Archive for category: Global Health

Information and stories about global health.

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How Health Riders in Thailand are Expanding Healthcare Access

health riders in ThailandGetting free medical care in Thailand does not always mean getting care at all. Official 2024 data from the Office of the National Economic and Social Development Council shows that 3.43 million Thais, which is 4.89% of the population, earn less than 3,078 baht, or $92.50, per month. That is the government’s defined poverty line. Within that group, 879,000 Thais fall into the “very poor” category, bringing home just 615 baht, or $18.48, monthly — about one-fifth of that poverty line.

Geographic Disparities

Where one lives in Thailand strongly determines how easily one can see a doctor. The agricultural sector suffers the most, with farmers making up 45.49% of all poor households. This is largely because gross farm incomes fluctuate wildly with weather and market prices. The way people spend their money also reveals deep inequality. The poorest 20% of households use half of their income just to buy food, while the richest 10% spend more on things like vehicles, electronics, travel and medical care.

This gap means that when poor families face serious illness, the cost of traveling to a distant city hospital often forces them to delay or skip treatment altogether, even though the care itself is free. That is where health riders in Thailand come in.

What Is Health Rider

In March 2024, Thailand’s Ministry of Public Health rolled out a new service called “Health Rider,” turning local health volunteers into home delivery drivers for prescription medicines. The program was announced by then-Public Health Minister Cholnan Srikaew at a ceremony in Nan province for National Village Health Volunteers Day. It fit under then-Prime Minister Srettha Thavisin’s “30-baht Plus” policy. That policy allows Thais to use just their ID card to access medical services anywhere in the country.

Health riders in Thailand focus on patients who are bedridden or have a hard time getting to hospitals. With the program’s help, these patients can have their medications dropped off at home at no cost. Before any delivery happens, a medical worker conducts an assessment to see whether it is safe for the patient to receive medicines this way. A telepharmacy system is also used to confirm that patients accept the drugs and understand how to take them properly. The program also gives health volunteers a chance to earn some extra money on the side.

Health Rider in Nan Province

The pilot program first launched in Nan province back in December 2023. In Nan, 14 hospitals participated in the test run, using a team of 78 health riders to bring medicines to patients who lived within 15 kilometers, or 9.3 miles, of those hospitals. Between December and March, they completed 2,796 delivery requests. The program also managed to shrink hospital pharmacy wait times by 14% each day.

By mid-March, Health Rider had expanded to 184 hospitals and clinics spread across 32 provinces. A total of 1,414 health riders in Thailand had delivered 44,174 medication orders. Based on the results of a ministry survey, 99.2% of patients said they were pleased with how fast their medicines showed up. They were also relieved to avoid a trip to the hospital just to pick up their prescriptions.

A Simple Solution With a Big Impact

Health Rider’s straightforward fix of bringing medicine to people solves one of the biggest obstacles to medical care that Thais face. For poor families in rural areas, the program means less money lost from hospital trips and less time away from work. With strong early results and high patient satisfaction, the service has the potential to further succeed in the foreseeable future as it continues to operate. It could reach millions more Thais who struggle to access medical care simply because of where they live.

– Melody Ruiz

Melody is based in Bronx, NY, USA and focuses on Good News and Technology for The Borgen Project.

Photo: Flickr

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How Water ATMs in Kenya Are Expanding Access to Clean Water

Water ATMs in KenyaFor millions of people, access to clean drinking water remains one of the biggest barriers to good health and economic opportunity. In Kenya, only about 68% of the population has access to basic drinking water services, meaning nearly one in three people still lack even a basic source of safe drinking water, with access dropping to just 56% in rural areas. Water ATMs in Kenya are helping change that reality by providing affordable and safe drinking water through prepaid smart cards and mobile payments. These automated systems reduce dependence on unsafe water sources while improving transparency, lowering costs and strengthening local water services. As organizations, local utilities and government partners continue expanding the technology, thousands of Kenyan families benefit from more reliable access to clean water.

A Smarter Way to Access Water

Unlike traditional water kiosks that rely on cash payments and attendants, water ATMs in Kenya allow users to purchase only the amount of water they need using prepaid smart cards or mobile money services. The automated systems operate throughout the day, reducing long lines while making water available whenever communities need it. Digital monitoring also allows operators to track water use, revenue and maintenance needs in real time. This helps reduce water theft and improve financial accountability.

Grundfos developed its AQtap water ATM technology in partnership with organizations including World Vision, county governments and Safaricom. In rural Kenyan communities, more than 20,000 people now receive clean drinking water through 60 automated water ATMs that provide a sustainable source of funding for ongoing maintenance and repairs.

Expanding Long-Term Water Security

As droughts and rapid urbanization place increasing pressure on Kenya’s water resources, innovative technologies become essential for long-term water security. Water ATMs create a sustainable system where affordable user payments help fund maintenance rather than relying solely on outside aid. For example, in Kwale County, the Kenya RAPID program introduced prepaid water ATMs managed by local water service providers. Because every transaction is recorded electronically, communities can clearly see how water fees are collected and used. This increased transparency and strengthened trust between residents and water providers while reducing opportunities for financial mismanagement.

