Archive for category: Health

Information and stories on health topics.

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Dangerous Diseases Impacting Djibouti

Diseases in DjiboutiThe residents of Djibouti face many challenges. Natural factors such as drought and higher temperatures affect not only residents’ basic needs but also their quality of life with disease and poverty distressing the population constantly. Here is information about some of the diseases impacting Djibouti.

Diseases Impacting Djibouti

Diseases impact the majority of communities in Djibouti. These are examples of some of the most severe illnesses harming vulnerable members in society. Both communicable and non-communicable diseases are threatening.

  • Malaria
  • Human Immunodeficiency Virus (HIV)
  • Cholera
  • Tuberculosis
  • Hepatitis B 

How Effective Is Medical Care in Djibouti?

Health centers are limited. This is attributed to a lack of staff and resources, which impacts Djibouti’s health care system. Medical systems are strained from pressure and the heavy disease rate.

There is a substantial divide in medical care between rural and urban areas. Urban areas are more likely to have a stronger infrastructure and more funding. Djibouti has 66 medical centers and most of them are located in the capital, Djibouti City. Peltier Hospital is the biggest hospital there, which is not only a place to treat disease, but also home to medical discoveries as research takes place there.

Poverty in Djibouti

A main cause of Djibouti’s hardships is because of poverty, which one can see through its medical care. Even though public health care costs less and is easier for people to access in Djibouti compared to private health care, there are lengthy wait times and staff shortages. Meanwhile, private health care has shorter wait times and more advanced staff.

About 79% of people in Djibouti live in poverty but 42% live in the most extreme conditions. Health care is a constant battle due to people lacking income and having a constant threat of disease. As private health care is more costly, most of the population cannot afford it.

Malaria and Genetically Engineered Mosquitos

Malaria is an ongoing issue in Djibouti. In the year of 2012, 27 cases took place but over the following years to 2020, it has dramatically grown to above 73,000. 

These statistics show how malaria is an increasing issue. Malaria is spread when a mosquito is infected and bites a living organism. This is not communicable, but the infection spreads in the blood stream. The cycle continues as a mosquito will bite the infected person and it resumes. In rare cases, people can catch it through blood transfusions.

In 2024, tens of thousands of genetically engineered mosquitos were created to mitigate the spread of infection thanks to Oxitecs Friendly™. The male mosquitos carry a gene that kills the female mosquitos, reducing malaria. Only female mosquitos carry the disease, so reducing them mitigates the spread of malaria.

HIV and Mobile Brigades

More than 1% of local people are diagnosed with HIV. This is classed as a high rate, underlining the conditions people of Djibouti experience daily. This chronic condition is a virus, that harms the immune system.

HIV passes from person to person through close contact with bodily fluids. Unfortunately, there is no current cure, but treatment can help. If it is not quickly treated, it can develop and become more serious.

Djibouti faces the harshest realities of poverty and this heightens HIV rates. Due to a lack of funding and awareness into health care, more people will unfortunately suffer. Women are more vulnerable to this because they are fearful to reach out for help to help end HIV. This is because of the negative stigma attached to HIV/AIDS.

However, new developments are emerging to reduce the negative stigma. One example is mobile brigades. These are vehicles with medical professionals that go to communities, test for HIV and bring awareness. In 2019, they raised awareness of HIV/AIDS to about 26,000 people who were at risk. Additionally, the mobile brigades provided 6,000 tests and treatment to 2,900 people.

Addressing Cholera

Another of the diseases impacting Djibouti is cholera. Cholera is a disease that is bacterial and passes through contaminated food sources. Cholera can cause stomach pain, sickness, dehydration and death in some severe cases. 

The latest cholera outbreak that Djibouti considered a threat was in 1893. However, the country continued to view cholera as high risk in 2007, and it is significantly dangerous for children. This is because children with cholera often do not show symptoms and fatalities can come about quietly.

UNICEF is implementing WASH interventions in several countries across the globe to eliminate cholera and Djibouti is one of its target countries. Some strategies include implementing reliable and safe water sources and medical treatments, and improving hygiene practices.

The Impact of Tuberculosis

There are around 40 to 499 cases every 100,000 people of the Djibouti population. Tuberculosis is a bacterial infection that is passed from one infected person to the other. This occurs through direct encounters as people can get it through contact with a contaminated person.

The statistics show that this disease is a persistent problem. This is reflected through safety information, as travelers are advised to do screening for their safety and others. This highlights the importance of medical care. Fortunately, it is a curable disease, although if not treated, it can be fatal.

The Prevalence of Hepatitis B

Hepatitis B is a virus that can cause liver issues and is another of the diseases impacting Djibouti. Depending on its severity, it can either be short term or long term. Hepatitis B is spread through bodily fluids or infection spread through blood.

Many see Hepatitis B as a prevalent issue because there is no cure. However, vaccines and treatments can reduce the possibility of Hepatitis B. According to recent data, out of every 100,000 people of the population of Djibouti, 1,044.47 people are diagnosed with Hepatitis B. The statistic is considered high. Sometimes people can be a carrier of it without their knowledge, making it more dangerous.

