Information and stories addressing children.

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IVI and GAVI: The Future of Vaccination in Developing Countries

IVIIn 2024, 4.8 million children below the age of 5 died worldwide, including a staggering 2.3 million newborns. Though the global mortality rate of young children is still far too high, it has almost halved in the past 25 years. In 2000, child deaths worldwide stood at an estimated 9.92 million. This decreased rate is thanks to a myriad of factors at play, but perhaps none more so than the advancement in immunization technologies.

The Work of GAVI and IVI

Organizations such as Gavi, the Vaccine Alliance and the International Vaccine Institute (IVI) are doing life-changing work, especially in developing countries.

Since Gavi’s establishment in 2000, it has aided in vaccinating more than 1.1 billion children in 78 countries; this is one-eighth of the globe’s entire population. These immunizations have, subsequently, averted more than 18.8 million future deaths, decreasing the global mortality rate drastically. Gavi particularly focuses on “zero-dose” children who have not received a single dose of their base-level vaccines and ensures that they are the first to be immunized.

The IVI, established in 1997, devoted itself exclusively to protecting vulnerable citizens of developing countries, who are situationally less capable of receiving necessary vaccinations. The remoteness of these nations creates barriers to immunization, including the lack of concrete infrastructure, weather conditions and political turbulence, among other factors. Currently, IVI operates under a treaty signed by both the World Health Organization (WHO) and 35 countries on several different continents. It is cementing local partnerships in developing countries, which lead to the issuance of immunization technologies in these nations.

Key Players

  • Dr. Sania Nishtar, CEO of Gavi, the Vaccine Alliance. Nishtar has devoted her career to campaigning and innovating solutions to global health issues. In 1998, Nishtar founded Heartfile, a nonprofit campaigning for health reform in Pakistan. More recently, Nishtar has focused on the improvement of vaccine delivery for Gavi. She has pioneered the integration of biometric technology into health care delivery, working with organizations like Simprints. Simprints has developed the first open-source biometric digital ID; its issuance in Bangladesh led to a 39% increase in maternal health coverage. Moreover, the introduction of Simprints in the Dhaka and Moulvibazar districts has confirmed the administration of more than 23,000 measles and rubella vaccines in these regions.
  • Dr. Shabir A. Madhi. Madhi is the current Dean of the Faculty of Health Sciences and Professor of Immunology at the University of the Witwatersrand, Johannesburg, South Africa. Currently, Madhi is devoted to important work on vaccines that protect both mothers and unborn babies during pregnancy from Group B Streptococcus (GBS) and Respiratory Syncytial Virus (RSV).GBS causes at least 90,000 newborn deaths and 46,000 stillbirths yearly; RSV is the leading cause of lower respiratory tract infections in children and causes at least 100,000 infant deaths per year. These deaths are highly concentrated in developing countries. Madhi has recently received licensure for a maternal vaccine that fights RSV. Vaccinating the mother against this virus drastically decreases the risk of disease in infants up to 6 months old.The rollout of this vaccination in developing countries will, undoubtedly, save countless lives. Madhi has also been working on a maternal vaccine for GBS, which, if successful, could have the benefit of protecting the mother, reducing risks of stillbirth and preventing disease in newborns. This vaccine, according to Madhi, should arrive by the turn of the decade.

Conclusion

By 2030, scientists are aiming to reach a neonatal mortality rate of at least 12 deaths per 1,000 live births, as compared to 17 deaths per 1,000 in 2024. With the increasing development and roll-out of advanced immunization technology in developing countries, this process should be faster than it has been in previous years. Deaths claimed by vaccine-preventable infectious diseases are on the decline. Thanks to numerous brilliant innovators, these numbers will keep decreasing.

– Sarina Maloy

Sarina is based in Bath, UK and focuses on Technology and Global Health for The Borgen Project.

Photo: Unsplash

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Driving Down Child Malnutrition in Sudan: Life-Saving Peanut Paste

Peanut PasteTwo-year-old Alfred arrived at a UNICEF stabilization ward in Juba with an arm circumference far into the red zone of severe acute malnutrition (SAM). Eight weeks later, he walked out the door with a sachet of life-saving peanut paste in Sudan, beaming for the first time in months. This story reveals proof that a simple nut-based food can tip the scales between life and death for Sudanese children.