With continued support from organizations such as Grundfos, Oxfam, local utilities and county governments, water ATMs in Kenya demonstrate how simple technology can improve public health and expand reliable access to clean water. Their growing success offers a practical example of how innovation can help communities build a healthier and more sustainable future.

The success of water ATMs in Kenya shows that innovation can help address global poverty. Expanding access to clean water starts with supporting proven solutions like water ATMs in Kenya. Continued investment and awareness will allow more communities to gain reliable access to safe drinking water. Together, these efforts can improve health and create lasting opportunities for future generations.

– Masa Qasim

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

Photo: Flickr

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4 Things You Need to Know About Healthcare in Spain

Healthcare in SpainOver the years, Spain has made healthcare an increasingly important priority, with 96.6% of the population participating in the national health system. Spain’s healthcare system is ranked among the best in the world, and it has undergone many changes to make it more accessible to the public. Here are four things to know about healthcare in Spain and how it adapts to the needs of people in the 21st century.

1. Top-Tiered Public and Private HealthCare System

Spain’s healthcare is fundamentally supported by the Sistema Nacional de Salud (SNS). The system provides medical coverage for almost all residents and 24-hour emergency services year-round. Services are located in primary care centers, hospitals and specialist clinics.

Eligibility and the cost of healthcare services in Spain depend on factors such as nationality, age and working status. These factors result in variations in fees or even receiving free services. The public healthcare system shows considerable quality of care, with a life expectancy of 83.1 years. Unlike many other countries that fund their public health system through health insurance, public healthcare is 70% funded by general taxation. The costs may vary slightly among autonomous regions. This makes Spain’s public health service accessible to more people, as children, the elderly and unemployed individuals can also access public medical services.

Nearly 26% of Spain’s population holds private healthcare, and people choose private agencies for various reasons. Apart from public healthcare, private healthcare is also an option for residents seeking shorter waiting lists and more comfortable facilities. Private healthcare centers such as Adeslas and Sanitas provide same-week access, while public hospitals work by reservation weeks prior to the appointment. Private hospitals tend to have more modern facilities and provide their clients with options to choose their doctor. Another reason some residents choose private healthcare is for its inclusivity. Many doctors in private healthcare centers are multilingual and can communicate with international patients in English.

The costs range from €45 to more than €400 per month. The variation in cost mainly depends on the age of the patient. The cost usually increases as age increases. This leads to one of the major limitations private healthcare has for elders. People aged 75 and above are only accepted by Adeslas, and the monthly cost is 200 to 400-plus euros. This is because healthcare products and facilities for elders are more expensive and complicated. Elders often require long-term support and daily care that are costly. For instance, for a patient with Alzheimer’s, the expense of daily care and long-term costs builds up to 81.4% of the total price.

2. Current Challenges

The Spanish healthcare system faces unexpected challenges, such as regional variations in service quality. Regions to the north of Spain and Madrid generally have better and higher coverage of healthcare, while the south suffers more from insufficient healthcare centers and healthcare professionals. This can be seen through life expectancy. Madrid has a life expectancy of 86.1 years, while the Basque Country, to the north of Madrid, has an average life expectancy of 87.4 years. Spain is seeing growing demand for more healthcare professionals to support the growing population in these southern regions.

Moreover, regional and language barriers start to occur due to the growing number of migrants and undocumented immigrants. Regions such as Catalonia have their own healthcare sectors, such as CatSalut, and these different healthcare services have different specialties. Some centers focus on high-tech devices, and others have primarily local clinics. This raises challenges when some residents need high-tech devices and treatments in areas where these services are unavailable. However, the government is actively working to reduce these regional differences.

3. Health in Relation to Poverty and Well-Being

Healthcare in Spain functions as a powerful poverty reduction tool, as it is free for the majority of the population. However, factors remain that cause parts of Spain to suffer from poverty. One of the major factors is that dental care is not included in the healthcare system and can be expensive. About 4.7% of Spanish households spend more than 10% of their overall income on dental care. This becomes a heavy burden for low-income families.

The government is actively working to reduce these regional differences. In 2025, the government distributed €172.4 million to autonomous regions of Spain to improve and expand the reach of primary healthcare. This also opens up new job opportunities in smaller regions struggling with poverty.

4. Supporting Other Nations

On March 11, 2026, Spain’s socialist government removed the administrative barriers that prevented people without a Tarjeta de Identidad de Extranjero (TIE) from receiving primary healthcare. This means expanding healthcare access to undocumented migrants or anyone who can prove they live in Spain. Health Minister Mónica García said the decree guarantees “everyone’s right to healthcare,” describing healthcare as a universal human right.

The decision to expand public healthcare drew fierce opposition from the far-right Vox party. Vox leader Santiago Abascal said the measure would create “a brutal pull factor for the migrant invasion,” a claim that echoes a widely discredited conspiracy theory about mass migration overwhelming European populations. Vox Vice President Ignacio Garriga separately argued Spain is “not the hospital of the world.”

