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THE TRIPLE TRANSITION


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The triple transition encompasses 3 shifts in Global Health:

  1. Economic growth spurring low-income countries to middle income status.

  2. Epidemiological transition: Shift in disease burden from infectious to non-communicable diseases.

  3. Widespread adoption of Universal Health Coverage.

Africa's economic progress over the last two decades has seen a growing number of low-income countries transition to middle income status. Concurrently, donor countries that have felt effects of the financial crisis and now find themselves dealing with a global pandemic, have been forced to reassess their budget sizes. This shift has meant that the external support previously received has reduced as donors re-evaluate and prioritize their available resources to areas in most need. Middle income countries are now expected to be not only more self reliant, but to also extend economical support and leadership to low-income countries regionally. This transition is delicate, since these countries also run the risk of falling back to low-income status. In order to consolidate the social and economic progress made, it is important to build on the lessons learnt and facilitate a knowledge transfer to neighbouring countries. Donor countries also need to continue providing incentives to countries that have demonstrated consistent growth during their own transition and have a proven track record of compliance, integrity and leadership.


The Epidemiological transition has been as a result of the multiple factors and is largely as a result of successes in Global health over the past five decades. As populations become healthier, mortality rates reduce. This means that older populations begin experiencing an increase in the incidence of diseases such as hypertension, obesity and diabetes that tend to affect older populations or are as a result of a more abundant lifestyle. Modern medicine as evidenced by the technological advancements in the pharmaceutical and therapeutics industries as well as medical equipment and specialized human resource has seen the development of better antibiotics, vaccines, antimicrobials and quality health service delivery. This has reduced the burden of communicable diseases and shifted the focus to non-communicable disease (NCD). However, this risk of transition towards NCD's unilaterally can cause a backward shift to communicable diseases if the focus isn't balanced and data driven as evidenced by the Covid-19 global pandemic.


Universal health coverage mandates that individuals and communities receive the health services they need without suffering financial hardship. The goal is to ensure all people can equitably access quality health services to safeguard all people from public health risks and to protect people from catastrophic impoverishment either as direct result of out-of-pocket spending on healthcare or as a result of the illness itself. This includes access to affordable essential medicines and vaccines for all. Countries need to be equipped to allow Universal health coverage to succeed and this requires legislation at all levels and strengthening of health systems across the board. A key component of Universal Health Coverage will be the shift in focus from curative interventions to preventive interventions with an aim towards building all-round healthier generations.


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