Child Malnutrition in Sudan

Sudan and South Sudan together form one of the world’s hungriest corridors. The conflict has displaced millions; crop failures have destroyed harvests and inflation has made staple foods unattainable. Insecurity has also crippled supply chains and closed health clinics, limiting access to screening, early treatment and food aid in the hardest-hit regions like Darfur and Upper Nile.

In July–August 2024, unprecedented floods across Sudan destroyed nearly 205,500 acres of farmland and displaced more than 44,000 people. This wiped out entire cropping seasons, deepening food shortages and pushing thousands more children into malnutrition.

According to UNICEF, more than two million children aged below 5 suffer from malnutrition, with 522,000 experiencing SAM. However, some actions can be taken: outpatient programs using ready-to-use therapeutic food (RUTF) routinely achieve 90% recovery rates.

What Exactly is in a Sachet?

RUTF is a blend of roasted peanuts, powdered milk, sugar, vegetable oil, vitamins and minerals sealed in a foil pouch. Since the product is energy-dense, has excellent shelf stability and requires no water or cooking, caregivers can administer the full treatment at home.

This not only frees up overwhelmed hospital beds but also shields children from unsafe water sources and health facility overcrowding. Nutritionists call it “medicine you can eat,” and parents know it simply as Sudan’s life-saving peanut paste. One 92-gram sachet supplies more than 500 kcal and a full day’s micronutrients.

Proven Results

  • Affordable. A six- to eight-week SAM treatment course costs about $69, far lower than prolonged inpatient care.
  • Mass impact. In crisis zones like Sudan, these sachets have enabled community-level treatment, reaching more children with fewer resources.
  • Fast recovery. Children with SAM often show dramatic improvement in just a few days of RUTF use, regaining strength, appetite and energy.

Every foil packet of life-saving peanut paste in Sudan delivers food and medicine in one lightweight dose, a huge advantage as clinics are distant and clean water is scarce.

The Takeaway

A single peanut pack has become the strongest shield against child malnutrition in Sudan. Alfred’s recovery exhibits that children survive and thrive when resources, farmers and determined mothers converge around a foil packet.

– Arabella D’Aniello

Arabella is based in Toronto, Canada and focuses on Good News and Technology for The Borgen Project.

Photo: Flickr

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Bringing the Focus to Child Marriage in Angola

Child Marriage in AngolaAngola, located on the southwest coast of Africa, has little data on child marriage. However, from the statistics that have emerged, it paints a rather alarming picture. The lack of stories from underage brides can indicate that there has been little investigation into this topic, making it even more crucial that the internet is bringing the focus to child marriage in Angola.

The Hard Facts

Angola’s legal age of marriage is 18. However, this law can have exceptions. If the guardians of a minor believe marriage to be in the best interest of the child, children can marry from as young as 15.

In Angola, 8% of girls are married before they are 15 years old. While this can appear to be a relatively low percentage, that is still 929,000 young girls. The statistic is even higher for brides under the age of 18, at around 30%. This means that at least 2.9 million girls are married before they reach the legal age of marriage in Angola. While child marriage is less common for boys, 6% of boys in Angola also marry before they are 18.

Why is Child Marriage Happening in Angola? 

Gender inequality is a primary cause of child marriage. The perpetuated belief that girls and women are lesser than their male counterparts can contribute to violence against girls. More than 7,000 girls reported in 2020 that they had experienced some form of physical, verbal or sexual violence. And, that same year, there were reports of a further 15,000 cases of violence against children. Violence against women correlates with the increased number of child brides. From 2017 to 2020, the yearly number of reported child marriages rose from 11 to 267.

Young girls are subject to the majority of child marriages, highlighting the strong tie to gender inequality. Girls are valued more for their potential relationships with men, rather than for their own independent futures. Young women will have their development stunted by these marriages, teaching them to rely on their husbands rather than their own skills. 

Additionally, COVID-19 largely affected Angolan girls. Only 19.73% of children attended a school prior to the pandemic and the closure of schools from 2020 puts children at a heightened risk of falling victims to child marriage and/or gender-based violence. Since the schools have been re-opened there is no data to show how many children have returned to school. The children will have been impacted from the years without education, and many are now too old to return to their studies.

