Archive for category: Health

Information and stories on health topics.

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Community Health Workers in Sierra Leone Save Mothers’ Lives

Community Health Workers in Sierra LeoneCommunity Health Workers (CHWs) in rural Sierra Leone are bringing maternal health support directly into villages. They connect families to clinics and hospitals better equipped to handle pregnancy and childbirth. They operate in a country that has faced some of the highest maternal health risks in the world.

UNICEF reported that Sierra Leone’s maternal mortality ratio reached 1,360 maternal deaths per 100,000 live births in 2015. Approximately one in 17 women faced a lifetime risk of dying from pregnancy-related causes at that time. However, national and partner-led investments have contributed to measurable improvement.

The World Bank modeled estimates show that Sierra Leone’s maternal mortality ratio declined to about 354 deaths per 100,000 live births in 2023, reflecting substantial progress over the past decade.

How CHWs Work

Community Health Workers in rural Sierra Leone reduce maternal risk by reaching women earlier, identifying warning signs during pregnancy and helping families reach health facilities quickly during emergencies. They usually conduct home visits throughout pregnancy and for up to a year after delivery, providing referrals and accompanying women to care when complications occur. They also serve as a first point of contact at the community level.

Key ways local health workers support safer pregnancy and childbirth include:

  • Home visits that encourage antenatal care and help spot complications early
  • Referrals and accompaniment that help women reach skilled care faster during emergencies
  • Follow-up after delivery that supports recovery and newborn health in the first year
  • Trust-building that increases the use of facility-based services over time

Partners In Health’s Work in Sierra Leone

Partners In Health began working in Sierra Leone during the 2014 Ebola outbreak, after the government requested support and committed to strengthening the health system beyond the emergency response. In partnership with Sierra Leone’s government, the organization supports 11 health facilities across eight districts and combines community outreach with strengthened maternity wards and emergency referral systems.

As Kono District’s only hospital, Koidu Government Hospital now provides safer maternal care after Partners In Health introduced essential services, including running water and 24-hour electricity. The organization also expanded clinical capacity through oxygen production and a functioning blood bank. These upgrades allow clinicians to respond to obstetric emergencies that once proved fatal, including hemorrhage and obstructed labor.

Partners In Health also employs the district’s only specialized obstetrician-gynecologist and pediatrician. It has expanded services to include an emergency room, a special care baby unit and 24-hour access to C-sections and other surgeries, ensuring women receive timely, skilled care during complications.

Beyond the hospital, Partners In Health operates Wellbody Clinic, a model primary health facility providing maternal care alongside services for infectious and chronic diseases. It also partners with smaller public primary health clinics across the district to extend access to care before and after childbirth.

Measured Gains in Maternal and Newborn Care

From 2020 to 2025, Koidu Government Hospital saw a 69% increase in the number of women delivering there. In 2025 alone, more than 2,700 deliveries occurred at Koidu Government Hospital and 44% were C-sections. The program attributes this to the hospital’s role as a key referral facility for pregnancy complications.

Partners In Health also reported an 8% decrease in maternal deaths at Koidu Government Hospital from 2020 to 2022. The organization also reported broader gains across its supported system, including a 73% increase in mothers served at its supported facilities and a 49% increase in patients supported by CHWs. These figures indicate both stronger facility capacity and more consistent outreach in communities with historically limited access to skilled care.

Traditional Birth Attendants and Emergency Referrals

CHWs in rural Sierra Leone strengthen maternal care by working alongside trusted community figures who already support women during pregnancy and childbirth. Partners In Health Sierra Leone trained 191 traditional birth attendants and integrated them into the formal health system. They provide health education, accompany women to clinics and help families navigate care.

In 2025, these traditional birth attendants made more than 110,000 visits, connecting pregnant women to health services. They also helped reduce obstetric complications, stillbirths and maternal deaths across Kono District. When complications escalate, Partners In Health Sierra Leone supports Sierra Leone’s National Emergency Medical Services with fuel for ambulances, enabling rapid referrals.

In 2025 alone, 562 pregnant women reached Koidu Government Hospital through this emergency pathway, turning community-level care into timely, lifesaving treatment.

Expanding Capacity in 2026

Partners In Health and the Ministry of Health plan to expand maternal and newborn services through the Paul E. Farmer Maternal Center of Excellence. The center is scheduled to open in February 2026 on the Koidu Government Hospital campus in rural Kono District. The new center will add 120 beds across four modern buildings and include three operating theaters, significantly increasing capacity for complex deliveries and emergency obstetric care.

As the first facility outside Freetown with a piped medical gas system, the center will allow clinicians to deliver oxygen and anesthesia directly at the bedside, reducing delays during critical interventions. Alongside expanded clinical care, the center will function as a rural training hub. It will equip the next generation of health care workers with the skills needed to sustain maternal and newborn services in underserved settings.

Why the Approach Matters

Community Health Workers in rural Sierra Leone improve maternal survival by shortening the time between the first signs of complications and skilled medical care. UNICEF has found that many women never reach a health facility to give birth and that expanding training, equipment and medical supplies plays a critical role in increasing access to skilled care. By pairing community outreach with better-equipped hospitals and clinics, Partners In Health and government partners now reach women earlier in pregnancy and respond more quickly when complications arise.

This system depends on CWHs, who bring care closer to mothers while linking families to facilities that can deliver lifesaving treatment during emergencies.

– Kira Dosanjh Rai

Kira is based in London, UK and focuses on Global Health for The Borgen Project.

