Archive for category: Health

Information and stories on health topics.

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Providing Health Care to Refugees in Border Countries

Health Care to RefugeesJordan is one of the world’s largest refugee-hosting countries relative to population. It shelters more than 3 million migrants and refugees, including more than 1.3 million Syrians, along with Iraqis, Palestinians, Yemenis and others. This influx has placed considerable strain on Jordan’s national health system, which must balance the needs of citizens with those of displaced populations. The challenge has grown increasingly political, raising questions of equity, inclusion and national identity.

Policy Evolution and the 2019 Reform

Jordan’s refugee health policy has evolved through a complex interplay of humanitarian priorities and national politics. Since 2012, the country’s Ministry of Health has collaborated with international partners, including UNHCR, WHO, UNICEF and bilateral donors, to integrate refugees into existing public health services, rather than establishing parallel systems. This model sought to ensure sustainability while maintaining the state’s control over its health infrastructure.

In April 2019, Jordan introduced a major policy change: Syrian refugees registered with UNHCR were permitted to access public health care at the “noninsured Jordanian rate,” effectively restoring access to government facilities after a period of reduced subsidies. This measure reflected an attempt to balance national cost constraints with humanitarian obligations and international diplomacy.

According to analyses by researchers, this decision was influenced by shifts in both domestic politics and global funding flows. Initial momentum for refugee inclusion, strong during the early years of the Syrian crisis, began to decline as fiscal pressures intensified and political attention shifted. Jordan’s leadership weighed the costs of long-term refugee care against concerns about public resentment and donor fatigue.

Donor Politics and the Multi-Donor Trust Fund

To sustain health-service delivery for refugees and vulnerable Jordanians, the government established the Jordan Response Plan (JRP) framework and a Health Sector Working Group. These bodies coordinate with the Jordan Health Fund for Refugees (JHFR), a multi-donor trust fund managed by the World Bank and the Ministry of Planning and International Cooperation. This mechanism pools donor contributions from the European Union (EU), Canada, Germany and other countries to support public health facilities that treat refugees.

The fund represents a hybrid model where humanitarian assistance and national systems converge, blurring traditional lines between emergency relief and development aid. Such arrangements also reveal how refugee health policy in border-host states is inherently political. International partners influence policy through funding priorities, while Jordan’s government uses refugee-health initiatives to strengthen diplomatic ties and demonstrate regional stability. Researchers argue that this dynamic reflects “policy integration by necessity,” a balancing act between sovereignty and donor expectations.

Equity and Inclusion in Practice

Despite the use of inclusive policy language, access remains uneven. Studies of Syrian and Palestinian refugees in Jordan show that health care equity depends heavily on legal status, registration and location. Refugees registered with UNHCR generally qualify for subsidized public health services. However, unregistered or urban refugees often face high out-of-pocket costs.

Research also finds that gender, chronic illness and camp residency shape who can obtain care. For example, while camp-based refugees may receive consistent primary care from NGOs, urban refugees struggle with costs for hospital care and medicines. The WHO’s 2023 review noted that health service utilization among refugees is constrained by both financial and administrative barriers, even where policies formally allow for inclusion.

This disparity underscores how refugee health is as much a political question of belonging as a technical challenge. When governments define access tiers by citizenship or registration, they reaffirm boundaries of national identity, determining who is seen as part of the social contract and who remains outside it.

Health Care as Diplomacy and Strategy

Jordan’s refugee health policy has also become a form of regional diplomacy. By maintaining access for Syrians and cooperating closely with international agencies, Jordan projects stability and reliability to donors and neighboring states. The World Bank and WHO both highlight Jordan as a leading example of a country “integrating refugees into national systems” within the Eastern Mediterranean Region.

This approach aligns humanitarian and strategic interests: providing health care prevents disease outbreaks, reduces social tensions and supports regional security. It also strengthens Jordan’s leverage in international negotiations, where hosting millions of refugees positions the country as a key partner for the West.

Lessons for Other Border-Host States

Jordan’s effort illustrates that refugee health policy is not solely a humanitarian issue but a political ecosystem involving ministries, donors and citizens. Effective inclusion relies on sound fiscal planning, effective diplomatic management and public trust. When handled strategically, as in Jordan’s integration model, health care for refugees can enhance both human security and state resilience.