The Solutions from The Angolan Government

The Angolan Government are now bringing the focus to child marriage in Angola. It has pledged that by 2030, it will have ended child and forced marriages. It is among 20 countries that have committed to this cause. From 2013, the government has co-sponsored numerous Human Rights Council resolutions which focus on putting an end to child marriage. Amidst this, it also signed a statement at the Human Rights Council which implored a solution to child marriage.

In 2019, the Angolan Government stated that they were in the process of adopting a national strategy to prevent child pregnancies and marriages. The government continues to address the issue of underage marriages, and it is hopeful that with a strategy in place, it can significantly reduce the number of cases.

The Work of Mwana Pwo

Created in 2017, Mwana Pwo is an organization based in Angola that aims to inspire leadership amongst women. Mwana Pwo translates to “girl child” in Chokwe. Maria Malomalo created this organization after going to a clinic for check-ups during her third pregnancy and realizing she was nearly always the oldest woman there. She was only 30 at the time. Maria began to question why so many young girls were marrying and giving birth at such a young age, this led to the creation of Mwana Pwo.

In terms of bringing the focus to child marriage in Angola, Mwana Pwo created the project Just a Child in 2022. The organization Bread for The World funded it, which works to eradicate world hunger. The objective of Just a Child is to reduce the number of cases of child marriage in Angola.

Poverty definitely has links to child marriages. Many families view marriage as a way for girls to escape poverty and simultaneously reduce costs for a household. This is why the work of Mwana Pwo is so essential. By encouraging young girls to become leaders and seek an education, the organization is enabling them to escape poverty independently. 

Mwana Pwo has stated that “The impact of poverty on child marriage is undeniable, but sometimes you also have to ask ‘why don’t they sell their sons? So it’s the whole issue around gender inequality and looking at women as ‘things,’ not as people.” 

The organization has set up facilities that allow young women and girls to develop new skills. Its information hubs provide a place for girls to enroll in courses such as entrepreneurship, IT and business. These skills are life changing and enable young girls to take control over their own futures. The website for Mwana Pwo goes into further detail on the great work it is carrying out and what it has accomplished with donations.

– Katie Gray

Katie is based in Glasgow, UK and focuses on Good News and Global Health for The Borgen Project.

Photo: Unsplash

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#67Strong4Kids: Jennifer Garner Takes Strides of Hope

#67Strong4KidsJennifer Garner, an actress and Save the Children trustee, ran 67 miles in a powerful show of support for the organization’s global efforts to treat children suffering from malnutrition. Garner ran a mile each day for 67 days through the #67Strong4Kids campaign, a fundraising challenge to raise awareness for the $67 it would take to support a child with malnutrition. The challenge was to raise awareness of the costs to provide a complete, six-week course of therapeutic food that could save the life of a severely malnourished child.

Garner has been working as a Save the Children artist ambassador for more than a decade. On Sunday, June 22, she was joined in Santa Monica, California, by Peloton instructor Becs Gentry and hundreds of supporters who took strides of hope to raise awareness and funds for children suffering from malnutrition. This was the final stretch of the run, sponsored by Brooks Running. The attendance was to support the charity’s efforts to provide ready-to-use therapeutic food (RUTF) to children in danger of going hungry globally.

“I’m feeling emotional and just really grateful — grateful to people for seeing what I was doing and either joining in or cheering me on,” says Garner. “It just feels like a nice intention to be out there.”

Child Malnutrition

Around the world, one in five deaths among children aged below 5 is associated with severe acute malnutrition. This condition can cause permanent damage to children’s physical and cognitive development and make them more susceptible to illness.

Garner says, “With climate disruptions, conflict and inequality, more children than ever are suffering from the effects of severe malnutrition, a condition that is preventable and treatable. Our 67 runs may be behind us, but the race for kids’ futures is ongoing. Together, we can help. For only $67, a child can receive a six-week course of RUTF and along with it, a chance at a healthier future. Thank you for partnering with Save the Children by joining with Becs Gentry and me. You are part of the solution!”

As of June 22, the #67Strong4Kids campaign has raised $500,000 to support severely malnourished kids globally.

Garner’s Advocacy Efforts

Garner has advocated on Capitol Hill and brought Save the Children’s early childhood education programs to her state of West Virginia. She traveled to Arkansas, California, Kentucky, Mississippi, South Carolina, Tennessee and Washington to meet with lawmakers, press and philanthropists to raise awareness for the foundation.