Spain is also a leading country in helping other nations with global disease control, providing funding through the World Health Organization (WHO) to support low-income countries in battling diseases. Spanish health authorities also work with other Latin American health services to improve safety standards and help them gain access to new technology. These partnerships support developing countries, as Spain works as a leader in global health.

The Future

Healthcare in Spain is one of the leading services worldwide. The system provides citizens with options for public and private care that serve national and international residents. Although challenges remain, Spain continues to work on refining healthcare for the public and supporting other nations.

– Jiayu Wang

Jiayu is based in Beijing, China and focuses on Good News and Global Health for The Borgen Project.

Photo: Flickr

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AI Is Fighting Gaps in Maternal Health in Sub-Saharan Africa

Maternal Health in Sub-Saharan AfricaAI innovations in maternal health care are closing a dangerous information gap for millions of expectant mothers, especially in Sub-Saharan Africa. Inadequate financing, weak governance, health workforce shortages and recurring shocks, including disease outbreaks and conflicts, are among the key barriers disrupting maternal and child health services. Up to 94% of maternal deaths occur in low-resource settings, primarily in sub-Saharan Africa, which account for a substantial share of global stillbirths and newborn deaths. The region is projected to record a neonatal mortality rate roughly twice the Sustainable Development Goal (SDG) target of 12 deaths per 1,000 live births by 2030. These numbers could decrease thanks to a Kenyan nonprofit that has built an artificial intelligence (AI) powered solution, putting trustworthy health information directly into mothers’ hands using a simple mobile phone.

A Lifeline Built on Simple Technology

Founded in 2016, Jacaranda Health is a nonprofit organization that uses AI-powered solutions to address maternal health gaps within government health systems. The organization developed PROMPTS, which stands for Promoting Mothers in Pregnancy and Postpartum. Through SMS, an AI-enabled maternal health messaging platform that delivers timely, accurate pregnancy and newborn health care information directly to mothers’ phones.

Initially a one-way push notification service, it quickly evolved. Parents receiving the reminders started texting back with questions, prompting Jacaranda Health to build a help desk to respond. As demand grew far beyond what a small team could manage manually, the organization integrated artificial intelligence to prioritize and answer incoming messages, shifting human intelligence to focus on urgent clinical cases.

From Hundreds to Thousands of Questions a Day

The scale of the shift has been significant. PROMPTS now answers between 10,000 and 12,000 health questions daily, with AI responding to approximately 70% of those questions, drawing on a database of more than 1 million health questions and answers.

According to Jacaranda Health’s cloud technology partner, the platform has reached 3.8 million mothers across Kenya, and the results extend beyond simple access to information. The organization reports a 20% increase in attendance at prenatal health visits and a 1.85-times increase in postpartum family planning among PROMPTS users.

This platform is deliberately designed for low-resource settings. PROMPTS operates as an SMS-based service specifically to avoid the limitations of internet access, ensuring that women without smartphones or reliable data connections can still receive support.

Designed for Equity and Local Context

PROMPTS supports women throughout pregnancy and the postpartum period by providing personalized health information aligned with national clinical protocols, in local languages mothers understand. Jacaranda Health has trained PROMPTS in Swahili, and the platform now operates in multiple sub-Saharan African countries, including Ghana, Kenya and Nigeria.

In March 2026, Jacaranda Health partnered with eHealth Africa, a Nigeria-based nonprofit, to launch PROMPTS in Kano State, Nigeria, with an initial target of reaching 25,000 mothers. The platform delivers maternal health information in both Hausa and English, and eHealth Africa leads the local adaptation and operational rollout, drawing on its extensive experience implementing data-driven health programs across Nigeria.

A Life-Changing Impact

The human impact behind these AI numbers is significant. In one case documented by Jacaranda Health’s cloud technology partner, PROMPTS flagged a message from a mother with a history of stillbirth describing severe headaches and blurred vision as urgent. Help desk agents reached out immediately and encouraged her to seek medical attention. She went to the hospital right away and weeks later gave birth to a healthy baby.

In Ghana, where PROMPTS is personified as “Nurse Mary,” the platform has assisted 36,500 mothers across 435 health facilities since launching in the Greater Accra Region. A public health nurse at Ashaiman Municipal Hospital described how mothers now arrive at the clinic discussing the text messages they received, sparking deeper conversations during routine health talks. The nurse called for the program to expand to other facilities to help ensure positive health outcomes for more mothers.

Closing the Gap Between Poverty and Survival

Maternal mortality in sub-Saharan Africa remains deeply tied to poverty, distance from care and lack of access to reliable health information. For women in rural or underserved communities, a text message offering accurate guidance can mean the difference between recognizing a danger sign in time or missing it altogether. By harnessing AI in maternal health care to scale trustworthy health information at low cost, Jacaranda Health and its partners are demonstrating how even simple technology, paired with the right design, can help break the link between poverty and preventable maternal death.

As PROMPTS continues expanding across the continent, it offers a model for how digital innovation can strengthen rather than replace the health systems that vulnerable mothers depend on most.