Photo: Flickr

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The Hear, Listen and Speak Program: Hearing Care in Bhutan

Hearing Care in BhutanHearing loss and ear disorders often go undetected and untreated, especially in infants and children. Disparities in health services and socioeconomic positions in Bhutan contribute to inequities in pediatric hearing care. The Hear, Listen and Speak (HLS) Program addresses the need for a better system by providing innovative and comprehensive solutions to gaps in pediatric hearing care in Bhutan.

Poverty and Health Care Disparities in Bhutan

In 2022, 10.1% of Bhutanese people lived below the national poverty line, with 87% of this population residing in rural areas. About 62% of Bhutan’s total population lives in rural areas, where access to services is more limited and socioeconomic conditions are generally poorer than in urban areas. Significant disparities in health care access exist between rural and urban populations, with rural residents having 3.4 times higher odds of using primary health centers rather than outpatient hospital services.

Socioeconomic Position and Hearing Loss

People with hearing loss are more likely to be unemployed, attain lower levels of education and earn lower wages. Meanwhile, people in lower socioeconomic positions are less likely to use hearing aids or access hearing care. Children in lower socioeconomic positions are less likely to receive early diagnosis and intervention.

They also have lower levels of device use and generally attend schools with fewer resources or rehabilitation programs. If hearing loss in childhood goes untreated, it can permanently impair speech and language acquisition, reducing a child’s likelihood of completing their primary education.

The Hear, Listen and Speak Program

The Ministry of Health of Bhutan launched the HLS Program in 2021 to address gaps in pediatric ear and hearing care for children ages 0-14 years with hearing loss and ear disorders. The national program provides early screening, diagnosis and intervention services. The HLS Program increases accessibility for rural populations by delivering the necessary technology, including hearing aid fittings, surgical capabilities and aftercare rehabilitation, at all levels of the health care continuum.

By equipping primary health centers with the technology to treat ear and hearing disorders, these services become decentralized and more accessible to rural communities. 

HLS Program Goals:

  • Early detection and intervention: Establish hearing screening in schools across all 20 districts to secure early identification and referrals for children with ear and hearing disorders. 
  • Integrated treatment and rehabilitation: Strengthen referral systems and service delivery to provide a wide variety of treatments, including hearing aid fittings, cochlear implants, surgeries and auditory-verbal therapy. 
  • Capacity building and workforce development: Train local health workers to deliver quality hearing care in Bhutan, including audiologists, ENT technicians and school health coordinators.
  • Infrastructure and technology strengthening: Establish earmold labs and digital referral systems and integrate hearing screening into health and education programs. 
  • Community engagement and policy integration: Promote information on pediatric hearing loss and health care to communities and encourage people to advocate for more representation in national public health and education systems. 

Program Results

By June 2025, the program had screened more than 104,746 children and identified ear and hearing conditions in 14,003 children (13% of those screened). By strengthening referral pathways and continuum-of-care camps, 32% of the children identified with ear and hearing conditions were registered for treatment. About 87% of those registered received care, including 81 hearing aid fittings and 73 surgeries.

Furthermore, the HLS Program established the first earmold lab in the country at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), revolutionizing hearing care in Bhutan. Earmold impression and hearing aid services for children are now available at the JDWNRH through the earmold lab.

Conclusion

Bhutan is making significant strides to upgrade its pediatric hearing care system across all levels of care through the HLS Program. The program ensures the sustainability of ongoing prevention and treatment for hearing loss and ear disorders in children by establishing the country’s first earmold lab. It also builds capacity through training and by empowering health workers, schools and communities across Bhutan.

With a strong focus on early detection and intervention, the program improves treatment for the estimated 60% of pediatric hearing loss that is preventable with timely intervention.

– Sarah Merrill

Sarah is based in Matthews, NC, USA and focuses on Good News and Global Health for The Borgen Project.

Photo: Flickr

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How Nutrition Policy Shapes Health Equity in South Africa

Health Equity in South AfricaIn South Africa, gaps in nutrition and food environment policies drive the double burden of malnutrition, including hunger, micronutrient deficiencies and rising obesity, despite sufficient food production. These policy gaps highlight the central role nutrition systems play in shaping health equity in South Africa.

How Economic Pressure Fuels Food Insecurity in South Africa

Economic pressures, rather than food availability, drive food insecurity in South Africa, pushing many families to struggle to access nutritious diets. Low-income individuals and households often choose cheaper, energy-dense alternatives that provide calories but few essential nutrients. High unemployment, structural poverty and rising living costs have made food increasingly inaccessible across South Africa.

The national energy crisis, particularly in Johannesburg and Cape Town, has further driven widespread hunger. In 2021, roughly 80% of South African households had adequate access to food, 15% had inadequate access and 6% had severe food insecurity. Food insecurity was more prevalent in urban areas, with the highest concentrations in Cape Town (241,000 households) and Johannesburg (239,000 households).

Households with young children are disproportionately affected. An estimated 683,221 households with children under age 5 experienced hunger and malnutrition. This has contributed to higher rates of stunting and impaired physical and cognitive development.

The highest prevalence is found in KwaZulu-Natal (20.1%), Johannesburg (13.6%) and Cape Town (12.4%). Since April 2021, 323 child deaths linked to malnutrition and hunger have been reported in the Eastern Cape.

Unequal Cities, Unequal Health: The Cost of Urban Planning Failures

As South Africa rapidly urbanizes, with more than 72% of the population projected to live in cities by 2030, food security policies remain inadequate. Low-income households in informal settlements and townships often lack access to affordable supermarkets. This forces them to rely on higher-priced spaza shops with limited access to fresh produce, directly deepening nutrition-related health inequities.