Conclusion

Jennifer Garner shared that her decision to run every day “was a small promise that I could keep to myself every day, but would be meaningful for me.” She has set a groundbreaking example by taking strides of hope, where each stride counts.

Her drive to take initiative and accept the #67Strong4Kids challenge has inspired countless runners and fans. Through all of its participants, Save the Children has acquired some of the resources needed to support malnourished children globally.

– Abirame Shanthakumar

Abirame is based in Ontario, Canada and focuses on Celebs for The Borgen Project.

Photo: Wikimedia Commons

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WhatsApp Tutors in Lebanon Are Educating Refugee Children

WhatsApp Tutors in LebanonIn Lebanon, Syrian refugee children often face unreliable internet and little access to formal education due to the conflict that recently happened in the area. Early this year, after a ceasefire took effect in Lebanon, much of the infrastructure remains in ruins. As a result, the region’s education suffered a large toll and it lost opportunities. However, a small but mighty resolution began with an unexpected platform: WhatsApp.

The Problem in Lebanon

Education is highly dependent on the infrastructure it lies on. Proper facilities, strong internet and a safe region determine the quality of education. However, in Lebanon, many children, especially those affected by the recent conflict, are facing a lack of access due to overcrowding, cost and legal barriers.

The lack of a strong digital infrastructure primarily explains this, underscoring the importance of education facilities. Regarding Lebanon’s education sector, the system has faced multiple issues, from the refugee influx to a significant port explosion and the COVID-19 pandemic. As a result, public education opportunities began to dwindle as the infrastructure started to collapse. This is where WhatsApp tutors in Lebanon began to change the picture.

WhatsApp Tutors in Lebanon Comes to the Rescue

When the state cannot provide education, WhatsApp tutors in Lebanon rise to the challenge by creating virtual classrooms. On WhatsApp, peer tutors share voice notes containing lessons on various subjects, including math and science.

In the absence of physical classrooms, teachers and tutors use WhatsApp to distribute assignments and collect submissions. A nonprofit called Jusoor has started providing $25 grants to refugee families to help them afford phones and data packages, enabling their participation in virtual education.

To save data and prevent potential outages, educators conducted lessons through chat and audio, which created a community where students began to support other students. To save data and avoid potential outages, educators delivered lessons through chat and audio, fostering a community where students began supporting one another.

The biggest life-saver for many families was that WhatsApp only requires a smartphone. Many other online platforms require a computer or other expensive hardware. WhatsApp allowed tutors in Lebanon to reach more students simply through mobile access.

The Digital Future

Research has found that conducting education through online platforms such as WhatsApp is not as effective as the physical classroom. However, in Lebanon, it is important to understand that WhatsApp and other similar platforms are the only opportunities many kids have.

Learning does not require a building or sophisticated technology. In areas devastated by war and conflict, such as Lebanon, tutors are creating makeshift classrooms using only mobile phones, chat messages and voice notes.

Despite limited resources and unstable conditions, they built a space where education continues, proving that determination and creativity can overcome even the harshest barriers to learning.

– Kallen Zhou

Kallen is based in Hattiesburg, MS, USA and focuses on Business and Technology for The Borgen Project.

Photo: Wikimedia Commons

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Ciudad de los Niños: A Non-Profit’s Impact on Tijuana’s Children

Ciudad de los Niños (City of Kids): A Nonprofit's Impact on the Children of Mexico Ciudad de los Niños is a civil organization serving the community of Tijuana, Mexico. It offers a home for children from unsafe families, as well as childcare, psychological and educational programs. From a guiding value of co-responsibility, the nonprofit shares a commitment with society and families to protect, care for and support children experiencing social disadvantages. These disadvantages include financial hardship, mental health issues, disabilities and not having safe or reliable parental care. 

The Borgen Project spoke with Marta Beltrán, director of Ciudad de los Niños; Maryel Nieves, head of communications; Gladys, coordinator of CAI Albergue Infantil; and Cinthia Saavedra, coordinator of Unidad de Servicios Especializados, to gain further insight into the organization’s work. 

CAI Albergue Infantil (Children’s Shelter)

The Albergue Infantil is a shelter home for children who have experienced abuse or abandonment from their caregivers. The children’s cases are evaluated by the state. In this process, the children are moved to shelter homes like the Albergue Infantil offered by Ciudad de los Niños. There is no specific time frame for the length of cases, so children can spend anywhere from a few months to several years at the home.