Looking Ahead

Overall, disease impacts all parts of life in Djibouti. With the hardships of natural disasters and lack of funding, poverty still continues to be the main issue. Funding gives access to medical care and education, and a better life for people of Djibouti. However, with more awareness, this can happen. The new medical achievements show a more positive future for the Djibouti nation.

– Daisy Maidment

Daisy is based in Manchester, UK and focuses on Global Health for The Borgen Project.

Photo: Wikimedia Commons

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Mobile Technology & Community Health Care in Malawi

Health Care in MalawiIn many rural communities in Malawi, the health care system continues to face significant challenges in delivering accessible, affordable services to its rural population. More than 80% of Malawians live in rural areas, where limited funding, inadequate medical supplies, bribery and unaffordable costs restrict access to essential health care. Many rural families walk long distances to reach the nearest clinic, thereby delaying health care until health complications become severe.

Limited access to health care increases the risk of death among young children in Malawi, as people who live far from health centers are less likely to receive medical care. This also affects pregnant women who live farther away from those facilities, as they are less likely to get prenatal checkups or professional help during childbirth. To address these challenges, Malawi has increasingly relied on Community Health Workers (CHWs), locally known as Health Surveillance Assistants (HSAs), who serve as important links between communities and health systems.

Recently, the introduction of mobile technology has paved the way for more effective health care delivery. Using mobile phones, digital reporting tools and health apps, CHWs can now track patient data, communicate with clinics and respond more quickly to medical needs and emergencies. These digital efforts are supported by organizations such as the Malawi Ministry of Health, which oversees community health programs and digital health systems and VillageReach.

This global nonprofit organization strengthens supply chains and digital health tools for frontline health workers in Malawi. Together, these technologies improve access to health care, support health education and strengthen health systems in rural communities.

Mobile Technology Strengthening Community Health Work

Mobile technology has become an important tool in strengthening HSAs across Malawi. Smartphones, tablets and SMS-based platforms enable HSAs to collect patient data, monitor symptoms and communicate directly with health facilities. One of the most widely used systems is the Malawi Ministry of Health’s mobile system, which enables live disease surveillance and medicine stock monitoring.

The Integrated Community Health Information System (iCHIS) is a mobile system implemented by the Malawi Ministry of Health. It supports HSAs by enabling them to record patient data digitally and submit accurate, up-to-date reports. This system replaces paper-based reporting and data collection, improving accuracy and speeding up communication with district health offices.

By helping track diseases and monitor maternal and child health, iCHIS strengthens community-level health care and improves response times in rural areas of Malawi. In a published report, Malawi’s Ministry of Health emphasized that digital reporting systems such as the iCHIS have reduced delays in community-level data reporting and improved decision-making at district health offices. Officials noted that real-time digital data allows faster responses to disease outbreaks and improves monitoring of maternal and child health services, particularly in hard-to-reach rural areas.

In addition, digital systems support health education by providing HSAs with updated information on nutrition and disease prevention. These tools strengthen communication between health workers and communities, improve trust in local health services and help ensure that patients receive timely and appropriate care. Overall, mobile technology has become an important tool for strengthening community-based health care delivery in Malawi, particularly in rural areas.

Organizations Supporting Digital Health Initiatives in Malawi

  • VillageReach: VillageReach supports Malawi’s health system by deploying digital tools that strengthen last-mile service delivery. The organization works with frontline health workers to use mobile reporting systems that improve data accuracy, reduce medicine stockouts and strengthen coordination between community health workers and health facilities. These tools also help health officials quickly identify supply gaps and respond before shortages affect patient care.
  • Partners In Health (PIH): PIH is another organization that works with Malawi’s Ministry of Health to strengthen rural health care delivery through technology and training. The organization focuses on improving data collection, disease surveillance and quality of care by supporting digital health systems used by HSAs. PIH also helps strengthen digital systems and supports CHWs with tools that improve patient tracking and follow-up care, especially for maternal health, HIV and infectious diseases.
  • Clinton Health Access Initiative (CHAI): CHAI supports Malawi’s Ministry of Health by strengthening digital health systems, improving supply chain management and expanding access to essential health services. The organization implements data-driven health programs that enhance disease surveillance, improve access to medicine and strengthen overall health system performance. Through partnerships with government agencies, CHAI also develops and improves digital tools that enhance health care delivery.

Through the combined efforts of these organizations, the workload of CHWs has been greatly reduced. These efforts show how combining community health work with mobile technology can expand health care access and improve outcomes even in developing regions.

Looking Ahead

As Malawi continues to invest in digital health, mobile technology is becoming an important tool for improving health care delivery. Indeed, expanding mobile network access, strengthening digital skills among health workers and improving data systems will help ensure progress. With continued support and partnerships, mobile health systems can address health care challenges, improve patients’ well-being and strengthen the country’s health system.

By giving HSAs better digital tools, Malawi shows how technology can help to reduce challenges in health care access. These systems support CHWs and provide a practical example for other low-income countries seeking to improve rural health care in affordable, effective ways.