These failures in the urban food environment directly undermine health equity in South Africa. Energy and infrastructure instability disrupt cooking, refrigeration and food storage. This reduces households’ ability to consume fresh foods, increasing reliance on processed and street foods.

Despite social grants such as the Child Support Grant and the Social Relief of Distress (SRD), many households earn too much to qualify for assistance yet too little to afford adequate food. Even among households that do qualify, grant amounts are insufficient to cover the cost of a nutritious diet, particularly amid rising food inflation in South Africa. The criminalization of street vendors and restrictions on trading spaces undermine the informal food system.

In turn, this reduces access to affordable food for low-income households and pushes many into more severe food insecurity.

National and International Initiative To Improve Health Equity in South Africa

To address persistent nutrition-related health inequalities, the South African government uses initiatives such as the National Food and Nutrition Security Plan (NFNSP). It also implements the National School Nutrition Program (NSNP) to improve food security and child nutrition among disadvantaged populations. In 2018, South Africa introduced the NFNSP (2018–2023) to address nutrition-related health inequities by strengthening food security for low-income and vulnerable populations.

The plan aims to reduce childhood obesity and cut adult obesity by 15% by 2023. Similarly, in October 2023, the Department of Basic Education reaffirmed its commitment to the NSNP. The program feeds more than nine million learners annually and reduces child hunger.

Beyond national initiatives, the United Nations (U.N.) Sustainable Development Goal 1 (No Poverty) underscores the urgency of addressing child poverty, as many children continue to experience deprivation despite broader social assistance programs. The United Nations Children’s Fund (UNICEF) also supports South Africa by strengthening child poverty measurement. It also helps guide policies that direct government spending toward services benefiting the most impoverished children.

Additionally, in 2025, World Health Organization Member States extended the Global Nutrition Targets to 2030 and aligned them with the Sustainable Development Goals. The updated framework maintains targets to reduce stunting, anemia, low birth weight and wasting, while strengthening goals to reduce childhood overweight and increase exclusive breastfeeding. This extension reinforces global commitment to accelerating action on maternal and child nutrition and reducing nutrition-related health inequities.

Final Thoughts

Addressing health equity in South Africa requires coordinated action on the social and structural drivers of health, including poverty, inequality, limited access to primary health care and food insecurity. Strengthening primary health care, expanding universal health coverage and sustaining programs such as NSNP and NFNSP are essential to protecting vulnerable populations and reducing nutrition-related health disparities.

– Yuhan Rong

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

Photo: Unsplash

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Maternal Health Programs in Egypt Are Reducing Poverty

Maternal Health Programs in EgyptMaternal health in Egypt is closely linked to poverty, as health complications during pregnancy and childbirth often result in costly medical bills. Less affluent communities in the country experience income loss due to these expenses. In response, Egypt has expanded maternal health programs aimed at improving access to health care while protecting low-income households from health-related financial hardship.

Health expenses contribute significantly to poverty in Egypt, especially for women in low-income and rural households. The lack of timely prenatal and delivery care that many pregnant women face often causes families to incur emergency medical costs that push them into debt or force them to delay treatment.

Improving maternal health helps avoid these financial shocks. Complications and out-of-pocket spending are reduced, allowing women to remain economically stable and active after childbirth.

Egypt’s Maternal and Neonatal Health Strategy

Through its Maternal and Neonatal Health Strategy, the Egyptian government has prioritized maternal health nationwide. This initiative focuses on expanding access to prenatal, delivery and postnatal services. The strategy emphasizes care through family health units, which serve as the primary point of contact for women during pregnancy.

By strengthening central care facilities, the government has increased early detection of pregnancy-related risks and improved referral systems for high-risk cases, particularly in underserved areas.

Egypt’s national “100 Million Healthy Lives” initiative has also contributed to improved maternal health outcomes. The campaign expanded nationwide screenings and referral services, enabling health workers to identify pregnancy-related risks earlier and direct women to appropriate care.

Early detection reduces the likelihood of costly complications during childbirth, helping families avoid emergency expenses that often deepen poverty.

International organizations play a key role in strengthening Egypt’s maternal health system. Programs supported by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) focus on improving antenatal care coverage, increasing skilled birth attendance and expanding postnatal follow-up services.

These programs prioritize vulnerable populations, including women in rural areas and low-income households, by improving service quality and reducing financial barriers to care.

Improved Maternal Health Reduces Poverty Risks

Evidence indicates that women with access to adequate maternal care face lower health-related financial risks and improved long-term economic outcomes. Healthy pregnancies and safe deliveries reduce income loss, support women’s participation in the workforce and improve child health outcomes. Overall, these outcomes strengthen household economic stability for low-income families.

Maternal health programs are an effective poverty reduction tool, as they reduce medical costs and help prevent long-term disability.

Despite progress, challenges remain. Access to quality maternal health care is limited by regional disparities and workforce shortages. Addressing uneven access to health facilities and staffing gaps will require sustained investment from the government and international partners.

Looking Ahead

Maternal health programs play a critical role in reducing poverty in Egypt by protecting women and families from preventable health costs and economic shocks. Continued investment in maternal health services, particularly for vulnerable communities, can further strengthen economic resilience and support long-term development.

– Hana Abulkheir

Hana is based in London, UK and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Sustained Funding & Combating HIV/AIDS in Comoros

HIV/AIDS in ComorosLimited health care infrastructure, economic vulnerability and heavy reliance on external humanitarian aid make the fight against HIV/AIDS in Comoros fragile. While HIV prevalence remains low, progress depends largely on donor-funded programs. Inconsistent and short-term funding threatens to reverse gains in prevention, treatment access and health system resilience. Sustained funding for HIV/AIDS in Comoros is essential to ensure long-term prevention, uninterrupted treatment and national health stability.