– Joy Kohol

Joy is based in Muncie, IN, USA and focuses on Good News, Global Health for The Borgen Project.

Photo: Unsplash

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How China Helps Alleviate Poverty in the DRC

Poverty in the DRCThe Democratic Republic of Congo is one of the biggest countries in sub-Saharan Africa, with access to incredible natural resources, such as minerals like cobalt and copper, and significant arable land. Despite this, most of the country has not benefited from this wealth. It is among the five poorest countries in the world. An estimated 69% of the country is considered under the poverty line, according to a national survey by the National Institute of Statistics, while the country’s inequality index is in line with the sub-Saharan African average at 38.1.

International Solutions to Poverty in the DRC

Developed countries have tried to help those suffering the most. One of them, in recent years, has been China, which has offered several forms of assistance aimed at reducing poverty in the DRC, including through agriculture. On Dec. 19, 2024, China and the DRC launched their first training session on agricultural technical cooperation in the capital city of Kinshasa. The goal of this partnership was to enable the DRC to leverage its agricultural resources, achieve self-sufficiency in food production and, in doing so, reduce poverty overall. The training lasted one month and involved more than 40 Congolese participants.

With similar goals in mind, in 2016, China, in partnership with the Food and Agriculture Organization, signed an agreement with the DRC that lasted two years and was worth $1.5 million, intending to increase nutrition and food security in the nation. The project ran from 2017 to 2019 and contributed to measurable change. Technical experts provided farmers with assistance aimed at growing agricultural production. Over the two years, the productivity and profitability of more than 2,200 households improved. Vegetable and cereal consumption needs were met, unlike before; net income improved, and farmers acquired new agricultural technologies.

To help with crop production, experts demonstrated various techniques to local farmers and showed them how to detect and keep pests away. One outcome of this was that rice yield saw increases of 133% to 466%. Similar results occurred in horticulture, with increases in cabbage, pepper, onion and tomato production. Technicians provided assistance on seedbed construction, seeding techniques, soil loosening and land preparation.

Ebola Outbreak Response

At the beginning of May 2026, an Ebola outbreak affected the DRC. The disease spread fast, and according to the European Centre for Disease Prevention and Control, there have been more than 800 related deaths.

Several countries responded with aid. Although the United States (U.S.) sent significant financial aid and medical experts, U.S. officials said the response was smaller in scale than in past outbreaks following cuts to USAID and the country’s withdrawal from the World Health Organization. In June 2026, China sent anti-epidemic medical experts to Kinshasa for a three-month mission in support of the DRC’s response to the outbreak, according to China’s National Health Commission. Two teams have been dispatched so far, including 10 experts specializing in laboratory testing, epidemiology and clinical treatment, working alongside local government.

In July 2026, China contributed a further $2.5 million in emergency funding to the Africa Centres for Disease Control and Prevention (CDC), much of it directed toward the DRC, bringing its total contribution to $4.5 million. The funding is intended to support surveillance, laboratory services, logistics, frontline response operations and community engagement. Africa CDC Director General Jean Kaseya praised China’s support, according to Chinese state broadcaster CGTN, calling the countries reliable partners.

A More Complicated Picture on Mining

China’s broader economic relationship with the DRC is less straightforward. In March 2026, Kinshasa signed a new agreement with China to deepen cooperation in its mining sector, including provisions for data sharing, investment protection and local processing. Chinese state-owned companies already control a majority of DRC’s largest cobalt mines, and Beijing remains the country’s largest bilateral creditor.

That relationship has drawn scrutiny. The DRC has reviewed earlier Chinese mining agreements amid allegations that promised infrastructure went unbuilt and that some Chinese-run operations underreported the cobalt they extracted; a Congolese court stripped one major Chinese mining company of control over one of the country’s largest cobalt mines following a dispute over royalty payments. The DRC has also signed competing minerals agreements with the United States in recent months, and Congolese officials have said they do not intend to align exclusively with either country.

Conclusion

China has become a significant source of aid and expertise for the DRC, from agricultural training to Ebola response funding, and officials on both sides describe the relationship in positive terms. At the same time, the scale of China’s economic role in the country, particularly in mining, remains a subject of ongoing scrutiny in the DRC. Both dynamics illustrate how a single country’s involvement in addressing poverty can be, at once, a source of tangible support and a matter of continued debate.

– Oisín Downes

Oisín is based in Galway, Ireland and focuses on Good News for The Borgen Project.

Photo: Flickr

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Food Security After the Ukraine War

Farmer harvesting wheat in a vast field under a clear sky. Food Security After the Ukraine WarMillions of households across developing countries continue to struggle with rising food costs despite improvements in global commodity markets. Food security after the Ukraine war will remain a major concern for governments, humanitarian organizations and vulnerable communities as food inflation limits access to basic necessities. Although international grain prices have fallen from their 2022 peak, many countries still experience elevated food prices that contribute to hunger, malnutrition and poverty.

