoting UHC based on the idea that resilient health systems provide a foundation for supporting a healthy and productive population, which in turn brings about comprehensive growth. Japan also announced that it would address new challenges in Africa such as improving financing in the health sector and strengthening the role of the private sector, while working closely with international organizations.

Moreover, Japan announced together with the World Bank, World Health Organization (WHO), the Global Fund, and other organizations, on the “UHC in Africa,” which sets out guidelines and specific actions that serve as a reference towards the realization of UHC. During the UN General Assembly High-Level Week in September 2017, Japan hosted an event to promote UHC, and generated global interest in the importance of UHC. Following that, at the UHC Forum 2017 held in Tokyo in December 2017, with the participation of Prime Minister Abe, Deputy Prime Minister Aso, United Nations Secretary-General Guterres, President Sall of Senegal, and other global leaders in the field of global health, the “Tokyo Declaration on Universal Health Coverage” was adopted. This Declaration represents the commitment toward accelerating initiatives for achieving UHC, and advocates the strengthening of global momentum toward achieving UHC, as well as the strengthening of cooperative systems among countries and organizations. In addition, Prime Minister Abe announced that Japan will provide a total amount of $2.9 billion in support going forward, to boost efforts on UHC by various countries and organizations. Furthermore, in April 2018, the UHC Finance Ministers’ Meeting was held during the IMF/World Bank Spring Meeting. During this event, Japan emphasized the importance of cooperation between finance ministers and health ministers, and of the involvement of finance authorities in building a sustainable health financing framework for achieving UHC.

In particular, under the “Basic Design for Peace and Health” enacted in 2015, Japan provides assistance that utilizes its experience, technology, and expertise, to achieve UHC that will “leave no one behind,” including the poor, children, women, persons with disabilities, the elderly, refugees and displaced persons, ethnic minorities and indigenous people. Specifically, support includes tangible assistance such as building hospitals, supplying medicines and medical devices, as well as non-tangible assistance such as human resources development and system building.

Primary healthcare services under UHC comprise all services ranging from nutritional improvement (see “(8) Food Security and Nutrition”), vaccination, maternal and child health, sexual and reproductive health, infectious disease control, non-communicable disease (NCD) control, and comprehensive community care and long-term care for the elderly. Among these, immunization is one of the most cost-effective investments, and it is estimated that 2 to 3 million lives could be saved through immunization each year. Japan has provided a total of approximately $110.6 million (Note 11) to Gavi, the Vaccine Alliance,* which was established in 2000 to improve the immunization rate in developing countries, since its first contribution in 2011. Gavi has provided immunization for 700 million children and saved more than 10 million lives since its launch in 2000. In order to promote this initiative, the Government of Japan announced in 2016 that it would provide an additional contribution of $76 million by 2020. As for bilateral assistance, Japan will contribute to increasing vaccination rates by providing assistance for vaccine production and management, as well as the maintenance and management of cold chains.

With regard to maternal and child health in developing countries, unachieved goals remain a big challenge, despite a significant reduction in the under-five mortality rate and maternal mortality rate, as well as an increase in births attended by skilled health professionals. Japan’s assistance aims to strengthen sustainable health systems by providing comprehensive, continuous maternal and child care and strengthening the ownership and capabilities of developing countries. In pursuit of these aims, Japan has been supporting countries such as Ghana, Senegal, and Bangladesh in an efficient manner. Through these assistances, Japan contributes to making necessary services accessible to all women at every stage of pregnancy (including that of adolescence and family planning), as well as for newborns and infants.

Furthermore, Japan is implementing activities utilizing the Maternal and Child Health (MCH) Handbook as a means of improving maternal and child health, based on its experience and expertise. The MCH Handbook can contribute to the Continuum of Care (CoC), from pregnancy, childbirth, the post-partum period (the period after the birth until the woman recovers to a similar condition before pregnancy, usually about one to two months after birth), the neonatal period, infancy, and to early childhood. It also enables mothers to acquire knowledge about health, which in turn raises awareness, and encourages behavior modification. Indonesia, where the MCH Handbook is already being widely used across the country by cooperation of Japan, shared its experiences and learnt mutually with Thailand, the Philippines, and Kenya where the MCH Handbook has been similarly utilized to provide maternal and child health services. These countries also discussed further possibilities as well as challenges of the MCH Handbook. In order to review the needs for conducting international training on the MCH Handbook after 2018, Indonesia also invited participants from Afghanistan and Tajikistan, which are now implementing the trial use of the MCH Handbook, to engage in an exchange of opinions.

In addition, Japan works with other development partners, such as the United Nations Population Fund (UNFPA) and the International Planned Parenthood Federation (IPPF), to promote maternal and child health that includes sexual and reproductive health services, and thereby improving the health of a greater number of women and children in aid recipient countries.