– Emmanuel Fagbemide

Emmanuel is based in Winnipeg, Canada and focuses on Technology and Global Health for The Borgen Project.

Photo: Unsplash

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Addressing HIV/AIDS in Malta

HIV/AIDS in MaltaMalta is a developed island located in the Mediterranean Sea, between Sicily and North Africa. With a relatively small population, 532,956 in 2023, according to the World Health Organization (WHO), the population still suffers from HIV/AIDS diagnoses. Despite these challenges, promising progress from NGO HIV Malta and the country’s effective health care facilities and expertise continue to steady the rate of positive infections. Here is information about HIV/AIDS in Malta.

What Are HIV and AIDS?

HIV, also known as human immunodeficiency virus, is a virus that results in illness from a weakened immune system. The virus attacks healthy cells in the body, ultimately exposing the body to other infections. People most commonly spread it through unprotected sex, contact with the body fluids of someone with HIV or even when sharing injection equipment.

Eventually, if people leave it untreated, it can lead to AIDS, which stands for Acquired Immunodeficiency Syndrome. AIDS is described as the last stage of HIV, where the body’s cells and immune system are severely damaged. It can eventually lead to death if people leave it untreated during the initial HIV stage.

The Times of Malta recorded Malta’s first case of AIDS in 1984. In 1986, an estimated 25 individuals had a positive HIV test, which triggered a national health response. The Health Education Unit published leaflets named Fatti dwar 1-AIDS, to warn people of the untreatable infection. Moving into the 2000s, positive HIV tests mounted to 210 in 2003. According to The Times of Malta, “HIV was then named a notifiable infection on January 27, 2004.”

According to the HIV Justice Network, Malta passed a disease transmission law in 2005, which made it a crime for someone with an HIV infection to recklessly or intentionally pass it on to another. The sentencing powers include life imprisonment, and monthly sentences or fines.

Poverty in Malta – HIV/AIDS Prevalence Amongst Migrant Groups 

While Malta’s economy continues to excel as a developed nation, poverty still affects the less fortunate, in this case, migrants fleeing their home to settle elsewhere. According to Trading Economics, Malta’s risk of poverty in 2024 reached 16.8%. Over the years, Malta has seen a fluctuating poverty rate, with both high and low peaks. Its highest recording reached 17.1% in 2019. The factors influencing poverty in Malta include variations in living conditions, unemployment rates and income inequality.

Across Malta, HIV/AIDS prevalence in migrants is more common than in nationals. To date, the country has welcomed 2,000 asylum seekers and 11,000 refugees, according to the World Health Organization (WHO). HIV testing is free for all individuals in Malta; however, if migrants receive a positive test, the treatment policy differs. Ultimately, those who do not have legal employment must pay for their treatment, resulting in higher untreated cases amongst migrants, due to high medical costs ranging between €600 to €1,500 monthly according to HIV Malta.

Background on HIV Malta 

HIV Malta is a non-governmental organization working to help focus on the well-being and necessary quality of life of those with HIV/AIDS in Malta. The NGO addresses HIV in Malta by implementing educational programs, prevention methods, advocacy groups and support services. Its main aims also include:

  • Relevant treatment and policy work should be carried out to improve the quality of life of those with HIV.
  • Educational campaigns that provide factual, knowledge-based information.
  • Making sure those with HIV can live their life with respect for their human rights.
  • Providing accurate information that is scientifically proven for testing and prevention. 
  • Working with stakeholders in the medical sector to perfect treatment. 
  • Working with the community and with other NGOs with strong, compatible objectives.

Key Accomplishments and Collaborations 

We Are Positive is an advocacy group that HIV Malta created in partnership with Checkpoint Malta and activist/artist Emma Grima. It aims to humanize HIV and promote sexual health in communities.

Its first artistic action, held in 2014 at the LOVE Monument in Spinola Bay, St Julian’s, included plastering the monument with 620 self-testing boxes and urging people to interact with them. The general public engaged in conversations, and people received encouragement to tell their HIV journey story. The box contained cards and stickers explaining where people could get tested. They highlighted the success of the campaign across their web page.

Checkpoint Malta also set up monthly peer support in 2024, encouraging those living with HIV to share their experiences in a confidential and safe space. Their ongoing monthly meetups provide an opportunity for people to communicate outside of medical settings.

The Future of HIV/AIDS in Malta 

With HIV Malta leading as a forefront NGO in providing expertise to reduce the spread and risk of HIV transmission across Malta, the country is looking at a promising decline in infections. According to the World Health Organization (WHO), the number of new HIV infections in Malta (per 1,000 uninfected population) has remained at 0.1 per 1,000 since the 1990s up until 2024. HIV/AIDS in Malta is showing promising progress with the availability of testing methods, prevention methods and treatment from expert clinics and hospitals. However, changes to treatment availability across the country, particularly for migrants, will help tackle the decline in positive infections.

– Zara Ashraf

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

Photo: Unsplash

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Health Effects of Poverty on the Elderly

Health Effects of Poverty on the ElderlyPoverty has long been associated with poor health outcomes, but its impact on older adults is often overlooked. Around the world, millions of elderly people live in poverty, facing barriers to basic needs such as food, housing and medical care. As global populations age, the health effects of poverty on the elderly have become an increasingly important global health concern.