HIV/AIDS in Comoros: A Fragile Success

HIV prevalence in Comoros remains below 1%, one of the lowest rates in sub-Saharan Africa. This success is largely due to early prevention strategies, cultural factors and donor-supported health programs. However, limited domestic health financing means that HIV/AIDS services depend heavily on external support for antiretroviral treatment (ART), testing services and public awareness campaigns. Any reduction in funding risks service disruption, increased transmission and setbacks to national health goals. Donor-supported programs have included nationwide HIV awareness campaigns, voluntary counseling and testing services and integration of HIV services into primary health care, all of which have contributed to maintaining low prevalence levels. Here is why sustained funding matters.

Continuity of Treatment

HIV is a lifelong condition with no cure and requires continuous treatment with antiretroviral drugs to suppress the virus and protect the immune system. According to the World Health Organization (WHO), uninterrupted ART significantly reduces HIV-related deaths and prevents drug resistance. Funding interruptions can lead to medication shortages, treatment gaps and declining health outcomes. Sustained funding for HIV/AIDS in Comoros ensures consistent patient monitoring, reliable medication supply and effective long-term care.

In Comoros, antiretroviral treatments are largely financed internationally, particularly grants from the Global Fund. According to UNAIDS, this external supply creates challenges such as supply chain delays, limited laboratory capacity and difficulties to provide a consistent patient follow-up across the islands. Sustained funding for HIV/AIDS in Comoros ensures consistent patient monitoring, reliable medication supply and effective long-term care.

Prevention and Education

Prevention and education programs are critical to maintaining low HIV prevalence in Comoros. One major example is the national prevention of mother-to-child transmission (PMTCT) program, supported by international partners such as UNICEF and WHO, which provides testing, treatment and counseling to pregnant women living with HIV; as a result, HIV prevalence among pregnant women stands at an exceptionally low level and infants born to HIV-positive mothers have consistently tested HIV-negative under this initiative.

Existing initiatives include community-based awareness campaigns supported by UNAIDS and the Global Fund, HIV testing and counseling services and outreach programs targeting young people and women. International assistance has supplied critical testing equipment and strengthened health worker training, helping expand access to HIV information and services. These programs promote safe practices, reduce stigma and encourage early testing. Long-term funding allows these initiatives to operate consistently and expand into underserved communities, particularly in rural areas.

Strengthening Health Systems

Efforts are underway to broaden health system improvements in Comoros. Investments have supported clinic infrastructure, trained health care workers and strengthened disease surveillance systems. However, challenges remain, including shortages of medical staff, limited laboratory capacity and unequal access to care between urban and rural regions. These weaknesses increase vulnerability to HIV transmission and hinder treatment access.

In Comoros, HIV/AIDS-related investments have contributed to improved primary health facilities and health worker training, but the country continues to face shortages of medical personnel and limited diagnostic infrastructure, particularly outside urban areas. According to the World Bank, stronger health systems improve economic resilience and reduce poverty in developing countries.

Solution in Action: The Global Fund

Established in 2002, the Global Fund has played a key role in supporting HIV/AIDS programs in Comoros. The Global Fund is one of the main external financiers of HIV/AIDS programs in Comoros, supporting HIV treatment and prevention efforts in collaboration with national health authorities. By financing antiretroviral therapy, HIV testing and health system strengthening, the organization has expanded access to essential services.

According to the Global Fund, its investments support the delivery of HIV services across the country, demonstrating how sustained international funding strengthens national health capacity. In 2023, countries supported by the Global Fund reported that approximately 25 million people were on antiretroviral therapy, and 53.8 million HIV tests were conducted through its investments, reaching millions with prevention services. While these figures reflect global outcomes, they illustrate the scale of support provided to countries like Comoros.

Poverty and HIV/AIDS in Comoros

Poverty remains a significant challenge in Comoros, where a large portion of the population lives below the national poverty line. Using the international poverty line of $3.65 per day, about 39.5% of Comorians lived in poverty in 2023, reflecting persistent economic hardship that constrains access to essential services like health care, education and transportation. In Comoros, long distances to health facilities, high out-of-pocket costs for care and shortages of trained health workers make it difficult for poor households to obtain HIV testing and treatment services, contributing to health inequalities. People living in poverty are also more vulnerable to poor health outcomes due to malnutrition and limited medical access. Addressing HIV/AIDS through sustained funding helps reduce these inequalities and supports broader poverty reduction efforts.

The Role of International Support

International support remains vital to sustaining HIV/AIDS programs. Comoros participates in regional HIV response efforts coordinated by UNAIDS and partners, such as Indian Ocean Island forum meetings aimed at strengthening prevention and treatment planning, demonstrating the active role of international support in shaping the country’s HIV strategy. Donor countries and multilateral institutions help bridge funding gaps while the government gradually strengthens domestic health financing. Sustained funding aligns with global commitments to end AIDS as a public health threat by 2030 and ensures that small island developing states like Comoros are not left behind.

Conclusion

The fight against HIV/AIDS in Comoros is about securing long-term public health and economic stability. Sustained funding ensures uninterrupted treatment, effective prevention strategies and stronger health systems. Programs supported by the Global Fund and other international partners show that long-term investment expands access to ART, increases testing in rural communities and reduces health disparities. With predictable and sustained funding, Comoros can continue to maintain low HIV prevalence, improve health outcomes and support sustainable development.

– Numahaiseta Sillah Tunkara

Numahaiseta is based in Duisburg, Germany and focuses on Technology and Politics for The Borgen Project.