For other border-hosting nations, the Jordanian case offers three takeaways:

  1. Integrate refugee care into existing national systems rather than creating separate structures.
  2. Align donor funding mechanisms with government priorities to ensure sustainability.
  3. Recognize that equitable access to health care reinforces social cohesion and prevents instability.

Providing health care to refugees, therefore, is not only a moral responsibility but also a strategic investment in regional peace and long-term system resilience.

– Clara Garza

Clara is based in Los Angeles, CA, USA and focuses on Global Health and Politics for The Borgen Project.

Photo: Flickr

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Abidjan Cholera Outbreak: A Preventable Crisis Fueled by Poverty

Abidjan Cholera OutbreakOn the muddy quay of Vridi Akobrakré, a small fishing village just outside Abidjan, the economic capital of Côte d’Ivoire in West Africa, a Red Cross volunteer pours treated water into the hands of a mother. Her children splash barefoot in a stagnant lagoon, unaware that just days earlier, three of their neighbors died from severe diarrhea. At this moment, the Abidjan cholera outbreak is more than a headline. It is a preventable crisis, driven by poverty and poor sanitation.

The Abidjan Cholera Outbreak and Emergency Response

On June 5, 2025, the Pasteur Institute identified Vibrio cholerae in the water. This bacterium causes cholera, a severe diarrheal disease that can be fatal within hours if left untreated. Health authorities immediately confirmed a cholera outbreak in Abidjan — the first in 15 years. The rainy season had just started, with flooding quickly spreading contaminated water. The dense housing of the most impoverished neighborhoods further fueled the outbreak, resulting in 491 confirmed cases and 20 deaths.

The government executed a swift emergency response. Water trucks delivered clean water to affected neighborhoods and temporary treatment centers opened for rapid patient care. Local health teams collaborated with the World Health Organization (WHO), which provided support for water treatment, chlorine distribution and hygiene education. NGOs such as UNICEF and the Red Cross established hand-washing stations and trained volunteers to monitor symptoms within the community.

Poverty and Neighborhood Vulnerability

Vridi Akobrakré, where the bacterium was first confirmed and similar informal settlements around Abidjan remain highly vulnerable. Homes are built above lagoons and most have no latrines or sewage systems. Flooding spreads contaminated water through streets, schools and marketplaces.

Poverty compounds the risk. Families cannot afford safe water and crowded homes make it difficult to maintain proper hygiene practices. The repeated vulnerability of these neighborhoods shows that emergency measures alone cannot prevent future outbreaks. Without structural changes, cholera will continue to strike the poorest communities.

NGO Response and Preventative Solutions

NGOs play a crucial role in addressing immediate risks and building resilience. The Red Cross distributes chlorine tablets and treats water points. UNICEF runs hygiene campaigns in schools and markets. Médecins Sans Frontières operates mobile treatment centers and trains rapid response teams. Experts report that ongoing monitoring, broader distribution of hygiene kits and public awareness campaigns are essential to prevent future outbreaks.

Preventing another cholera outbreak in Abidjan also requires long-term investment. Governments must build sewage networks, drainage systems, formal latrines and pipe clean water for low-income neighborhoods. Equitable urban planning and continuous hygiene education help communities adopt safer practices. Subsidized access to safe water, community sanitation programs and strengthened health systems, along with the establishment of surveillance and rapid response teams, are crucial.

Since the cholera outbreak began, hygiene campaigns have reached thousands of schoolchildren, teaching proper handwashing and safe water practices. Early signs suggest these interventions are slowing the spread of cholera. However, experts warn that without continued support and infrastructure improvements, outbreaks will recur.

Turning Crisis Into Change

Back in Vridi Akobrakré, the mother dips her children’s hands into treated water and watches volunteers continue their rounds. For families affected by the Abidjan cholera outbreak, clean water remains fragile. But the crisis has sparked meaningful action. Community volunteers are now trained to monitor symptoms, treat contaminated water and educate their neighbors on proper hygiene.