Income Insecurity Among Older Adults

According to the World Bank, poverty remains widespread in many low- and middle-income countries, where social protection systems are often weak or underdeveloped. Older adults in these settings are particularly vulnerable because many no longer participate in the workforce and lack reliable sources of income. Without pensions or savings, elderly individuals may struggle to afford basic necessities, placing them at higher risk of poor health outcomes.

Barriers to Health Care Access and Malnutrition

Limited access to health care is one of the most serious health effects of poverty on the elderly. The World Health Organization (WHO) reports that health systems in many developing countries face challenges such as insufficient funding, limited infrastructure and shortages of health care workers. These systemic issues can make it difficult for older adults to receive regular medical attention, particularly for chronic conditions that require ongoing care.

Beyond physical health, poverty also affects mental and social well-being in old age. The absence of adequate social protection can lead to isolation, stress and reduced quality of life. According to the United Nations Department of Economic and Social Affairs, social pensions and income support programs play a critical role in protecting older adults from extreme poverty and improving overall well-being.

Food insecurity is another major concern linked to elderly poverty. The United Nations notes that older adults living in poverty are more likely to experience malnutrition due to limited access to nutritious food. Malnutrition weakens immune systems, increases susceptibility to illness and slows recovery, further worsening health outcomes for elderly populations living in poverty.

Global Efforts to Address Elderly Poverty

International organizations are working to address these challenges through policy support and health system strengthening. The WHO collaborates with national governments to improve primary health care systems, aiming to expand access to essential health services for vulnerable populations, including older adults. While these initiatives do not always target the elderly exclusively, strengthening health systems can indirectly improve access to care for aging populations.

Looking Ahead

The health effects of poverty on the elderly highlight the need for stronger social protection systems and accessible health care services worldwide. As global populations continue to age, addressing elderly poverty will remain essential to improving public health outcomes and ensuring that older adults can live with dignity. Expanding income support, improving access to medical care and strengthening health systems are critical steps toward reducing health disparities among elderly populations.

– Nishanth Pothapragada

Nishanth is based in London, ON, Canada and focuses on Global Health for The Borgen Project.

Photo: Flickr

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How Limited Rural Health Care Fuels Poverty in Laos

Poverty in LaosLimited access to health care in Laos plays a significant role in sustaining poverty, particularly among ethnic minority communities in remote areas. Although the Lao People’s Democratic Republic has made notable progress in economic development, many rural villages remain physically isolated from essential health services due to challenging terrain and underdeveloped infrastructure

As a result, preventable illnesses often go untreated, which reduces household productivity and increases financial vulnerability. Addressing rural gaps through strengthened primary health services and community-based programs remains essential for reducing poverty.

Geographic Barriers and Infrastructure

Geographic isolation serves as a primary barrier to health care in Laos. The country’s mountainous terrain and limited road infrastructure leave many communities cut off from health facilities, according to the Healthy Newborn Network. In some remote areas, villages sit several days away from the nearest health center.

Approximately 3% of villages in certain provinces remain completely isolated from basic social services. Poor road conditions exacerbate these challenges during the rainy season, when travel becomes dangerous. This physical isolation contributes to low utilization of health services among remote populations, as they often have reduced expectations for service delivery.

Economic Impacts on the Rural Poor

Although Laos introduced policies to reduce financial barriers, these measures often fail to reach the poorest populations. Free health policies can be regressive when rural households cannot use services due to indirect costs, such as transportation and lost income.

Health emergencies are a primary cause of household vulnerability and poverty relapse in the country. Farming households are twice as likely to fall back into poverty compared to non-farming households when agricultural and health shocks combine. While national poverty rates declined from 33.5% to 23.2% over a decade, progress could have been greater if vulnerable households had not slipped back into poverty following health-related shocks.

Maternal Health and Intergenerational Poverty

Maternal health challenges further reinforce the cycle of poverty in Laos. High rates of adolescent pregnancy and maternal malnutrition undermine economic prospects, as approximately 40% of pregnant women experience anemia, according to the Healthy Newborn Network. Children born to mothers with lower levels of education or who are themselves stunted face a higher risk of poor health outcomes, which perpetuates an intergenerational cycle of low productivity, according to the World Bank. Strengthening health care in Laos through targeted maternal programs can break this cycle and improve long-term economic stability.

Community Health Solutions

Village Health Volunteers (VHVs) form the backbone of rural health delivery and serve as the primary link between remote communities and the formal health system, according to the BMC Health Services Research. VHVs operate in nearly every village and manage health promotion, sanitation and disease monitoring.

The CONNECT initiative, with the support from the World Health Organization (WHO) and the Ministry of Health, also strengthens trust and improves service uptake. The program currently supports 259 villages across 10 provinces by developing joint action plans with local leaders.  These local solutions empower communities to take ownership of their health outcomes.