Photo: Flickr

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A $50 Million AI Investment Will Boost Health Care in Rwanda

Health Care in RwandaBill Gates and OpenAI are planning to invest $50 million into AI health care systems in sub-Saharan Africa. The investment, which will chiefly benefit communities in Rwanda, will be implemented by 2028 and seeks to address persistent staff shortages in thousands of primary health clinics.

The Problem: Health Worker Shortages

Sustainable Development Goal (SDG) 3, one of 17 global SDGs set by the U.N. in 2015, is to “ensure healthy lives and promote well-being for all at all ages” by 2030. A key step toward realizing this goal is ensuring that everyone has access to quality health care. It follows that for a nation to have universal access to quality health care, it must have an appropriate number of health care professionals to tend to the needs of its population.

Rwanda and other sub-Saharan African nations have traditionally experienced a deficit of health care professionals according to their needs. In 2022, it was estimated that Africa as a whole needed a total of 9.75 million health workers to meet the health care needs of its population, of which it had only 43%. The number of health care workers in Africa is expected to increase.

However, at the current rate, only about 49% of the workforce needed to meet the continent’s health care demands will be in place by 2030. At this pace, SDG 3 will remain out of reach, leaving millions of Africans without access to quality health care.

To meet SDG 3 targets by 2030, African nations must significantly expand their health care workforce or adopt alternative strategies to improve health care efficiency and service delivery.

The Solution: AI Integration in Health Care

AI has great potential to provide a novel solution to the shortage of health workers in sub-Saharan African nations. Rwanda has just one health care worker per 1000 people, well below the WHO-recommended average of 4.45 per 1000 people. The $50 million investment proposed by the Gates Foundation and OpenAI in Rwanda will support the integration of AI into local health care clinics.

This technology will assist health workers with daily tasks, allowing clinics to operate more efficiently. As a result, the introduction of AI is expected to significantly improve health care outcomes across the country. Health workers in Rwandan clinics will be able to use AI tools to handle a range of administrative tasks, including record-keeping, automatic transcription of patient visits and the creation of clinical summaries.

This will allow doctors to see more patients and focus their time on critical responsibilities such as diagnosis and treatment. AI will also benefit maternal and child health. Sub-Saharan Africa accounted for almost 70% of global maternal deaths in 2023. By analyzing large datasets, AI can predict potential health problems during pregnancy, ensuring that doctors are well-prepared to treat patients and aware of regional health trends.

Rural communities in Rwanda are expected to benefit significantly from the integration of AI-driven telemedicine. These areas often have limited access to medical professionals and AI-enabled tools will allow doctors to monitor, diagnose and treat patients remotely through technologies such as smartwatches. This approach has the potential to reduce health care disparities in remote regions.

Furthermore, patients will be able to interact with AI chatbots that can answer basic medical questions, assist with scheduling doctor appointments and provide medication reminders.

Overall

The Gates Foundation and OpenAI’s $50 million investment will provide a novel solution to the shortage of health care workers in sub-Saharan Africa. The use of AI in the health care system in Rwanda will allow health professionals to care for a far greater number of patients while ensuring the quality of medical care remains high. AI is forecast to have an overwhelmingly positive impact on the health systems of sub-Saharan nations, making a universal basic standard of health care seem more achievable than ever.

– Arthur Horsey

Arthur is based in Hampshire, UK and focuses on Business and Technology for The Borgen Project.

Photo: Flickr

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The HIV Epidemic in Zambia: Project HOPE

HIV Epidemic in ZambiaAccording to the Centers for Disease Control and Prevention (CDC), in 2023, 9.8% of Zambia’s population ages 15 to 49 was living with HIV, with about 15,000 related deaths recorded that same year. Based on the distribution of HIV across the population, the United Nations Children’s Fund (UNICEF) classifies Zambia as having a generalized HIV epidemic. HIV epidemics are considered “generalized” when transmission occurs largely through sexual activity in the general population, meaning programs that focus only on specific vulnerable groups are unlikely to significantly reduce overall transmission or achieve eradication.

In Zambia, several nongovernmental organizations (NGOs) have worked to reduce the impact of the HIV epidemic. These include the Elizabeth Glaser Pediatric AIDS Foundation and FHI 360. One of these organizations was Project HOPE, a global health and humanitarian organization operating across five continents with a mission to improve access to care and health outcomes worldwide. Project HOPE has operated in Zambia since 2019, focusing on reducing the effects of the HIV epidemic, particularly among children and adolescents.

Project HOPE’s Efforts in Zambia

Because Zambia is experiencing a generalized epidemic, HIV transmission occurs primarily through unprotected sexual activity. However, there is a significant disparity between young men and women ages 15 to 24. In 2020, HIV prevalence among young women was 5.7%, compared with 1.8% among young men. This disparity may be linked to factors such as high rates of early pregnancy, earlier sexual debut, coercion linked to unequal power dynamics and age-disparate sexual relationships, all of which are prevalent among adolescent girls and young women in Zambia.

Project HOPE identified these dynamics as a major concern and focused its work on addressing the underlying socioeconomic factors that influence HIV transmission among adolescents and young adults.

On the ground, Project HOPE supported HIV treatment efforts by helping ensure access to pre-exposure prophylaxis (PrEP), counseling adolescents and young people on positive sexual health practices and supporting HIV health informatics programs. The organization also partnered with the Centre for Infectious Disease Research in Zambia to support the Empowered Children and Adolescents Project through community interventions and case management.