Russia and Ukraine play a crucial role in global food production. Before the war, the two countries accounted for nearly 30% of global wheat exports, around 20% of maize exports and more than 50% of sunflower oil exports. When Russia invaded Ukraine in February 2022, disruptions to Black Sea shipping routes immediately affected global food supplies and international markets. The United Nations Food and Agriculture Organization (FAO) reported that its Food Price Index reached an all-time high of 159.7 points in March 2022, largely driven by soaring cereal and vegetable oil prices.

Why Food Prices Have Not Fully Stabilized

Although commodity markets have become less volatile since 2022, food security continues to face several challenges. Transportation and shipping costs remain higher than before the conflict in many regions, while global supply chains are still recovering from initial wartime disruptions. Several countries also introduced export restrictions to protect domestic food supplies. For example, India restricted wheat exports in 2022, while countries including Kazakhstan and Serbia implemented temporary controls on grain exports. Although intended to stabilize domestic markets, these measures reduced food available on international markets and increased prices for import-dependent countries. According to the World Bank, food price inflation remains above 5% in many low- and middle-income economies, while several countries continue to experience food inflation exceeding 20%.

Changing Climate and Food Prices

Climate-related disasters have added another layer of pressure to global food systems. Droughts, floods and extreme heat have reduced agricultural production across several regions, making food markets more difficult to stabilize. According to the World Food Programme (WFP), conflict, the changing climate and economic instability now intersect to create one of the world’s largest food security crises. In countries already dependent on imported food, failed harvests and extreme weather events often lead to even higher prices and reduced food availability. As a result, global food security today is shaped not only by geopolitical conflict but also by climate-related disruptions affecting agricultural production worldwide.

The impact of high food prices extends far beyond grocery bills. According to the World Bank, food inflation continues to place enormous pressure on low-income households that already spend a significant portion of their income on food. The World Bank estimates that around 700 million people worldwide live in extreme poverty, surviving on less than $2.15 per day. Even modest increases in food prices can force families to skip meals, reduce dietary quality or withdraw children from school to afford basic necessities. Countries across Sub-Saharan Africa, West Asia and South Asia remain especially vulnerable because many rely heavily on imported food. Rising prices have increased food insecurity, malnutrition and financial hardship for millions of households already living near or below the poverty line.

How International Organizations Are Responding

Despite ongoing challenges, international organizations continue to strengthen global food security through emergency assistance and long-term agricultural investments. Founded in 1961, WFP operates in more than 120 countries and territories, providing emergency food assistance, school meals and nutrition programs. In 2024, the organization assisted more than 150 million people, helping communities affected by conflict, climate disasters and economic crises. The FAO, established in 1945, supports more than 130 countries by strengthening agricultural production, improving farming techniques and helping governments build resilient food systems that can better withstand future shocks. Meanwhile, the World Bank has committed more than $45 billion toward food and nutrition security initiatives since 2022. These investments support farmers, improve irrigation systems, strengthen agricultural supply chains and increase access to affordable food in vulnerable countries. Together, these organizations are helping countries move beyond emergency relief by investing in long-term food resilience, agricultural productivity and sustainable development.

Food Security After the Ukraine War

Although international commodity markets have improved since the height of the crisis, food affordability remains a significant global challenge. Ongoing geopolitical tensions, climate-related disasters and fragile supply chains continue to affect food access for millions of people. However, there are encouraging signs of progress. Investments in climate-resilient agriculture, stronger food systems and expanded humanitarian assistance are helping vulnerable communities recover. Programs led by the WFP, FAO and World Bank continue to improve agricultural resilience, support farmers and expand access to nutritious food. Continued international cooperation, targeted investments and sustainable agricultural development will be essential to reducing poverty and ensuring that future global shocks do not leave millions of people vulnerable to hunger. By strengthening food systems today, governments and humanitarian organizations can build a more secure and resilient future for communities around the world.

– Srinidhi Madhavan

Srinidhi is based in Leeds, UK and focuses on Politics for The Borgen Project.

Photo: Pixabay

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Improving Health Access: Motorcycle Ambulances in Zambia

Motorcycle Ambulances in ZambiaFor many families living in rural Zambia, reaching a health facility can be one of the biggest challenges during a medical emergency. According to the World Bank, more than three in four rural households live below the poverty line, with 80% of the country’s poor residing in rural areas. Poor roads, long travel distances and limited transportation often delay treatment, especially for pregnant women and young children, making it even harder for low-income families to access timely medical care. Across rural Zambia, motorcycles are being used in different ways to improve access to health care. Motorcycle ambulances in Zambia transport patients during emergencies, while motorcycles and bicycles enable health workers to deliver vaccines, monitor pregnant women and reach remote communities. Research published by the World Health Organization highlights that timely access to emergency care depends on strong referral and transport systems, particularly in low-resource settings.

Motorcycle Ambulances

In many rural areas, conventional ambulances cannot easily travel on rough or narrow roads. Research funded by the United Kingdom (U.K.) Foreign, Commonwealth and Development Office in 2020 found that motorcycle ambulances provide a practical and lower-cost alternative for transporting patients in remote communities. The study reported that motorcycle ambulances reduced delays in reaching health facilities, particularly for women experiencing obstetric emergencies, making them an effective option where standard ambulances are difficult to operate. Faster transportation can help patients receive treatment earlier, potentially reducing the need for more expensive medical interventions.