International Support for Health Care in Laos

International donors play a critical role in financing primary health care in Laos, which helps offset low domestic spending. In 2019, donor funding accounted for 26.7% of primary health care financing.

The WHO continues to support reforms such as the National Health Insurance strategy and modernization efforts. Expanding these primary health services and sustaining international funding are essential steps toward improving health outcomes and supporting long-term poverty reduction. By prioritizing these issues, global leaders can help ensure that rural populations in Laos have the tools they need to escape poverty.

Conclusion

Limited access to rural health care continues to fuel poverty in Laos by exposing vulnerable households to health shocks, financial strain and long-term economic insecurity. Geographic isolation, workforce shortages and rising costs disproportionately affect rural and ethnic minority communities, reinforcing cycles of poor health and poverty. Expanding primary health care services, strengthening community-based programs and sustaining international funding are essential steps toward improving health outcomes and supporting long-term poverty reduction in Laos.

– Aila Alsakka

Aila is based in Nottingham, UK and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Universal Health Insurance in Egypt: Expanding Access to Care

universal health insurance in egyptLow-income families, who are especially vulnerable to financial shocks, continue to face significant barriers to accessing affordable health care in Egypt. The nation has launched a Universal Health Insurance system to address these challenges primarily by aiming to reduce out-of-pocket spending and expand coverage to reduce poverty caused by medical costs.

Egypt Launched Universal Health Insurance to Expand Coverage

The Egyptian government introduced the Universal Health Insurance system in 2018 through Law No. 2 of 2018, as part of a comprehensive reform of the health sector. The law was established through a phased nationwide rollout across governorates to ensure a sustainable and realistic implementation. It additionally mandates health insurance coverage for all Egyptian citizens.

Low-income households, informal workers and vulnerable groups receive subsidized insurance premiums from the government. This grant allows millions of Egyptians to access health services regardless of their employment status.

The Universal Health Insurance emphasises primary as well as preventive care to reduce the potential long-term costs and enhance population health outcomes. The Ministry of Health has expanded several systems under the Universal Health Insurance framework such as family health units and screenings. This reform strengthens early diagnosis and treatment.

Additionally, it reduces the normative reliance on costly hospital care while simultaneously helping less affluent households avoid hefty health expenses that generally push families into poverty.

Reducing Out-of-Pocket Spending

Before implementing the Universal Health Insurance system, Egyptians primarily relied on out-of-pocket payments to finance their health care. This heavily affected low-income households, essentially forcing families to delay necessary treatment or incur debt due to these high medical costs.

The Universal Health Insurance system aims to decrease the risk of financial risk by expanding prepaid coverage and as enrollment increases, insured households face significantly less health-related expenses and improved financial security.

Poverty in the nation is heavily driven by health-related expenses as uninsured experience income loss due to treatment costs that often push low-income communities below the poverty line.

The Universal Health Insurance system helps break this vicious cycle by ensuring these families have access to affordable health care while maintaining a steady household income. Evidence indicates that insured populations are more likely to be economically stable and seek timely care, according to the World Bank.

Challenges Remain as the System Expands

Egypt continues to face challenges in implementing this health care system, despite substantial progress. Regional disparities and workforce shortages are a barrier to having the rural and underserved areas receive insurance, as they require additional infrastructure investment to ensure equitable access.

However, the government, alongside international partners continue to invest in health facility upgrades and workforce training to tackle shortages in order to strengthen nationwide service quality.

Universal Health Insurance plays a crucial role in expanding access to health care and reducing poverty in Egypt. Continued investment can further strengthen universal health insurance in Egypt and support long-term poverty reduction.

– Hana Abulkheir

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

Photo: Wikimedia Commons

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America First Global Health Strategy Investing in Kenyan Health

America First Global Health StrategyThe U.S.’s America First Global Health Strategy formalized a five-year agreement with Kenya, marking the first of many anticipated bilateral agreements with developing nations. Under this strategy, a co-investment model with Kenya has been established, allowing funding to flow directly from government to government, rather than through traditional channels such as USAID or nongovernmental organizations.

The America First Global Health Pact

On December 4, 2025, U.S. Secretary of State Marco Rubio and Kenyan President William Ruto signed the America First Global Health Strategy. Under the agreement, the U.S. will invest up to $1.6 billion, while Kenya will contribute $850 million to support critical public health initiatives, including HIV/AIDS, tuberculosis, malaria and maternal and child health. The framework aims to strengthen healthcare infrastructure in developing nations while enhancing diplomatic relations.

As the first country to sign, Kenya serves as a test case for a potential major shift in global health partnerships. The America First Global Health Strategy reflects a shift in the U.S.’s foreign aid ideology. After dismantling the USAID earlier this year, which resulted in significant cuts in funding for several global health programs, the current administration has sought out a framework it hopes will support state sovereignty and self-reliance.

Strengthening Africa’s HIV Response Through Direct Funding

At the 23rd International Conference on AIDs and STIs in Africa, UNAIDS executive director, Winne Byanyima, argued that health management has not been a priority in Africa, where funds are typically allocated toward debt repayment, as opposed to community health. Africa accounts for the majority of new HIV cases globally, with women representing 62% of infections. Economic disparities and lack of access to education are contributing factors.