Through these efforts, Project HOPE provided antiretroviral therapy to 388,836 adults and children living with HIV and delivered gender-based violence education to 2,565 individuals. On Sept. 8, 2025, Project HOPE announced that it had ended operations in Zambia as of June 2025. The organization cited reductions in U.S. foreign assistance funding following a realignment of foreign aid policy as the primary reason for the decision.

The America First Global Health Strategy

The America First Global Health Strategy was introduced by the U.S. Department of State in September 2025. The strategy responded to concerns about inefficiencies in global health foreign assistance programs. According to the Department of State, only about 40% of global health aid reached frontline workers and commodities, while 60% supported technical assistance, program management and other overhead costs.

Officials attributed this imbalance to earlier policies that emphasized direct investment through NGOs, which they said created parallel supply chains and procurement systems alongside local governments.

As a result, the policy shift led to significant reductions in U.S. Agency for International Development funding for NGOs, with a greater emphasis on delivering aid through local governments. The stated goal is to strengthen public health systems and build long-term self-sufficiency in responding to crises such as the HIV epidemic.

The Role of NGOs in Zambia

As the America First Global Health Strategy takes shape, organizations such as Project HOPE have struggled to sustain operations in countries like Zambia. However, Steven Neri, Project HOPE’s senior regional director for Africa, emphasized the continued importance of NGOs when speaking with The Borgen Project.

“Project HOPE was able to bring our expertise from across Africa and around the world to support the HIV prevention, care and treatment program in Zambia,” Neri said. “Our ability to bring lessons from outside Zambia and work with Zambians to translate those lessons into effective HIV programs is something that I am proud of.”

Neri also highlighted the role of the President’s Emergency Plan for AIDS Relief (PEPFAR), which has invested more than $110 billion in HIV programs globally, in advancing innovation and expertise in HIV management.

The Future of HIV Management in Zambia

Although Project HOPE has concluded its operations in Zambia, HIV epidemic management continues through coordination between the U.S. and Zambian governments. On Nov. 18, 2025, the Department of State announced that the first doses of lenacapavir had been delivered to Zambia.

Lenacapavir is a twice-yearly injectable PrEP medication that offers a long-acting alternative to daily oral pills, particularly for individuals who face challenges with adherence or access to health care. On Nov. 4, 2025, after 12 working days of review, both tablet and injectable forms of lenacapavir received approval for HIV prevention from the Zambia Medicines Regulatory Authority.

As U.S. funding shifts away from NGOs and places greater responsibility on local governments, Project HOPE has emphasized the importance of retaining proven best practices during this transition. Neri expressed cautious optimism about the future of HIV management in Zambia while stressing the need for continued support for on-the-ground delivery.

“Making lenacapavir available in Zambia is consistent with the original focus of PEPFAR,” Neri said. “Without medicines, it is impossible to have a successful HIV program, and without program funding, it is hard to imagine how access to medicines will improve. The two go hand in hand.”

– Nikhil Kumar

Nikhil is based in Lexington, MA, USA and focuses on Global Health and Politics for The Borgen Project.

Photo: Flickr

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Melioidosis in Bangladesh Threatens Rural Communities

Melioidosis in BangladeshHidden beneath flooded rice fields and carried by monsoon rains, a little-known disease is shaping a quiet public health crisis. Melioidosis in Bangladesh exists at the intersection of climate, poverty and limited health care access. Yet it remains largely invisible in national disease statistics.

For many patients, the illness never earns its real name, instead slipping through the health care system disguised as more familiar conditions. Rural communities suffer the most severe consequences, as their livelihoods depend on daily contact with soil and water. Understanding why melioidosis continues to evade recognition is essential not only to saving lives but also to protecting the people who sustain Bangladesh’s economy and food security.

Misdiagnosed, Misrepresented and Misunderstood

Melioidosis manifests differently from person to person and can range in severity from flu-like symptoms to skin abscesses and sepsis. Burkholderia pseudomallei enters the body through ingestion, inhalation or skin cuts, allowing it to infect the bloodstream, lungs and skin, sometimes simultaneously. Because the bacteria can affect multiple organ systems, melioidosis is often misdiagnosed as tuberculosis, fungal infections or even cancer.

These misdiagnoses can delay treatment, even though antibiotics must be started promptly and completed fully to improve recovery outcomes. Since the ’60s, hospitals in Bangladesh have reported only around 100 cases of melioidosis. This figure is widely believed to underestimate the true burden of the disease.

One study estimates that melioidosis in Bangladesh could account for up to 17,000 cases and 9,500 deaths each year. This gap is mainly due to limited clinical awareness and insufficient laboratory capacity for proper diagnosis. Patients with other underlying conditions, known as comorbidities, are at a higher risk of melioidosis, including those with diabetes, alcohol use disorder and chronic lung disease, which may complicate diagnosis further.

Rural Communities in Bangladesh at High Risk

Burkholderia pseudomallei is well-adapted to Bangladesh’s warm, humid climate. The bacterium thrives in environments with year-round high temperatures, waterlogged soil and frequent monsoon rainfall. As a result, rural communities, particularly those dependent on agriculture, face the greatest risk of infection.

Agriculture accounts for nearly 90% of rural employment and many farmers work barefoot or without protective equipment, increasing their exposure through direct contact with contaminated soil and water. Social factors further compound the risk. Poverty rates in rural Bangladesh stand at around 20%, compared with 16.5% in urban areas.

Illness caused by melioidosis can prevent individuals from working, deepening economic hardship for affected families and communities. Looking more broadly, the agricultural sector is one of the most productive in Bangladesh’s economy, contributing around 11% of the national GDP. Rural farming communities sit at the heart of this system.

