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By 2050, I hope the world shares a global conviction that health progress is worthwhile for all. To get there, we must ground our work in excitement about a new generation of health innovations being able to solve old problems. It must be championed across Africa and South and Southeast Asia, embraced by political and cultural leaders worldwide and backed by a global network of funders. If we are successful, we will witness the end of preventable maternal and child deaths; the establishment of strong domestic systems for evaluating, approving and distributing new innovations; global enthusiasm for a handful of world-class health multilaterals; and restored development assistance for health to at least pre-pandemic levels. A shared vision Here’s a 2050 scenario I believe is in reach: At a global health conference, a Nigerian health advocate named Aisha tells her story. As a young pregnant woman in a rural area in 2035, she was visited by a community healthcare worker who — with minimal training and in minutes — used her phone to perform an ultrasound confirming Aisha’s baby was neither breech nor underweight. When armed conflict erupted nearby, prenatal medications were delivered by drone. Months later, she began bleeding and went to the nearest clinic to deliver. There, a package of data-based interventions reduced subjective assessments by her clinician, as research shows that visual judgment of how much a woman is bleeding during childbirth can be off by up to 89 percent. Removing the guesswork, the clinician used a simple surgical drape (a sterile sheet or piece of fabric) that measured Aisha’s blood loss. When Aisha exceeded the margin of safety, an automatic protocol of anti-haemorrhaging medicine was prescribed. Aisha’s baby was born healthy, receiving a stick-on, heat-stable vaccine patch. Back in her village, Aisha continued her child’s pentavalent vaccine series with locally available patches, swiftly protecting against deadly diseases at 6, 10 and 14 weeks. Over the next decade, Aisha becomes a health worker, going door-to-door encouraging other mothers to vaccinate their children. Through advances in digital connectivity, she joins a coalition of community health organizers across Africa and Asia advocating for new treatments and benefiting from policy reforms and research innovations that cut approval times for breakthrough vaccines in half. In India and Kenya, digital platforms transform real-time monitoring of drug safety and uptake in ways unimaginable from the days of the COVID-19 pandemic. A new multilateral emerges as a trusted hub for channelling diversified resources into climate-driven health risks and pandemic readiness. Thanks to new commitments — from African sovereign wealth funds, blended finance instruments and debt restructuring deals — development assistance enjoys a reincarnation. Maternal and child health outcomes across low- and middle-income countries are at their best point in human history. It is this mix of high and low tech that shapes the future and saves lives. This is also a future we must earn. History tells us that women, children and those living in poverty are not centered in the story without hard-fought advocacy. Today the headwinds are extreme: development assistance for health is projected to fall by at least 20 percent from 2024 levels, hitting Global South health systems hardest. Yet progress needs to be nine times faster to reduce maternal mortality to meet targets the world set for itself on these basic measures of humanity; at the current pace, the world will miss the deadline by decades.
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