It is reported that 46% of adolescent girls are not enrolled in school, exposing them to sexual and gender based violence. UNAIDS has welcomed this framework, as it aligns with its goal of significantly reducing HIV infections by 2030. The initiative aims for 95% of people with HIV to know their status, 95% of those diagnosed to receive treatment and 95% of those treated to achieve viral suppression.

Direct funding to the Kenyan government is expected to strengthen its ability to respond promptly to public health concerns and maintain control over its health priorities.

What Kenya Risks

Despite its potential, there has been backlash. The Consumer Federation of Kenya is seeking to dismantle the agreement, arguing that it violates the constitution as it pertains to concerns with health data privacy. The Consumer Federation of Kenya also argues that there isn’t sufficient oversight as to how sensitive health information would be transferred and used.

The Nairobi High Court has suspended parts of the agreement pending a full hearing. There have also been concerns of service disruption during the transitional phase from the NGO programs.

A New Development Era?

If Kenya’s experience produces positive health outcomes, the America First Global Health Strategy can serve as a blueprint for American partnerships with other nations in Africa. So far, Uganda and Rwanda have also recently signed agreements under this co-investment model. Whether this agreement marks a breakthrough in global health cooperation is yet to be determined.

However, Kenya’s outcome will likely influence agreements with other developing nations and the evolution of international development policy in the 21st century.

– Gloria Bwenge

Gloria is based in New York, NY, USA and focuses on Global Health and Politics for The Borgen Project.

Photo: Pixabay

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Pakistan’s HPV Vaccine Rollout: Protecting 13 Million Girls

Pakistan’s HPV Vaccine RolloutIn September 2025, the Government of Pakistan initiated a transformative public health landmark with the launch of Pakistan’s Human Papillomavirus (HPV) Vaccine Rollout. This national campaign targets 13 million girls aged 9-14, providing them with critical protection against the virus. Given that Pakistan loses approximately eight women every day to cervical cancer, totaling more than 2,500 preventable deaths annually, this initiative represents one of the most significant advancements in women’s health in the nation’s history.

A Phased Strategy for National Coverage

Central to the success of Pakistan’s HPV Vaccine Rollout is a strategic, phased implementation plan supported by Gavi, the Vaccine Alliance, the World Health Organization (WHO) and UNICEF. The first phase of the campaign focuses on Punjab, Sindh, the Islamabad Capital Territory and Azad Jammu and Kashmir. Following this initial push, the government plans to expand the program to Khyber Pakhtunkhwa in 2026, with Balochistan and Gilgit-Baltistan scheduled for 2027.

By the end of this period, the program aims to reach more than 17 million girls nationwide. The campaign utilizes the Cecolin bivalent vaccine, which the WHO pre-qualifies for use in immunizing against HPV types 16 and 18. These two strains are responsible for the vast majority of cervical cancer cases globally.

To make the program sustainable, Gavi provided 67% of the initial funding, while the Pakistani government committed to a 33% co-financing share. This financial arrangement ensures that the vaccine remains free of charge for all eligible girls. This, thereby, removes the economic barriers that often hinder access to health care for impoverished families.

Overcoming Stigma Through Community Leadership

Since the HPV vaccine is administered to adolescent girls, health officials anticipated challenges regarding social stigma and vaccine hesitancy. To address these concerns, Pakistan’s HPV Vaccine Rollout adopted a “whole-of-society” approach. The government collaborated with local civil society organizations and influential Islamic scholars to build community trust.

These religious leaders played a vital role by publicly endorsing the vaccine, emphasizing that protecting life and preventing disease are core values that align with religious teachings. This communication strategy also utilized the powerful slogan “Sayhat Mand beti Sayhat Mand Gharna,” which translates to “Healthy daughter, healthy family.” By framing the vaccine as an investment in the prosperity of the entire household, the campaign successfully shifted public perception.

Data from the first phase of the rollout indicate a significant decline in vaccine refusals. At the start of the campaign, approximately 300,000 families expressed hesitation. However, through targeted counseling and outreach, this number dropped to 90,000, allowing the campaign to achieve more than 72% coverage in its early stages.

Mobile Outreach for Marginalized Groups

A critical component of the rollout is its ability to reach marginalized and underserved populations, including the 50% of eligible girls who are currently out of school. To ensure no girl is left behind, the government deployed a multi-pronged delivery system. While schools and fixed health facilities serve as primary vaccination sites, mobile teams and special outreach units travel to remote villages and high-risk urban areas to administer vaccinations.

This approach brings the vaccine directly to those who face the greatest geographic and social barriers to care. To support this massive logistical effort, the WHO trained more than 49,000 health workers in vaccine administration, cold chain management and community engagement. These workers are also part of a new digitization project that integrates training manuals into a unified digital learning system.

This technological advancement enables frontline vaccinators to access updated information and report data in real-time, thereby strengthening the overall resilience of Pakistan’s immunization infrastructure.