Coordinator Gladys works directly with these children. She focuses on creating a family-like atmosphere and wants the children to have a loving and dignified childhood. She ensures that all fundamental emotional needs are met, guided by love.

Unidad de Servicios especializados (Unit of Specialized Services)

The Unidad de Servicios Especializados is Ciudad de los Niños’ psychological unit. Here, the nonprofit offers therapy to children and parents for mental health, trauma and disabilities.

Typically, the children are between 3 to 17 and a half years old. For kids with disabilities, the unit offers speech therapy, teaches sign language and provides hearing aids. For parents, they work with therapists outside the organization to connect them. Psychiatric services are included at the unit for patients who may need medication.

Prices are adjusted and decided after an assessment of family income. This allows low-income families to access needed psychological services. Equity is practiced, as the price is set using context and understanding of differing situations.

Initially, patients can have a hard time, as the therapists challenge them and help them confront difficult emotions. However, as treatment progresses, patients begin to feel proud of themselves for their successes. Similarly, the workers often have to figure out solutions, but feel very fulfilled seeing their patients’ progress.

Estancia Infantil (Day Care)

Ciudad de los Niños offers a daycare for working parents. To qualify for the program, both parents must be employed. However, the organization makes exceptions. If a parent is continuing their education, they may still qualify, since they cannot be with their child during class. Also, in consideration of summer vacation, children who are alone at home due to their parents’ working hours are accepted into the daycare. 

The daycare promotes equity, as low-income families can receive scholarships. Furthermore, the requirement helps ensure that working families have better access to childcare, as there is less competition from families with a stay-at-home parent.

Programa Educativo (Educational Program)

The children at Ciudad de los Niños attend public school and are further supplemented through educational programs at the organization. The organization connects with the schools to understand what each child needs to improve. They also focus on the students’ homework. Additionally, Ciudad de los Niños offers its own curriculum on art, plastic art and ecology.

The education program goes beyond its unit. It is present in all the aforementioned units, most notably at the Unidad de Servicios Especializados. In the case of mental disabilities, the unit implements pedagogy to provide effective aid to patients with neurodivergence.

All of the units work together. A child in the Albergue Infantil may go to therapy at the Unidad de Servicios Especializados and participate in the Programa Educativo after school for a concept they may not have understood at school.

Volunteers

Ciudad de los Niños welcomes volunteers across its programs, including at the Estancia Infantil, which supports young children. Volunteers assist with caregiving, play-based learning and basic needs such as organizing supplies. In the past, volunteers have donated school supplies and toys through independent fundraising efforts. The organization fosters a welcoming environment for volunteers, often including them in group activities and highlighting their contributions on social media.

Looking Ahead

Ciudad de los Niños offers direct aid to the community of children and even parents in Tijuana, Baja California, Mexico. At the Albergue Infantil, children are given a second chance at a childhood filled with love, respect and integrity that they did not receive in their original homes. At the Unidad de Servicios Especializados, children with mental disabilities or traumatic upbringings can seek healing and peace through the help of psychologists and therapists. Likewise, at the Estancia Infantil, hardworking parents receive child care support. This allows for social mobility, as parents can grow their careers or have two incomes instead of one. Finally, in the educational program, children receive further instruction in subjects like arts and ecology and receive help with their homework. Parents and children experiencing financial challenges, mental health concerns, disabilities and unsafe homes can find help at Ciudad de los Niños.

– Andrea Roji

Andrea is based in San Diego, CA, USA and focuses on Good News for The Borgen Project.

Photo: Ciudad de los Niños

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Vietnam’s Two-Child Policy Repealed: Here’s What That Means

Vietnam’s Two-Child Policy
Vietnam is in trouble. The country, in recent years, has become one of South-East Asia’s most talked about and exciting economies. The capital, Ho Chi Minh City, has become a thriving powerhouse of investment. However, demographics tell a different story. In 2015, Vietnam was declared an ‘aging’ country. Meanwhile, by 2035, it could become an ‘aged’ country. With a significant percentage of the population over 65, the momentum of the Vietnamese economy is coming to a gradual halt. When the birth rate dropped to 1.91, lower than the recommended replacement rate of 2.1, the government quickly acted and repealed Vietnam’s two-child policy.