NGOs continue to distribute chlorine tablets, hygiene kits and set up hand-washing stations in schools and markets. If governments and international partners invest in sanitation, infrastructure and poverty reduction, these efforts can become permanent. Safe water systems, drainage improvements and community-led education programs could protect residents from future outbreaks.

What began as a tragedy is turning into a blueprint for resilience, showing that even the most vulnerable communities can lead the way when crisis meets coordinated action.

– Tina Kusal

Tina is based in Montrose, CA, USA and focuses on Global Health for The Borgen Project.

Photo: Flickr

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The Last Mile Against River Blindness in Cameroon

river blindness incameroonIn the rugged highlands of western Cameroon, a silent threat loomed for decades: Onchocerciasis or “river blindness.” Transmitted by the bite of blackflies breeding in fast-flowing rivers, the disease causes severe itching, skin changes and, in its most advanced form, irreversible blindness. For communities living along the valleys of the Meme and Mbam rivers, onchocerciasis did not just affect health; it hampered schooling, work and development in already impoverished areas.

Background

Cameroon has long been an endemic country for onchocerciasis. Indeed, a geospatial modelling study of Africa and Yemen estimated that, as of 2018, national-level infection prevalence in Cameroon exceeded 5% and in some focal regions was much higher.

In response, Cameroon launched community-directed treatment with ivermectin in 1996 under the World Health Organization’s African Programme for Onchocerciasis Control. After APOC ended in 2015, the country continued elimination activities through the WHO’s Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN), which now coordinates regional support.

Mass Drug Administration

At the heart of Cameroon’s strategy has been annual mass drug administration of ivermectin delivered through community-directed treatment. Over 15 years of campaigns in several districts have sharply reduced infection levels. In the Tombel Health District, for instance, after 15 consecutive years of treatment, microfilaria prevalence fell to 1.5% and nodule prevalence to 6%, indicating progress but not full interruption of transmission
Yet, remote mountain villages present persistent challenges. A 2024 study along the Cameroon–Chad border noted that onchocerciasis transmission remains ongoing despite decades of CDTI.

Localised vector habitats, seasonal migration of workers, and gaps in treatment coverage are among the underlying factors. A detailed study in the Meme River Basin highlighted how poverty, farming occupations, housing conditions and limited health seeking behaviour all hamper elimination efforts.

Community-Directed Distributors

Community health volunteers, called community-directed distributors (CDDs), carry the burden of delivering ivermectin and tracking treatments in hardscrabble terrain. But their efforts are constrained by low motivation, logistical bottlenecks and limited training. A qualitative study in three rural districts of Cameroon found that inadequate numbers of CDDs and weak understanding of the disease among health staff hamper progress.

Despite these challenges, when coverage is high and sustained, the health benefits are profound. People treated with ivermectin experience relief from itching, healing of skin lesions and prevention of visual impairment, according to the World Health Organization (WHO). In Cameroon’s Meme River Basin, researchers also found that annual community-directed treatment improved productivity and reduced stigma around the disease.

The Future

Progress in Cameroon against river blindness shows how persistence pays off. National health authorities continue annual community-directed ivermectin campaigns with support from the WHO’s Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN). The country also participates in regional cross-border monitoring with Chad and Nigeria to track transmission and share data.

According to the WHO’s ESPEN program, several health districts in Cameroon have already transitioned to post-treatment surveillance after interrupting transmission, marking key milestones toward national elimination.

– Katie Williams

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

Photo: Flickr

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WHO’s EIOS 2.0 Brings AI to Early Outbreak Detection

EIOSThe World Health Organization (WHO) launched an upgrade to its Epidemic Intelligence from Open Sources (EIOS) in October 2025. Smarter and more inclusive, WHO’s EIOS 2.0 is expected to considerably amplify the early warning system’s capabilities. The goal is to prevent or reduce the number and degree of public health emergencies.

Like its predecessor, EIOS 2.0 is a sophisticated web-based interface that sifts through readily available information from various sources, including media, social platforms, official government websites, news sites and other sources. It analyzes the data obtained to identify clues that point toward the possible spread of contagious diseases or public health threats. According to a press release, as of October 2025, 110 nations have joined the initiative.