Building a Sustainable Future for Women’s Health

The long-term success of Pakistan’s HPV Vaccine Rollout will depend on its transition from a campaign-style initiative to a routine part of the national health system. Starting in the second year, the government intends to integrate HPV vaccination into routine immunization schedules for all 9-year-old girls. This integration will ensure that every new cohort of adolescent girls receives protection as a standard part of their primary health care.

By prioritizing evidence-based solutions and fostering international partnerships, Pakistan is moving closer to the World Health Assembly’s goal of eliminating cervical cancer as a public health problem by 2030. The progress made in 2025 demonstrates that even in complex social environments, determined political leadership and community-focused strategies can overcome obstacles to save thousands of lives. This rollout stands as a powerful example of how targeted health interventions can break the cycle of illness and poverty, securing a brighter and healthier future for the next generation of Pakistani women.

– Elena Cárdenas

Elena is based in Monterrey, México and focuses on Global Health and Politics for The Borgen Project.

Photo: Flickr

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The Limitations of the Health Care System in North Korea

Health Care in North KoreaNorth Korea is a socialist country that maintains a free health care system influenced by the former Soviet Union. In 1947, the country’s founder introduced a free health care system. Kim Il-sung later established the Universal Free Health Care System (UFHCS) to implement it fully, achieving universal health coverage.

Initially, North Korea’s health care system operated effectively. However, it began to break down in the mid-to-late ’90s due to the Arduous March. The collapse of the Soviet Union, natural disasters and economic sanctions imposed by the U.S. and U.N. severely affected North Korea’s socioeconomic progress and public health. It led to widespread malnutrition and high mortality rates from communicable diseases.

The health care system deteriorated steadily and was unable to provide even basic services, largely because it relied entirely on government support under the socialist model.

The State of the Health Care System in North Korea

North Korea ranks lowest in East Asia and 193rd out of 195 countries worldwide. It also ranks 187th out of 195 for health care access, indicating that reasonable health care is difficult to obtain. In North Korea, the leading causes of death are stroke and ischemic heart disease.

In 2021, noncommunicable diseases accounted for the highest number of deaths. North Korea’s leader closed the country’s borders after COVID-19 emerged. Although the government officially claimed there were no recorded infections, media outlets citing sources inside the country reported COVID-19–like symptoms among soldiers.

North Korean authorities also tightly censor and control all media. While the number of articles mentioning the UFHCS remained stable between 2015 and 2018, ranging from 53 to 63 per year, the figure dropped sharply after 2019. By 2024, Rodong Sinmun no longer mentioned the UFHCS at all. Notably, the word “Inmin” (meaning “people”) also disappeared from articles.

Although hospitals in North Korea historically preserved this term, its removal signals that citizens’ inherent right to health care is no longer explicitly recognized in official discourse.

The Realities Behind North Korea’s Health Care System

According to an Amnesty International publication, despite the government’s claim of a free health care system, citizens were required to pay for medical services during the ’90s. In many cases, patients paid with cigarettes, alcohol or food even for the most basic consultations. As a result, many people avoided visiting doctors and instead went directly to markets to buy medicine.

It became especially common for North Koreans to self-medicate with addictive narcotic painkillers for minor illnesses such as the common cold. After the collapse of North Korea’s rationing system, informal markets known as jangmadang emerged as the core of the unofficial economy. However, following Kim Jong-un’s rise to power in 2012 and the outbreak of COVID-19, authorities closed borders and began shutting down these markets.

As border controls tightened and medicine shortages worsened during the COVID-19 pandemic, North Korean authorities expanded domestic production of so-called Koryo medicine, a form of traditional medicine. However, this approach proved harmful due to serious side effects. According to Daily NK, out of 163 reported medical incidents in health facilities, 130 involved drug abuse or misuse and 93 were linked specifically to side effects from Koryo medicine.

Many North Koreans were already aware of these risks. However, they continued to rely on such treatments because of severe medicine shortages. While the government attempted to address supply gaps, it created additional problems by failing to evaluate the safety and effectiveness of Koryo medicine systematically.

Aids From Nonprofits

During COVID-19, most international aid workers left North Korea after the government closed its borders and tightened import controls. This led to severe shortages of medicines and vaccines. In 2023, following a vote by the WHO’s Executive Board in favor of North Korea, U.N. agencies and NGOs sent more than four million vaccine doses to Pyongyang.

These included vaccines for hepatitis B, measles and tetanus. The primary targets were children and pregnant women who had missed life-saving vaccinations due to the COVID-19 pandemic. The vaccination drive was the result of an extended collaboration among UNICEF, Gavi and the WHO.

Roland Kupka, the then-UNICEF Acting Representative in the DPRK, stated that the return of vital vaccines marked a significant step toward protecting children’s health and survival in the country. In addition, UNICEF provided new freezers and temperature taggers to ensure vaccines could be stored safely, even in the most remote areas. Kupka also noted that, to sustain progress in restoring pre-pandemic vaccination levels and ensure every child receives vital, life-saving vaccines, DPRK authorities should allow the return of UNICEF and U.N. international staff to the country.