Vietnam’s Two-Child Policy

Since 1988, the Vietnamese government has kept a rule of no more than two children per mother – this was in response to an extremely high birth rate of more than four babies in the 1980s. Given Vietnam’s struggling post-war economic state, it introduced the policy to control overpopulation. Demographics could, however, quickly stagnate the emerging Vietnamese economy in the 2030s, primarily hurting the poor the most, with rural and underdeveloped areas struggling to grow economically.

Challenges for the Elderly

Elderly Vietnamese often move from thriving cities, with developed infrastructure, to rural areas after retirement. With only two children to care for elderly relatives, many Vietnamese struggle in their old age, coupled with the lack of infrastructure in certain peripheral provinces. Younger Vietnamese workers are reluctant to move to these rural areas, with a lack of work opportunities and limited access to services. This disconnects retirees from their family, keeping young people in cities such as Hanoi.

The Vietnamese government spends a significant amount on health and social care. In the late ‘80s and early ‘90s, the percentage of state budgets spent on health, population and family-planning was around 30%. The rising elderly population would only continue the burden on government services, should the situation worsen. Many wonder what effect this rise will have on the existing poor in Vietnam; will the burden increase if poor families are having more babies? It is unclear that those in poverty will have more children as a result of these reforms.

Boosting Birth Rates

Vietnam already spends 5% of the state budget on health, population, and family planning. If these birth-rate boosting measures were not put in place, social programs for the elderly are expected to cost 0.4% of GDP by 2050. The long-term costs clearly outweigh the risk.

The Vietnamese government also seems to be specifically targeting population centers such as Ho Chi Minh City, for increased fertility. Compared with the overall birth rate of 1.91, Ho Chi Minh City saw levels as low as 1.39. The government, in response to this, instituted a ‘baby bonus’ – a grant of around $120 for those having two children before 35.

By encouraging wealthier areas to have more children, alongside a robust family planning safety net, Vietnam can increase its birth rate whilst taking the burden away from poorer families. This allows the long term economic development and diversification necessary for Vietnam to continue its economic growth, further providing for the poorest in the country.

Why This Was Necessary

The window of opportunity was shortening. Vietnam has been clearly moving towards a situation all too common in Asian countries with strong or developing economies. An aging population, rapidly turning into an aged one, and not enough working-age adults to combat this. 

Short-term fixes have been put in place, such as a raise in the retirement age from 55 to 60 for women, and 60 to 62 for men. The Prime Minister has even made personal pleas, asking women to marry before 30 and have two children before 35. These efforts, however, are only small aspects of a larger story.

Repealing Vietnam’s two-child policy demonstrates a structural shift in the Vietnamese government’s approach to combating the aging population. This move will not only help the poor in the long-term, but future-proof the Vietnamese economy against imminent stagnation.

– Lee Stonehouse

Lee is based in Newcastle upon Tyne, UK and focuses on Good News and Politics for The Borgen Project.

Photo: Wikimedia Commons

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Rwanda CHWs Child Survival: Volunteers Reduce Child Deaths

Rwanda CHWs child survivalRwanda’s community health worker model, widely known as “Rwanda CHWs child survival,” drove the nation’s under-5 mortality rate to plummet from 158 deaths per 1,000 live births in 2000 to about 40 in 2023, a drop exceeding three-quarters. That feat makes Rwanda one of only four low-income nations to clear the 75 % benchmark since 2000.

Life-Saving Trios in Every Village

At the core of Rwanda’s child survival strategy is a network of about 45,000 CHWs, three elected volunteers in each of the country’s nearly 15,000 villages. The “binôme,” a male-female CHW pair, treats common childhood illnesses such as malaria, diarrhea and pneumonia, diseases that pose serious risks to young children. Meanwhile, a female maternal health worker monitors every pregnancy from the first trimester to postpartum.

Most recruits complete about three months of intensive classroom and hands-on instruction in integrated community case management, maternal-newborn care, nutrition counseling and family-planning services. They must score at least 80 % on a post-course exam before being certified; brief refresher modules update drug protocols and data-reporting skills each year.

Cash for Results Keeps Quality High

Since 2009, Rwanda’s Ministry of Health has operated a community performance-based financing (cPBF) scheme that sends group bonuses directly to legally registered CHW cooperatives. These quarterly bonuses, wired through the Ministry of Economy and Finance, are released only after each group meets specific maternal and child health targets.