Yet, they often have the least access to health care due to geographic and financial constraints. Protecting farmers and their families from melioidosis, therefore, supports not only their health and livelihoods but also the country’s food security and export capacity. This underscores the need for adequate protective equipment and timely access to effective antibiotic treatment.

Fighting for Futures: The South Asian Melioidosis Congress

In 2023, the third South Asian Melioidosis Congress (SAMC) met in Dhaka, Bangladesh, to discuss emerging research concerning the tropical disease and to share methods of its detection and management. These educational meetings aimed to raise awareness of melioidosis and provide physicians with the tools for accurate diagnosis. This proved successful, with nine reported cases of melioidosis in Bangladesh soon after the SAMC’s conclusion, each patient with different symptoms.

This reflects the vigilance of health care professionals regarding the early diagnosis of melioidosis as empowered by the collective effort of the SAMC to fight this disease. Following the conclusion of the fourth SAMC at the end of 2025, organizers are hopeful that renewed awareness will lead to more diagnosed cases being reported in Bangladesh. The theme of the fourth SAMC, “Melioidosis: The Great Mimicker,” highlighted the disease’s ability to mimic a wide range of illnesses.

The most recent congress brought together experts from across the world in Northeast India to discuss key issues surrounding melioidosis, including diagnostic approaches, public health implications and treatment guidelines. These discussions aimed to raise awareness of the disease and strengthen future efforts to protect vulnerable rural communities.

– Charlotte Bunn

Charlotte is based in Bristol, UK and focuses on Global Health for The Borgen Project.

Photo: Flickr

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How Organizations Advance Equitable Health Care in Eritrea

Health Care in EritreaAlthough health care in Eritrea has improved in important areas, such as declining mortality rates, over the past decade, vulnerable populations and rural communities continue to face the adverse effects of health care disparities. Several international organizations and community-based programs work to bridge the gap and increase accessibility to quality health services.

Health Care Disparities in Eritrea

Numerous disparities in health care access and services exist between urban and rural populations in Eritrea. The percentage of women receiving antenatal care from a health care professional in Eritrea increased significantly from 49% in 1995 to 70% in 2002. However, access remained uneven, with 91% of women in urban areas receiving antenatal care compared to just 59% in rural areas

A similar disparity appears in facility-based childbirth. In urban areas, the proportion of women giving birth in a health facility rose from 58% in 1995 to 62% in 2002. In contrast, the figure for rural women increased only slightly, from 7% to 9% over the same period.

Disparities in access to obstetric services were also evident across education levels. In 2002, approximately 88% of women with some secondary education were assisted by a trained health worker during childbirth, compared with 36% of women with only primary education and just 12% of those with no formal education.

Multiple disparities also exist in child health outcomes:

  • In 2002, the infant mortality rate was 48 per 1,000 live births in urban areas, compared to 62 per 1,000 in rural areas.
  • The under-5 mortality rate stood at 86 per 1,000 in urban areas, rising to an average of 117 per 1,000 in rural communities.
  • Stunting affected 20% of children whose mothers had higher education, compared with 35% of children whose mothers had primary education and 44% of those whose mothers had no formal education.

Disparities in Mental Health Treatment

Due to the increasing prevalence of mental health disorders in Eritrea, mental illnesses are among the leading causes of disability, comorbidity and mortality in the country. In 2014, the prevalence rate for common mental disorders was 14.5% and the estimated number of children with intellectual disabilities was between 30,000 and 40,000. However, because adequate mental health workers and services are limited, many mental illnesses and disorders are likely undetected or misdiagnosed.

Nonetheless, several organizations provide essential support to Eritrean refugees. Around 5,000 people flee the country each month to escape hardship and mandatory military service, increasing the need for mental health services in refugee camps. Doctors Without Borders (MSF) launched a mental health program in 2015 in Ethiopia’s Hitsats and Shimelba camps, offering counselling and inpatient and outpatient psychiatric care.

The Jesuit Refugee Service (JRS) also provides Mental Health and Psychosocial Support through counselling, psychological first aid, referrals and community-based activities that strengthen social connection and resilience.

Expanded Program on Immunization

The World Health Organization (WHO) identified physical barriers as a major challenge to immunization coverage in rural communities. In response, WHO implemented the Expanded Program on Immunization (EPI) in Eritrea to improve vaccine access, reaching more than 42,000 children and 150,000 mothers. By 2024, the program achieved national immunization coverage rates exceeding 95% for several vaccines.

UN Sustainable Development Cooperation Framework for Eritrea

The country program for Eritrea, outlined in the U.N. Sustainable Development Cooperation Framework 2022-2026, aims to enable more Eritreans to benefit from equitable and inclusive health and social services by 2026. The program outlines some goals for improved health and social services, including:

  • Increase the percentage of births attended by trained personnel from 71% to 85% to reduce preventable maternal deaths. 
  • Reduce the adolescent birth rate for girls aged 15-19 years from 27 per 1,000 to 14 per 1,000.