Final Remarks

The limitations of North Korea’s health care system are increasingly evident. Although authorities continue to claim that health care is free, shortages of food and medicine worsened after COVID-19. To cope, people relied on unofficial street markets, but these were also shut down due to government policy.

While international attention and cooperative engagement have increased, they must be matched by meaningful domestic policy efforts.

– Yunjaelee

Yunjaelee is based in Vancouver, Canada and focuses on Global Health and Politics for The Borgen Project.

Photo: Flickr

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Elderly Poverty in Tunisia Is Pushing Reform

Elderly Poverty in TunisiaElderly poverty in Tunisia is becoming increasingly visible as the country’s population ages and more people retire without secure incomes. In the next few decades, the share of older adults is expected to continue rising, putting pressure on pensions, health care and social assistance.

An Aging Population With Limited Incomes

Tunisia is one of Africa’s oldest societies, with people aged 60 and above accounting for approximately one-tenth of the population. This share is expected to grow rapidly over the next two decades. While the country has made notable progress in reducing overall poverty, the national poverty rate still stood at 16.6% in 2021.

A regional profile on aging notes that 40% of Tunisian men aged 60 to 64 are still working, compared to just 5% of women of the same age. This gap suggests that many women enter old age without their own income and remain reliant on welfare support or their spouses. As life expectancy rises and family structures change, these disparities place older people at greater risk of poverty when work ends or family support weakens.

Pensions Protecting Formal Workers

Tunisia’s pension system is comprehensive by regional standards. Contributory schemes operate through two main funds: the National Pension and Social Insurance Fund (CNRPS) for public sector workers and the National Social Security Fund (CNSS) for private sector workers. Together, these funds help older people and those with disabilities retire without falling into extreme poverty. By 2018, 75% of Tunisia’s population had contributed to some form of pension scheme, a high rate for a developing country.

Minimum pensions are linked to the legal minimum wage. For example, one rule sets the minimum benefit at approximately two-thirds of the minimum monthly salary for the entire career. This link is important for redistributing resources and reducing elderly poverty among formal workers in Tunisia.

However, many people are still excluded from the system. Those without contracted work or in seasonal jobs—especially in rural and agricultural areas—often fail to accumulate enough contributions to qualify for a decent pension. Older women, who tend to have lower lifetime labor force participation, are particularly likely to be excluded or receive only very small pensions.

Cash Transfers for the Most Impoverished Seniors

To support people who can not rely on government pension schemes, Tunisia operates the National Program for Assistance to Needy Families (PNAFN). The program, established in 1986, targets households that are unable to work due to old age, disability or chronic illness. Since its inception, the value of the PNAFN transfer has increased at a rate faster than the minimum wage.

Beneficiary households receive around $61 to $69 per month, equivalent to about 45% of the minimum wage, along with quarterly top-ups for families with children in school. The program is also linked to free medical cards under the Assistance Médicale Gratuite (AMG) scheme, giving needy older adults access to public health services at little or no cost. During the COVID-19 pandemic, the PNAFN and AMG databases enabled the government to rapidly deliver emergency cash transfers to hundreds of thousands of impoverished households, many of which included older people.

These measures helped mitigate poverty and showed how social assistance can protect seniors during crises.

Health and Community Services for Older Tunisians

Income is only one form of elderly poverty in Tunisia; access to affordable health and care services is just as important. Tunisia’s social system provides health coverage through a mix of social programs and tax-funded insurance. These include the National Health Insurance Fund (CNAM) and the AMG scheme, which assist low-income households.

Government reports highlight efforts to bring services closer to older people. This includes expanding mobile teams that provide health and social care at home, as well as establishing day centers where seniors can receive support and participate in community activities. These services are essential for older adults who live alone, have limited mobility or are unable to afford private care.

Gaps That Need Closing

Despite these programs, significant gaps remain. Before the pandemic, about 17% of Tunisians still lacked any form of medical coverage, leaving many older adults exposed to costly treatments and check-ups. Studies of the pension system note that benefit levels are often insufficient to cover basic needs and many non-contracted and rural workers are not covered.

The lack of inflation adjustments in many of these schemes also means that pension purchasing power declines over time. However, charities and civil organizations have called for broader social protection that guarantees a basic income in old age, regardless of employment history. Proposals include expanding social coverage, improving targeting to reach isolated older adults and exploring the introduction of a universal social pension to supplement contributory benefits.

Toward a Dignified Old Age in Tunisia

Elderly poverty in Tunisia is shaped by both the strengths and limitations of its social protection system. Strong pension contributions and an innovative cash transfer program have already prevented many older citizens from falling into extreme poverty. However, coverage gaps, low benefit levels and rising health costs mean that too many seniors still rely on insecure family support or must continue working into old age.

If Tunisia succeeds in strengthening pension coverage, expanding social care and ensuring that older people have access to affordable health and community care, the country can change the narrative of population ageing. Rather than being a story of vulnerability, it can become one of dignity and inclusion for its growing elderly population.

– Jibreel Meddah

Jibreel is based in Cardiff, UK and focuses on Good News and Politics for The Borgen Project.

Photo: Flickr