Riders for Health

Founded in 1989, Riders for Health supported Zambia’s health system between 2009 and 2016 by working in the Eastern and Southern provinces. Rather than simply providing motorcycles, the organization supplied motorcycle management, rider training and preventive maintenance systems that helped community health workers travel safely and reliably to rural communities. The program ended in 2016 because the Zambian government was unable to cover the core operating costs needed to sustain it in the long term. A field trial published in the American Journal of Public Health found that Riders for Health’s motorcycle management system improved vehicle reliability and supported more consistent health outreach services. The study highlighted how preventive maintenance and rider training reduced breakdowns, helping health workers reach remote communities more efficiently and reliably.

World Bicycle Relief

Motorcycle transport is only one part of improving access to health care. World Bicycle Relief has spent more than a decade expanding mobility in Zambia by providing Buffalo Bicycles to community health workers, students and entrepreneurs. The organization reports that it has distributed more than 340,000 bicycles across the country since beginning its work there. World Bicycle Relief explains that bicycles help community health workers spend less time traveling and more time caring for patients. Its health impact data shows that, in Zambia, community health workers using Buffalo Bicycles served 63% more households than those without bicycles during one of the country’s worst droughts. A case study from the Palabana Health Clinic also found that bicycles reduced travel time for health workers from four hours to about one hour, allowing them to visit more patients each day.

Government and UNICEF Initiatives

The Government of Zambia has also partnered with organizations such as United Nations International Children’s Fund (UNICEF) and Gavi, the Vaccine Alliance, to strengthen vaccine delivery in remote communities. UNICEF reports that the DRIVE Initiative uses specially equipped motorcycles operated by trained community members to deliver vaccines safely to remote health facilities. The initiative supports 1,273 health facilities across 41 districts, covering areas where most of Zambia’s zero-dose children live. UNICEF also estimates that the program will save health workers about 600 hours of service delivery each month, allowing them to spend more time caring for patients while helping reduce vaccine shortages and strengthen routine immunization. These efforts show that improving transportation can strengthen the entire health system, from emergency referrals to preventive care.

Improving transportation is helping address one of the major barriers to health care access in rural Zambia. Motorcycle ambulances in Zambia, motorcycles for health workers and bicycles for community outreach are helping connect remote communities with essential services. Through programs supported by organizations such as Riders for Health, World Bicycle Relief and UNICEF, transportation is becoming an important part of strengthening rural health systems. Continued investment in these solutions can help more families access timely medical care while reducing the challenges caused by distance, limited mobility and poverty.

– Abisola Oladipupo

Abisola is based in Hatfield, UK and focuses on Good News for The Borgen Project.

Photo: Wikimedia Commons

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The Last Mile of Care: Community Health Workers in Lesotho

Community health workers in LesothoFor residents of Lesotho’s mountain districts, reaching a clinic means a walk of several hours across some parts of southern Africa’s highest terrain. This distance determines who receives treatment just as much as a shortage of treatment. Yet a growing network of community health workers in Lesotho is narrowing that gap, carrying Human Immunodeficiency Syndrome (HIV) treatment support, maternal care and disease monitoring directly into villages that the formal health system has struggled to reach.

A Health System Under Strain

Lesotho carries one of the heaviest HIV burdens in the world. An estimated 18.5% of adults ages 15 to 49 were living with HIV in 2023, and roughly 236,000 people 15 and older were on antiretroviral therapy that year, according to the U.S. Centers for Disease Control and Prevention (CDC). Tuberculosis compounds the crisis: an estimated 664 cases occurred per 100,000 people in 2023, and half of all Tuberculosis (TB) cases involved HIV coinfection, making continuous, coordinated care essential rather than optional.

That disease burden overlaps heavily with poverty, and the overlap is sharpest outside Lesotho’s towns. An estimated 27.6% of the rural population lived in multidimensional poverty in 2018, compared with 5.6% in urban areas, according to an analysis by the Oxford Poverty and Human Development Initiative using Lesotho’s Demographic and Health Survey data. Rural residents make up 63.7% of Lesotho’s population, meaning the country’s poverty is concentrated in precisely the districts where distance from a clinic is greatest. This compounds the barriers households already face in reaching care. It also underscores why community health workers in Lesotho are being asked to close a gap that health facilities alone cannot.

Before Lesotho had a national health reform in 2014, primary care clinics were characterized by insufficient staffing, inadequate space and a lack of supplies, according to a peer-reviewed study published in PLOS Global Public Health. The country’s earlier village health worker program existed outside of the formal health system, staffed by undercompensated volunteers who had little supervision or support.

Rebuilding the Village Health Worker Model

The 2014 reform, carried out by the government of Lesotho with support from the nonprofit Partners In Health, restructured how community health workers in Lesotho are recruited, trained and paid. A 2025 study in BMC Health Services Research found the reform introduced a formal reselection process to replace inactive workers, assigned two health workers to each village instead of one and created specialized roles, with one worker focused on tuberculosis and HIV and another on maternal and child health. New supervisor and coordinator positions were added to oversee reporting, and monthly stipends rose from 300 to 400 South African rand, paid electronically rather than in cash.