Ways EIOS 2.0 Benefits Low- And Middle-Income Countries

  • Free Access: Member nations and eligible organizations can utilize the WHO’s outbreak detection tool. This is the same technology high-income countries enjoy, at no charge.
  • Preventing Economic Fallout: Pandemics impose a heavy burden on families and societies. During the COVID-19 emergency, an estimated 70 million people around the world fell into extreme poverty.
  • Minimizing Loss of Life: A model studying the health emergency that led to the COVID-19 pandemic estimated that up to 35% of the deaths in Wuhan, China, might have been avoided had steps to control the disease’s spread been taken one week earlier. In other cities, 50% of those who perished might have been saved.
  • Interface Translations: EIOS 2.0 is now available in multiple languages, increasing accessibility for users with limited English proficiency.
  • Semantic Search: Keyword search is now smarter as the system identifies context and intended meaning.
  • Radio Sources: Enabling a speech-to-text feature allows EIOS 2.0 to investigate radio communications. This could potentially catch information that may not have been otherwise captured, particularly in more vulnerable areas.

Does Epidemic Intelligence Work?

Africa experiences the highest number of health emergencies each year. Indeed, as of November 2023, there were 130 active outbreaks across the continent. In the same year, an evaluation of the EIOS system showed that in 22 countries, 50% of health events were detected before national announcements or official WHO communications.

WHO studies show that in countries using EIOS, the median time between the first detected health event and notification to the Pan American Health Organization (PAHO) or WHO dropped from 14 days to 11. In fact, it was the EIOS system that first detected a “pneumonia” outbreak in Wuhan, China, in 2019.

One example is the Korea Disease Control and Prevention Agency (KDCA), which utilized the EIOS system between June and October 2023 to detect 425 events. These mainly included mpox and dengue fever. Eight of these events were identified before official declarations, on average, 20 days earlier. In Brazil, an event involving Haff disease was identified and tracked in 2022.

EIOS 2.0’s Promise for Inclusive Global Health Preparedness

In its first iteration of EIOS, WHO demonstrated the advantages of using an intelligent agent that can filter through hundreds of thousands of data sources and discern the likelihood of a health emergency in real-time. Indeed, with EIOS 2.0’s new features, AI capabilities and interface, more regions around the world can benefit from a free-to-use system that can strengthen existing pipelines. With earlier warnings, health authorities can take immediate measures to prevent catastrophic pandemics like those that have sunk millions of people deeper into poverty.

– Johanna Lorena Arredondo Gonzalez

Johanna is based in Pittsburgh, PA, USA and focuses on Technology and Global Health for The Borgen Project.

Photo: Pexels

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Diseases Impacting Chile

Diseases Impacting ChileKnown for its long coastline and diverse landscapes, Chile has made significant strides in public health, with an average life expectancy of 81 and continued progress in reducing infant mortality. However, the nation continues to face public health challenges. These include a difficult COVID-19 response, high numbers of cancer deaths and ongoing problems with cardiovascular disease. Here is more information about the diseases impacting Chile and efforts to address them.

Cancer Progress

In recent years, cancer has rivaled cardiovascular disease for the title of leading cause of death in Chile, with 31,440 reported cancer-related deaths in 2022. In response to cancer being one of the most persistent diseases impacting Chile, the government has implemented multiple policies to fight the disease. The government passed laws to lower tobacco use, increase the number of HPV vaccines and facilitate more cancer research and clinical trials within the country.

In 2018, Chile implemented a national cancer plan. The plan focuses on shortcomings in prevention, diagnosis and treatment for patients across the country. Officials saw success with the formation of a national cancer registry and the existing tumor banks, with one example being roughly 700,000 cholecystectomies being performed since the start of the plan.

Cardiovascular Disease Concerns

Heart disease remains one of the leading causes of death in Chile, at around 25% of all deaths. According to the World Health Organization (WHO), this number was 33,504 in 2023 – an increase in deaths from 2019. Significant risk factors like hypertension, which affects nearly one in four adults in the country, are often unknown to patients and lead to an increased risk for Cardiovascular Disease (CVD). 