Under the original split, 30% of every payment went to individual workers and 70% stayed in the co-op account to build capital. Co-ops invest that reserve in income ventures and about 52.7% choose livestock projects such as dairy goat or poultry sheds. In contrast, others buy bicycles, maize mills, or seeds for micro-loan funds.

Profits boost household income and keep attrition low, while the promise of the next bonus keeps each village team laser-focused on service coverage and timely referrals.

RapidSMS: A Text That Saves a Life

A 2018 nationwide evaluation reported that Rwanda’s CHWs fired 9.3 million RapidSMS messages between 2012 and 2016, flagging births, danger signs and supply gaps in real-time. Those real-time alerts let supervisors dispatch antibiotics, restock bed nets and organize ambulances faster, raising antenatal care, facility delivery and post-natal rates in the districts studied.

Scaling Up Again

Rwanda is digitizing its frontline workforce by formulating an electronic Community Health Information System (eCHIS). It was built in 2023 and a pilot has already helped train 600 community health workers across three districts to capture visits on a smartphone app.

Also, on May 30, 2025, Rwanda’s Health Ministry rolled out a new AI-powered mobile platform to train and support all 58,567 CHWs on their smartphones, replacing costly face-to-face workshops. The system links each visit to the community electronic medical records (cEMR) database so supervisors can track patient trends and drug stocks in real-time.

Conclusion

Rwanda’s experience proves that community trust, modest pay for performance and real-time data can significantly reduce child deaths. Health ministries that are struggling with high under-5 mortality now have hope to combat it, especially with the Rwanda CHWs child survival model.

– Arabella D’Aniello

Arabella is based in The Hague, Netherlands and focuses on Good News for The Borgen Project.

Photo: Wikimedia Commons

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Addressing Healthcare in Nepal

Healthcare in NepalNepal is a country in South Asia, home to some 30 million people. The country is located in the Himalayas, bordering China and India. Nepal is also known for being the home of the tallest mountain in the world; Mt. Everest, as well as being the birthplace of the Buddha. Nepal is a developing country, and as a result, it still faces certain challenges when it comes to healthcare. Rural healthcare in Nepal can be particularly challenging.

About Healthcare in Nepal

Nepal is a predominantly rural country. Approximately 79% of the country lives in rural areas. As a result, there is a significant urban and rural divide in the country when it comes to healthcare. Because of the country’s hilly and mountainous terrain, expanding healthcare programs to rural areas can be challenging. Rural areas have fewer clinics, healthcare personnel and medical equipment than urban areas. Rural healthcare in Nepal faces many such challenges. The access to proper healthcare is not distributed evenly throughout the country.

A mix of public and private services provide healthcare in Nepal. The government provides basic healthcare services. Private sectors provide a larger number of services. People in urban areas rely more on the private sector for healthcare. People in rural areas rely more on public healthcare services. Pharmacies are the leading providers in the private sector. But in general, most citizens rely more on the private sector. About 63% of Nepalese relied on the private sector regardless of their economic background. Public hospitals are the primary healthcare facilities in the country, followed by primary healthcare centers, health posts, private facilities and basic healthcare service centers.

Challenges With Healthcare Access in Nepal

About 20.3% of the Nepalese population lives below the poverty line, according to the Asia Development Bank (ADB). The United Nations classifies Nepal as one of the least developed countries in the world. This makes it difficult for the Nepalese government to provide adequate healthcare, especially in rural areas. The country’s economic status makes rural healthcare in Nepal a challenging endeavor for the government.

Despite its economic situation, the Nepalese government has taken efforts to improve the country’s healthcare situation. The country’s constitution declares healthcare a fundamental human right. It also guarantees that every Nepalese citizen has a right to free basic healthcare services from the state. In addition to this, the Nepalese government has initiated a national immunization program to vaccinate the population against various diseases. In 2015, the government passed the Immunization Act, which confirms the right to vaccinations for all children by way of an efficient immunization program.

Nepal has also had programs specifically designed to vaccinate children. About 65% of 1 to 2-year-old Nepalese children have received all necessary vaccines. However, there is still room for improvement. Specifically, there are significant disparities regarding who receives vaccines. Education level and caste play a big role in vaccine distribution. People belonging to lower castes, and those who have not received any education are less likely to be properly vaccinated. The urban and rural divide comes into play here, as people living in rural and remote areas are less likely to have received proper vaccinations due to their caste or education level.