To achieve these goals, the program implemented several interventions, including:

  • Strengthening the capacity of health workers: Training doctors, nurses, midwives and anesthetists across Eritrea to provide quality emergency obstetric care, post-partum care, family planning, HIV prevention and gender-based violence support.
  • Building health system resilience: Deploying internationally trained obstetricians and gynecologists to remote and underserved areas, supported by technology to improve communication and service delivery nationwide.
  • Increasing access to maternal waiting homes (MWHs): Expanding and improving MWHs, which provide accommodation for pregnant women from remote areas during the final weeks of pregnancy, to enhance safe deliveries and postnatal care.
  • Advocacy: Promoting awareness of preventable maternal deaths and unmet family planning needs to inform government policies, planning and budgeting.
  • Supporting the National Fistula Diagnosis and Treatment Center (NFDTC): Strengthening services for fistula prevention, treatment and rehabilitation to ensure adequate national coverage.
  • Expanding adolescent and youth services: Strengthening and utilizing the existing network of youth-friendly centers to improve access to care.
  • Strengthening HIV prevention services: Enhancing delivery of HIV prevention interventions, particularly for high-risk populations such as female sex workers.
  • Empowering women and young people to use health services: Using community outreach and mobilization to increase uptake of HIV and gender-based violence services.
  • Reinforcing health information systems: Reestablishing and improving health management information systems, including maternal and perinatal death surveillance and response mechanisms.

Additionally, the country program works in collaboration with UNICEF and the WHO to strengthen the distribution and supply chain systems for medicines and medical supplies across Eritrea. This joint initiative aims to address unmet needs in family planning, reduce preventable maternal deaths and combat gender-based violence and harmful practices.

Community-Based Programs

  • Malnutrition Screening and Detection: UNICEF and the Ministry of Health (MoH) work together to train community health volunteers to use mid-upper arm circumference (MUAC) tapes to screen for and detect malnutrition in children under 5 and to provide referrals for treatment. These volunteers deliver life-saving interventions to approximately 50,000 acutely malnourished children each year.
  • Bare Foot Doctors Initiative (BFDs): BFDs trained through UNICEF help strengthen community-based service delivery in areas facing geographic barriers to health care. Their deployment has enabled 68,000 women and children to access essential public health services. By 2022, UNICEF had trained a total of 121 community members as BFDs.
  • Community Health Workers (CHWs): CHWs are a key component of community-based child health interventions in the Maekel Region aimed at reducing child mortality. Indeed, CHWs provide case management for pneumonia, malaria and diarrhea, the leading causes of death among children under 5 and lead community education sessions on child health. The MoH provides training and oversees the distribution of medical supplies and medications used by CHWs. The program has improved access to health care services and strengthened relationships between the MoH and local communities across the Maekel Region.

Conclusion

Notable work is being done to improve health care in Eritrea. Trained CHWs and volunteers extend services to areas previously out of reach. Organizations implementing health interventions benefit vulnerable populations and areas, including Eritrean refugees.

Organizations implementing health interventions are reaching vulnerable populations, including Eritrean refugees and helping to close existing care gaps. Together, these initiatives continue to drive progress toward a more equitable health care system in Eritrea.

– Sarah Merrill

Sarah is based in Matthews, NC, USA and focuses on Good News and Global Health for The Borgen Project.

Photo: Pixabay

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Reclaiming Health Care for Indigenous Communities in Canada

Indigenous Communities in CanadaIn Canada, health care is socially determined. More precisely, health care for Indigenous communities faces several barriers that generate disproportionate health statistics compared to non-Indigenous Canadians. Indigenous people have a lower life expectancy and are at a greater risk of developing chronic and infectious diseases.

They also experience higher rates of mental health issues, as well as substance abuse and are more likely to be discriminated against by health care professionals.

The Barriers

One of the greatest barriers for Indigenous communities seeking health care is geography, especially for those living off-reserve and in remote areas. In a survey conducted by Statistics Canada, more than half of Inuit respondents reported having to travel more than 1,500 kilometers to access health care. In that same survey, one in five Indigenous people reported experiencing discrimination and racism by health care professionals.

In some cases, this prejudice would lead to inadequate care, misdiagnoses and negatively impact mental health. Health care for Indigenous communities also falls short when it comes to diseases. Indigenous peoples have a higher risk of developing chronic diseases such as diabetes. cardiovascular diseases and respiratory illnesses compared to non-Indigenous Canadians.

This is partially due to the aforementioned health care barriers and can also be attributed to intergenerational trauma and forced erasure of traditional medicinal practices.

The Case of Joyce Echaquan

Joyce Echaquan’s death on September 28, 2020, at the Joliette Hospital Center in Quebec is one fatal instance of racial discrimination against Indigenous peoples by health care professionals. Echaquan, a 37-year-old Atikamekw woman and mother of seven, went to the hospital for severe stomach pain. She recorded hospital staff verbally berating her on her phone and passed away shortly after posting the video to social media.

Her case received widespread media attention and prompted protests, marches and vigils in Montreal and surrounding Quebec cities to bring hospital staff to justice. A call to action in her name, the Joyce’s Principle, “aims to guarantee to all Indigenous people the right of equitable action, without any discrimination, to all social and health services.” The Joyce Principle has since been adopted by the federal government and by universities such as McGill.

The Canadian Medical Association (CMA) covered her story in its historical and ethical review report and apology to Indigenous peoples released in 2023.

Indigenous-Led Initiatives

Indigenous representatives across Canada are calling for more initiatives led by their own communities to ensure that health care is delivered in a culturally safe way. The First Nations Health Authority (FNHA) in British Columbia is one such initiative. It is the only health authority in Canada to operate on a provincial scale and its mission is to establish culturally safe care by managing and funding health programs.

It has been successful in operating clinics and health centers across the province and in encouraging respectful collaboration with Indigenous people since 2013. Similar initiatives, such as the Keewatinohk Inniniw Minoayawin (KIM) in Manitoba and the Sioux Lookout First Nations Health Authority (SLFNHA) in Ontario, aim to provide culturally safe health care at the provincial level, on par with the FNHA.

– Brittany Buscio

Brittany is based in Montreal, Canada and focuses on Good News and Global Health for The Borgen Project.

Photo: Flickr