The Chilean government has embarked on a mission to increase awareness of hypertension and CVD as a whole. In 2013, the country partnered with the Pan-American Health Organization (PAHO) and the United States’ Centers for Disease Control and Prevention. Across the greater South American region, over three million people have received treatment for hypertension as a result of these partnerships. Concrete successes include the creation of public hypertension clinics, expansion of health coverage in the country and increased data collection to ensure patients are identified before cardiovascular disease can develop.

COVID-19 Difficulties

Chile never established a national lockdown, leading quarantine guidelines to be inconsistent in different localities. With more than 5 million total cases and more than 64,000 deaths, Chile was one of the most affected nations in South America. As recently as 2022, the country saw 13,433 COVID-19 deaths, despite having a vaccination rate of 94.62%. 

Although COVID still poses a risk, Chile has demonstrated its ability to mobilize quickly when it comes to vaccinations. The success of vaccine distribution, combined with low vaccine skepticism in the country, means that Chile is equipped to respond more effectively to the next potential pandemic.

Looking Ahead

Chile’s proactive public health policies and investment in health care infrastructure offer a model for other developing nations. The few diseases impacting Chile still have a grip on the population, with preventable deaths in cancer and cardiovascular disease making up more than 50% of deaths in the country. However, Chile has reasons to be optimistic, with progress being made each year when it comes to infrastructure and research in combating these issues. 

– Benjamin Pugh 

Benjamin is based in Kansas City, MO, USA and focuses on Good News and Politics for The Borgen Project.

Photo: Flickr

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Morocco’s Gen Z Protests: Better Education and Health Services

Morocco’s Gen Z Protests: A Movement for Better Education and Health Services In September 2025, the Gen Z movement GenZ212 mobilized supporters in 11 Moroccan cities, including Casablanca, Rabat, Marrakesh and Agadir, to protest the neglect of health care and education services in the country. The recent deaths of eight pregnant women in Hassan II Hospital triggered younger generations to protest for urgent investment in national health care. The protesters also criticized the Moroccan government’s spending priorities on football infrastructure for the 2025 Africa Cup of Nations and the 2030 FIFA World Cup. The people of Morocco demanded that these funds be invested in education, employment opportunities and health care.

Progress and Persistent Gaps

In the last two decades, life expectancy has increased from 66.8 years in 2000 to 75.7 years in 2025,
 and vaccination coverage reached 94.5% in 2023, leading to the elimination of polio and diphtheria.
 The government has also invested in educational accessibility for vulnerable groups with frameworks like the 2000 Education Framework Law and national initiatives such as the National Human Development Initiative (INDH) in 2006. However, despite these improvements, many Moroccans still lack access to quality health care and education.

Morocco’s Gen Z Protests

The GenZ212 movement started the protests in September 2025 and used social media platforms to mobilize hundreds of supporters to join the cause. About 200 protesters were arrested as police used force to disperse crowds. Studies revealed that 43% of young Moroccans aged 18–29 spend three to five hours per day on social media. Hundreds of young Moroccans also supported the movement online. They used social media platforms such as Instagram and TikTok to raise awareness and counter misinformation.

The movement grew from 1,000 to 180,000 members using the platform Discord for coordination, discussion and decision-making. They were not affiliated with political parties or unions and demanded more public spending on health and education, less corruption and greater political accountability.

Young Moroccans also participated in protests across many cities, including Casablanca and Rabat. GenZ212 used digital organizing as the backbone for their protests. The movement integrated digital awareness and civic action to demand political and social changes in the country.

The Current Situation

In rural areas of Morocco, residents often lack access to health care services due to worker shortages and limited insurance. Twenty percent of the population lives more than 10 kilometers from a primary care facility. Rural areas also face challenges in providing education services, including a lack of teacher training and classroom overcrowding. As of 2022, 64% of Moroccan 10-year-olds cannot read or understand a simple text.

In response, the Moroccan government and NGOs launched reforms to expand access to education and health care. In 2021, the WHO launched the National Plan to Combat Childhood Cancer at St. Jude Children’s Research Hospital to improve treatment access and expand pediatric oncology and palliative care. From 2020 to 2022, the childhood cancer survival rate rose from 68.2% to 72.2%, and the goal is to reach 80% by 2030.