Solutions

In 2012, the country began the Reaching Every Child program to vaccinate all Nepalese children. The program is part of the broader National Immunization Program, designed to properly immunize and vaccinate citizens from deadly diseases. Through this program, the Nepalese government aims to vaccinate every child across the country, regardless of whether they live in urban or rural areas.

Other strides have been taken to expand rural Nepal’s access to healthcare. The Internet Society is leading an Effective Broadband for Health program for rural areas in Nepal. The program established wireless broadband services in Nepalese villages. It also provided remote villages with telemedicine solutions, and helped build proper healthcare infrastructure.

Looking Ahead

Nepal still has a lot of room for improvement when it comes to expanding healthcare to rural areas. Rural areas still lack things like healthcare infrastructure, personnel, medicine and accessibility. However, the country is actively working to improve the situation. The constitution declares healthcare a human right and gives every citizen access to free basic healthcare services. Additionally, companies like the Internet Society are also working to expand healthcare access to remote areas through wireless broadband services. 

– Samriddha Aryal

Samriddha is based in Centreville, VA, USA and focuses on Celebs for The Borgen Project.

Photo: Wikimedia Commons

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Digital Birth Registration in Nigeria

Digital Birth Registration in NigeriaIn Nigeria, more than 50% of children under 5 years old remain unregistered at birth, leaving more than seven million children without legal identity or access to essential services. Without formal documentation, these children often cannot receive vaccinations, enroll in school or access societal protection programs. Birth registration is a fundamental right under the Convention on the Rights of the Child. It plays a critical role in protecting children from trafficking, child labor and early marriage. However, digital birth registration in Nigeria is a powerful tool for addressing this gap.

In partnership with UNICEF and the National Population Commission (NPC), the Nigerian government has launched an ambitious initiative to digitize birth registration in Nigeria. It aims to do this through an integrated Electronic Civil Registration and Vital Statistics (e-CRVS) system. The program aims to register more than nine million under 5 children and five million infants using mobile devices and a cloud-based digital database.

How Digital Registration Works

The pilot phase of the e-CRVS program was active at test sites in Nasarawa, Lagos, Kano, Borno and Enugu states, where local health facilities and mobile teams register children at the point of care. Digital tables and software allow frontline workers to capture live birth data and instantly generate certificates. The system is linked to Nigeria’s National Identity Number (NIN) platform, operated by the National Identity Management Commission (NIMC), ensuring each child receives a permanent identity number for life.

This integration allows public institutions to cross-reference birth records with healthcare, immunization and education systems. It also makes tracking child development easier, planning vaccine campaigns and ensuring social services reach the most vulnerable.

Health Benefits of Legal Identity

A legal identity is not just a certificate but a gateway to health equity. According to UNICEF, children enrolled through digital birth registration in Nigeria are more likely to be vaccinated, receive medical care earlier and attend school. In regions with low birth registration, health systems often struggle to track and follow up with children who miss vaccines or drop off routine care schedules.

Digital birth registration allows real-time data to be shared with national immunization registries, helping ministries of health identify gaps, forecast demand and avoid supply chain breakdowns. This is particularly crucial in rural areas where children are most at risk of preventable disease and malnutrition.

Supporting Sustainable Development Goals

Nigeria’s digital birth registration initiative aligns with Sustainable Development Goal (SDG) 16.9, which calls for providing legal identity for all, including birth registration, by 2030. The initiative also contributes to broader SDGs focused on child health (SDG 3), inclusive education (SDG 4) and gender equality (SDG 5) by ensuring that girls and boys alike are counted and protected from birth.

Final Remarks

According to the latest edition of the ID4D Global Dataset, approximately 1.25 billion people do not have a digitally verifiable identity, primarily due to documentary requirements and distance to registration points. Many of these people reported the consequences following them into adulthood through financial and technological barriers. Nigeria’s scalable model could serve as a blueprint for other low and middle-income countries seeking to close the identity gap.

By digitizing birth registration, Nigeria is improving access to basic health and education services and restoring visibility, dignity and protection to millions of children who have long been left out of the system. As implementation continues, the program could reshape how governments track child welfare, deliver public services and uphold the rights of every child, starting from day one.

– Rebecca Lee

Rebecca is based in Scotland and focuses on Technology and Global Health for The Borgen Project.

Photo: Flickr