By 2017, the reform had trained and deployed 5,359 village health workers using a standardized curriculum, extending coverage across more than 70 primary care clinics in four districts, representing close to 40% of Lesotho’s population, according to the PLOS Global Public Health study.

Measurable Gains in Rural Care

The same study found that facility-based deliveries rose from 2% to 33% of births in reform districts between 2013 and 2017, with the share of health centers adequately equipped for childbirth rising from 3% to 95%. Quarterly antenatal care visits increased from an average of 1,877 to 2,729, the number of children fully immunized by age one nearly tripled, from 191 to 294, and quarterly HIV testing volume more than doubled, from 5,163 to 12,210.

Partners In Health has since expanded a Rural Health Initiative built on the same community health worker model, operating seven clinics in Lesotho’s mountain districts. These serve more than 90,000 people in areas that would otherwise have limited access to physicians. The organization also runs the country’s first treatment program for multidrug-resistant and extensively drug-resistant tuberculosis, based at Botšabelo Hospital in Maseru and supported by community-based follow-up. The program reports a cure rate of 77% for a form of the disease that patients often abandon treatment for midway through its long course.

The Work Still Ahead

Community health workers in Lesotho are, by design, a cost-effective way to extend a limited health budget further: workers are drawn from the villages they serve, trained on core protocols and paid a fraction of a clinician’s salary while reaching people a clinic alone would not. The open question is scale. The 2014 reform covered four of Lesotho’s 10 districts, and expanding the same structured, supervised model nationwide will require sustained funding and continued training capacity.

Even so, the shift already underway marks a break from the informal volunteer system that preceded it. Where a village once relied on a single undercompensated worker with little support, many now have two trained, paid health workers connected to a functioning referral system. For a country where the nearest doctor can still be hours away, that change in structure, more than any single new clinic, is what is making rural care measurably more reachable.

– Saakshi Bhat

Saakshi is based in San Marcos, CA, USA and focuses on Global Health and Politics for The Borgen Project.

Photo: Wikimedia Commons

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Community Health Workers in Rwanda Are Improving Rural Health

Community Health Workers in RwandaFor many people living in rural communities, distance, poverty and limited medical resources can make it difficult to access health care. Although Rwanda has made significant progress in reducing poverty over the past two decades, many rural families still face financial and geographic barriers to receiving timely medical care. Community health workers in Rwanda are helping bridge that gap by bringing essential health services directly to underserved communities. Through basic medical care, health education and referrals, these trained volunteers have become a cornerstone of Rwanda’s health system while improving health outcomes for some of the country’s most vulnerable populations.

Bringing Health Care to Rural Communities

Rwanda’s Community Health Worker Program was established in 1995 following the 1994 genocide and has expanded steadily under the country’s Ministry of Health. Today, approximately 58,000 community health workers serve communities across Rwanda. The program is supported by partners including the World Health Organization (WHO), United Nations Children’s Fund (UNICEF) and Health Builders, which help provide training, supervision and technical support. Community health workers receive training to monitor pregnancies, identify illnesses, promote vaccinations and connect patients with health facilities when additional care is needed. Because they live in the communities they serve, they can identify health concerns early, educate families and encourage people to seek treatment before illnesses become more serious. This approach has helped reduce barriers to health care for low-income families who may otherwise struggle with transportation costs or long travel distances to clinics.

According to the WHO, Rwanda has made remarkable progress in maternal and child health over the past two decades. Maternal mortality declined from more than 1,000 deaths per 100,000 live births in 2000 to approximately 203 in 2020. During the same period, under-five mortality also declined significantly, reflecting major improvements in community-based health services and access to primary care.

Improving Maternal and Child Health

One of the program’s greatest successes has been improving maternal and child health. Community health workers track pregnancies, encourage prenatal checkups and identify warning signs that require medical attention. They also educate parents about nutrition, breastfeeding and childhood illnesses while helping children receive routine vaccinations.

According to UNICEF, Rwanda has achieved consistently high childhood vaccination coverage while significantly reducing under-five mortality during the past two decades. Researchers have also found that community health workers have contributed to reductions in maternal mortality by connecting pregnant women with health facilities, encouraging skilled birth attendance and ensuring timely referrals when complications arise. These services are especially important for families living in poverty, where delayed treatment or limited access to medical care can have life-threatening consequences. By delivering preventive care directly within communities, community health workers help reduce health inequalities and improve access to essential services for thousands of Rwandan families.

A Model Recognized Around the World

The success of community health workers in Rwanda has gained international recognition. The World Bank reports that Rwanda has met or exceeded many global health targets by emphasizing preventive care, community participation and strong primary health care systems. Technology has also strengthened the program. Rwanda introduced RapidSMS, a mobile phone reporting system that allows community health workers to register pregnancies, monitor expectant mothers and quickly report high-risk cases to nearby health facilities.