The World Bank financed a total of $750 million by 2023 for Morocco’s Education Support Program to support the government’s Strategic Education Roadmap (2022–2026). The reform agenda aims to expand early childhood education, invest in teacher training and reduce learning poverty.

Earlier this year, the government reviewed these reforms with the goal of restoring confidence in public schools and addressing previous shortcomings. The education budget rose to $8.5 billion, up from $6.8 billion in 2019, with the expansion of 230 Pioneer Middle Schools, benefiting more than 200,000 students.

Post–Gen Z Protests

The civic participation and digital activism of Morocco’s Gen Z protests prompted a response from both the king and the government. On Oct. 10, King Mohammed VI addressed Parliament and called for faster social and economic reforms.

Government spokesperson Mustapha Baitas also acknowledged the protests. As a result, on Oct. 20, the government announced major social reforms in direct response to the demonstrations. The 2026 draft finance bill strengthens public education, creates 27,000 new jobs in education and health care, and allocates $13 million to these sectors. The youth political participation bill will cover up to 75% of campaign expenses and invite citizens under 35 to join politics. The party reform proposal will enhance political party transparency and encourage women and youth to join or establish political parties.

One sign of this new transparency was the public livestreaming of a parliamentary committee meeting on health care reform on Oct. 1. This event marked a shift toward transparency and public participation in policymaking.

Looking Forward

Morocco’s Gen Z protests marked a turning point in the country’s social and political landscape. Indeed, what began as a reaction to failures in health and education evolved into a nationwide demand for accountability, equality and transparency. The movement demonstrated the power of digital mobilization and the determination of Morocco’s youth to shape the future of their country. Morocco’s Gen Z has shown that civic engagement and collective action can drive reform for social justice and improved public services, offering hope that youth-led movements will help build a more equitable future for the country.

– Angela D’Avino

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

Photo: Pixabay

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A Step Toward Health Equity: Free Health Screenings in Indonesia

Free Health Screenings in IndonesiaAs of 2010, around 56% of Indonesians were covered by some form of health insurance. However, at this point, coverage was mixed, including government programs for lower-income individuals, private health insurance and coverage for employees of the state. In an effort to fill the gaps and unify the disparate insurance options, the Indonesian government introduced the Jaminan Kesehatan Nasional, its attempt at universal health coverage for Indonesians.

While the new system applies to all Indonesians, there remain gaps as certain health care facilities have declined to accept this new health care system of coverage.

The Pemeriksaan Kesehatan Gratis Program

In Indonesia, the most common causes of death include stroke and heart disease, two conditions whose risks can often be managed with regular checkups. To address this, President Prabowo Subianto fulfilled one of his campaign promises by launching a program that offers free health screenings for all citizens of Indonesia each year on their birthday. The goal of these checkups is early detection of cardiovascular diseases, congenital disorders and other chronic conditions that require regular monitoring.

The program, known as Pemeriksaan Kesehatan Gratis (PKG), was designed to provide free health screenings to more than 280 million citizens of Indonesia. Interestingly, it uses citizens’ birthdays as a cultural connection point to encourage participation in the screenings. In addition to this unique aspect, encouraging Indonesians to keep in mind the importance of the checkup, the program also makes use of the digital program SATUSEHAT, which was promoted during the COVID-19 pandemic.

This would allow people to seamlessly use the already widely downloaded program for not only making appointments, but also offering access to a personal health record.

Shifting Indonesia’s Mindset Toward Preventive Care

While the program primarily targets reducing the impact of major chronic conditions and improving health outcomes, Health Minister Budi Gunadi Sadikin has emphasized another goal. He aims to change Indonesians’ mindset and behavior toward preventive health care through this campaign. When the campaign was launched, Sadikin noted, “Our culture is checking when we’re already sick … that cuts closest to the grave,” describing the behavior of Indonesians as looking to health care for treatment over prevention.