●Public Health Emergencies

In a globalized world, as infectious diseases easily spread beyond national borders and have a serious impact on the entire international community, it is important to put in place countermeasures for emerging and re-emerging infectious diseases*. The Ebola outbreak in the countries of West Africa from 2014 to 2015 took many lives and resulted in the spread of infection to neighboring countries and the secondary infection of medical personnel, and thus became a major humanitarian, economic, and political challenge for the international community. Moreover, Ebola has been spreading once again in the Democratic Republic of the Congo since May 2018. In addition to financial assistance, Japan has seamlessly provided a variety of assistance to such affected countries and international organizations, including the dispatch of experts and provision of emergency relief goods. Furthermore, Japan supported the efforts to overcome the Ebola crisis through public-private cooperation such as the provision of medicine, rapid test kits, and thermography cameras utilizing Japanese technologies.

From the point of view that building a sustainable and resilient health system is crucial to controlling infectious diseases, Japan announced at TICAD VI in 2016 that it will strengthen the capacity of prevention, preparedness and response to public health crises, particularly in African countries, and realize an Africa in which all people have access to health services. To that end, Japan is swiftly implementing assistance that contributes to their social and economic recovery, including assistance for the health sector such as capacity building of medical staff and improvement of medical facilities, infrastructure development, and food security enhancement.

Moreover, Japan, as a nation that proactively contributes to the peace and prosperity of the international community, has led discussions in international fora such as the G7 and TICAD, on the establishment of a framework of the international community for responding to these health crises (the Global Health Architecture). In particular, on the occasion of the G7 Ise-Shima Summit in 2016, Prime Minister Abe announced a contribution of $50 million to the WHO Health Emergencies Programme. Japan contributed $25 million by the end of the same year, and $3 million in 2018. It also contributed approximately $10.80 million to the Contingency Fund for Emergencies (CFE) in 2016, and approximately $3 million to the WHO Health Emergency Programme in 2018. These contributions to the WHO Health Emergency Programme and CFE are being used to respond to the 2018 outbreak of Ebola virus disease in the Democratic Republic of the Congo.

In addition, with the support from the Government of Japan, the World Bank took the opportunity of the G7 Ise-Shima Summit to launch the Pandemic Emergency Financing Facility (PEF)*, and Japan announced a contribution of $50 million for the PEF before any other country. During the Ebola outbreak in the Democratic Republic of the Congo in 2018, PEF contributed $12 million to the crisis response efforts. Japan also led the establishment of the Standard Operation Procedures (SOP) for WHO to respond to emergencies in cooperation with the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Furthermore, Japan newly established the Japan Disaster Relief (JDR) Infectious Diseases Response Team in 2015, which were dispatched to the Democratic Republic of the Congo to provide assistance for the yellow fever outbreak in 2016, and for the Ebola epidemic in 2018. Through these efforts, Japan has been providing swift and effective assistance in infectious disease affected countries.

●Responding to Antimicrobial Resistance (AMR)

Antimicrobial resistance (AMR) (Note 12) is a serious threat to public health, and in recent years more and more countermeasures against AMR have been taken. Japan has formulated the “National Action Plan on Antimicrobial Resistance” in April 2016 in order to promote its own countermeasures. In the same month, Japan hosted the Tokyo Meeting of Health Ministers on Antimicrobial Resistance in Asia, and adopted the “Asia Pacific One Health Initiative on AMR” which comprises four pillars including a surveillance system and a laboratory network, as well as antimicrobial access and regulation. The G7 Ise-Shima Summit also took up AMR as one of the priority agendas of health, and compiled policies for the G7 countries to cooperate with each other. Moreover, at the High-level Meeting on Antimicrobial Resistance in the United Nations General Assembly held in September the same year, the “Political Declaration of the high-level meeting of the General Assembly on antimicrobial resistance” was adopted. The declaration required each country and the related United Nations institutions to promote countermeasures, and the Secretary General of the United Nations to establish cross-sectoral working groups. Accordingly, the Tokyo AMR One Health Conference was held in November 2017. AMR countermeasures were also discussed at the G20 Buenos Aires Summit in 2018.

●The Three Major Infectious Diseases (HIV/AIDS, Tuberculosis, and Malaria)

SDGs target 3.3 sets out the goal of ending the epidemics of the three major infectious diseases by 2030, and Japan has been providing support toward achievement of this goal through the “Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund),” an organization established at the G8 Kyushu-Okinawa Summit held in 2000. From the time of its establishment in 2002 to the end of December 2018, Japan has contributed approximately $2.119 billion to the Global Fund. Additionally, Japan provides supplemental bilateral aid to the developing countries receiving support from the Global Fund, in order to ensure that measures against these three major infectious diseases are implemented effectively in those countries. Japan also strives to strengthen mutual cooperation on health systems, community empowerment, and policies for maternal and child health in those countries.