The system has improved communication between villages and health centers, helping mothers and newborns receive care more quickly when complications arise. As countries continue searching for ways to improve access to health care, community health workers in Rwanda demonstrate how investing in community-based medicine can improve health outcomes while reducing the barriers created by poverty. By bringing essential services directly into underserved communities, Rwanda has created a sustainable model that continues to save lives and offers valuable lessons for other developing countries seeking to strengthen their health systems.

– Masa Qasim

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

Photo: Flickr

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Tackling Superbugs: Nanotechnology in India and Brazil

 

Nanotechnology in India and BrazilAntimicrobial resistance (AMR) poses a real threat to vulnerable groups in developing countries. Low-income groups and populations living below the poverty line are disproportionately affected. Global research published in The Lancet expects AMR to cause 39 million deaths globally between 2025 and 2050.

The economic effects may cause significant losses globally. As the World Bank reported, by 2050 AMR is expected to lower the global gross domestic product (GDP) by around 3.8% annually, with 28 million people potentially slipping into poverty.

In biotechnology, nanotechnology promises new avenues for tackling superbugs in high-risk countries such as Brazil and India. By specifically targeting infections, nanoparticles can bypass resistance. This approach can reduce medication costs for low-income populations, positively affecting economic development.

Health Crisis in India and Brazil

India and Brazil are among the G20 countries with the highest proportion of people living below the extreme poverty line. Antibiotic resistance is disproportionately high among these populations. According to the Institute for Health Metrics and Evaluation, antibiotic resistance in India has caused 300,000 deaths annually since 1990, placing the country among those with the highest numbers.

In Brazil, approximately 32,000 deaths each year are attributed to antibiotic resistance, the highest rate among Latin American countries. The situation in both countries places enormous strain on their health care systems. Experts believe antibiotic resistance could trigger a serious health crisis, accompanied by rising public costs and a decline in GDP. For Brazil, the World Bank estimated a loss of 4.4% to 5.1%.

Poor hygiene standards, high settlement density, particularly in slums, contaminated water, and a lack of access to adequate medical care and infrastructure put people living in poverty at a higher risk of developing antibiotic resistance than those with higher incomes.

The situation worsens with the misuse of antibiotics. Individuals from low-income groups often take underdosed medications due to financial difficulties. Additionally, they share drugs with family or neighbors, resulting in insufficient doses. This allows stronger bacteria to survive and multiply with more resistance.

Furthermore, regulations in many regions encourage the misuse of antibiotics. Vendors often sell these medications over the counter as substandard or counterfeit products. This market promotes the growth of resistant bacteria and accelerates their spread.

Nanotechnology in India and Brazil

To counter the threat of antibiotic resistance in Brazil and India, cost-effective nanoparticles may provide promising solutions. Materials are used on a very small scale, allowing them to develop unique properties. Nanotechnology is used either as an antibiotic itself or as a carrier for antimicrobial agents to combat infections more effectively.

Nanoparticles, classified into metallic, organic, carbon-based, and hybrid systems, can bypass mechanisms of antibiotic resistance. Their mode of action resembles a Trojan horse: transporting and protecting the antibiotic, they smuggle the active ingredient into the infected cell. Additionally, they can destroy biofilms, slime layers formed by resistant bacteria, penetrating the pathogen and damaging its proteins, enzymes and DNA.

Although India and Brazil lead in nanoparticle research, they face challenges in implementing nanotechnology to tackle superbugs in their health care systems. Besides concerns about environmental and biological risks, which require further research, developing countries face financial hurdles. Insufficient production capacity, supply chain difficulties and regulatory barriers hinder the fight against antibiotic resistance, trapping people below the poverty line in a cycle of illness and financial hardship.

Research and Development of Nanotechnology

Nonprofit organizations such as the India AMR Innovation Hub (IAIH) aim to tackle superbugs by providing financial support to biotech startups and fostering scientific collaboration. For example, the startup Module Innovations developed an ultra-fast diagnostic method using “Size Dependent Signal Amplification of Nanoparticles” (SDSAN). This method can detect urinary tract infections within 15 minutes. Over the next five years, the India AMR Innovation Hub plans to move 10 to 15 biotechnology projects, including nanotechnology initiatives, from the laboratory stage to the development phase.

The Brazilian National Nanotechnology Laboratory (LNNano) provides facilities and technical and scientific support for research into the effects of nanomaterials on biological systems and the environment. The development of nano-based drug delivery systems and nanoparticles with modified surfaces makes the fight against drug-resistant bacteria 10 times more effective.

Looking Ahead

To reduce the negative global impacts of antibiotic resistance in heavily affected countries such as India and Brazil, international development aid and policy initiatives are crucial for improving the health of people living in extreme poverty. By promoting the development of appropriate infrastructure for production and distribution and supporting governments in establishing regulatory frameworks, nanotechnologies in India’s and Brazil’s health care systems could create millions of jobs worldwide and boost global GDP. Moreover, millions of lives can be saved.

– Oliwia Kowalak

Oliwia is based in Berlin, Germany and focuses on Technology and Solutions for The Borgen Project.

Photo: Pixabay