As bilateral assistance for HIV/AIDS countermeasures, Japan is providing assistance such as spreading knowledge to prevent new infections, raising awareness, widely providing testing and counseling, and enhancing distribution systems of drugs to treat HIV/AIDS. In particular, Japan Overseas Cooperation Volunteers (JOCVs) for Infectious Disease and HIV/AIDS Control are vigorously engaged in activities such as the spreading of knowledge and understanding of prevention among more people, as well as care and support of people living with HIV/AIDS, mainly in Africa.

With regard to tuberculosis, under the “Stop TB Japan Action Plan,” MOFA and the Ministry of Health, Labour and Welfare (MHLW), in cooperation with JICA, the Japan Anti-Tuberculosis Association, and the Stop TB Partnership Japan, have contributed to reducing the annual number of deaths from tuberculosis in developing countries, particularly in Asia and Africa. These efforts aim to achieve a 10% reduction of the number worldwide (160,000 people, based on 2006 figures) by making use of Japan’s own experience and technology to take measures against tuberculosis through a public-private partnership. Also, based on the Global Strategy and Targets for Tuberculosis Prevention, Care and Control after 2015, a global strategy to achieve the targets by 2035, adopted by WHO in 2014, MOFA, MHLW, JICA, and other organizations revised the Action Plan once again in 2014, and reaffirmed that Japan will continue to work on measures against tuberculosis on a global level.

In addition to these efforts, with regard to malaria, a major cause of infant mortality, Japan provides assistance for anti-malaria countermeasures such as initiatives through the strengthening of local communities, and assistance in cooperation with WHO.

●Polio

Although polio is on the brink of being eradicated, Japan has been working mainly in cooperation with UNICEF to provide support for its complete eradication with a focus on three countries where cases of infection are still being identified (countries where wild strains of polio are constantly present)—Nigeria, Afghanistan and Pakistan. Specifically, in February 2017, Japan contributed ¥4 billion in support for measures to eradicate polio in Nigeria, Chad, Niger, Cameroon, and Central African Republic, in cooperation with UNICEF, and successfully immunized an estimated 72 million children under the age of five. In Nigeria, after a case of infection from the wild polio virus, which had not been discovered since 2014, was reported in 2016, no new cases of infection have been confirmed up until November 2018.

In addition, Japan has contributed a total of ¥13 billion in Afghanistan since 2002, in cooperation with UNICEF. Furthermore, in Pakistan, Japan has provided grant aid amounting to a cumulative total of more than ¥11 billion in coordination with UNICEF since 1996, and provided an ODA loan of approximately ¥6.3 billion in 2016. This assistance has contributed to reducing and eradicating polio. ODA loan conversion was adopted as a new approach for this ODA loan. Under this approach, the Gates Foundation repays the debt owed by the Pakistani government when certain targets are achieved. Most recently in FY2018, Japan also provided grant aid of approximately ¥1.009 billion to Afghanistan, and approximately ¥510 million to Pakistan. Through vaccinating approximately 31 million children under the age of five, these programs are expected to help in reducing the number of new polio cases as well as eradicate polio in both countries.

●Neglected Tropical Diseases (NTDs)

“Neglected Tropical Diseases (NTDs)” which include parasitic and bacterial infections such as Chagas disease, Filariasis, and Schistosomiasis, infect more than 1 billion people worldwide, and cause major socio-economic losses to developing countries. Since infectious diseases can have an impact beyond national borders, the international community must work as one to combat them. Thus, Japan also cooperates closely with all the relevant countries and international organizations on countermeasures against NTDs. Since 1991, Japan has engaged in launching a full-scale effort against Chagas disease, which is also known as a “disease of poverty,” in Central American countries, and contributed to reducing the risk of infection by providing assistance to establish a system for dealing with Chagas disease vectors. Also in 1998, Japan launched the “Hashimoto Initiative,” and has since contributed to global parasitic control efforts. With regards to Filariasis, Japan supplies educational materials to provide knowledge and understanding to a large number of people, in addition to antiparasitic agents. Moreover, Japan also conducts preventive education through the dispatch of JOCVs in order to reduce the number of new cases and prevent the spread of diseases.

Furthermore, in 2013, Japan launched the Global Health Innovative Technology Fund (GHIT Fund), the first public-private partnership in Japan, with the purpose of facilitating the development of new drugs for infectious diseases in developing countries, such as NTDs. The GHIT Fund aims to control infectious diseases in developing countries through the research and development (R&D) of effective therapeutic medicine, vaccines, and diagnostic products, while promoting global cooperation with R&D institutions both inside and outside Japan. Moreover, in 2016 Japan announced that it would make a total of $130 million contribution for UNDP in order to promote the R&D of new drugs against NTDs as well as to prepare and support the supply of drugs, and has been fulfilling this commitment steadily. Going forward, these efforts are expected to contribute to the treatment of patients suffering from NTDs in Africa and other parts of the world.

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1. Note 11:Until the beginning of FY2018
2. Note 12:Micro-organisms such as pathogenic bacteria and viruses having resistance to antimicrobial agents such as antibacterial and antiviral agents, rendering these agents ineffective.

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