After eight months of the program, the health minister reiterated his stance during an October press conference, highlighting the major risk factors affecting Indonesians. “The easiest examples are high blood pressure, high blood sugar and cholesterol. Indonesians usually ignore these until they suffer a stroke or heart disease,” he said. He appears determined to shift the nation’s view of health care toward preventive care and transform Indonesia’s overall health culture.

Promoting Health Equity Through Free Access

An article in the Lancet magazine additionally comments on the effect of the program on health equity, which is important for improving the health outcomes for Indonesians facing poverty:

  • Regular health checkups improve health education, which can empower individuals to manage risk factors and avoid severe health conditions like strokes and heart attacks.
  • The program offers free screenings to everyone, regardless of socioeconomic status, which ensures that everyone is receiving the same level of care. Additionally, it allows Indonesians in poverty to have access to health care resources they may have previously been unable to afford.
  • The program prioritizes early interventions, especially in at-risk populations. So individuals who may not have previously had access to preventative care are more likely to receive follow-up visits and treatments to ensure their risks are managed for severe health conditions.

Conclusion

Overall, the PKG program is an ambitious initiative that aims to provide free health screenings to all citizens of Indonesia. Its goals include reducing mortality from conditions such as stroke and heart disease and shifting public attitudes toward preventive care. However, the program also has secondary effects that promote health equity. These benefits are especially valuable for Indonesians living in poverty, as they help improve access to health care within limited means.

– Nikhil N Kumar

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

Photo: Flickr

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Expanding Access to Health Care in Malawi

Health Care in MalawiMalawi’s quest for universal health and development is defined by the Health Sector Strategic Plan III (HSSP III), which runs from 2023 to 2030. It builds on previous reforms, aligning with global targets such as the Sustainable Development Goals (SDGs) and the WHO’s triple billion objectives. This plan arrives after a decade marked by both dramatic health improvements and enduring challenges in Malawi.

Population growth, urbanization, poverty and vulnerability to epidemics persist; yet, the government, along with its partners, continues to push for a vision of equitable access to high-quality care and financial protection for every citizen.

Health Care in Malawi

The foundation of the health transformation in Malawi rests on nine pillars defined in HSSP III: service delivery, social determinants, infrastructure, human resources, medical products, digital health, health research, leadership/governance and health financing. The Health Benefits Package (HBP) delivers essential interventions targeting maternal health, child survival, infectious diseases and a rising burden of noncommunicable diseases.

Key reform highlights include integrating vertical programs into comprehensive, unified health platforms and scaling digital health records across the system. Additional reforms focus on decentralizing district-level planning, strengthening supply chains and implementing performance-based management for health care workers.

Beyond government engagement, key NGOs and public-private partnerships, such as the Christian Health Association of Malawi (CHAM), expand essential services deep into rural areas. At the same time, new contracts incentivize client satisfaction and outreach.

Successes

Malawi has experienced one of Africa’s most rapid improvements in life expectancy, rising from 55.6 years in 2010 to 64.7 years in 2020. This represents an increase of more than nine years, outperforming many regional peers. This growth is largely due to dramatic reductions in mortality and infectious disease. Maternal mortality fell from 444 deaths per 100,000 live births in 2010 to just 349 deaths per 100,000 in 2017, meeting and surpassing the previous HSSP II target.

Under-five mortality fell from 84.2 deaths per 1,000 live births in 2010 to 38.6 per 1,000 in 2020. Infant mortality also declined, dropping from 52.4 to 29 per 1,000 over the same period. Meanwhile, HIV prevalence among adults ages 15–49 declined from 9.1% in 2017 to 8.1% in 2020 and HIV-related deaths dropped dramatically to 0.63 per 1,000 people by 2020.

The quality of health care in Malawi has also improved, as evidenced by rising client satisfaction levels from 83% in 2020 to nearly 90% in 2022. There is also an increased adherence to minimum standards and routine client feedback. Financial risk protection, a crucial shield against poverty, now sits at an index of 97.45%, among Africa’s highest. Additionally, out-of-pocket payments account for just 11.9% of total health spending, a significant contributor to keeping families out of medical poverty.

Furthermore, mobile clinics operated by NGOs and CHAM have brought care to remote populations. This is evidenced by more than 309,000 visits in Mulanje District from 2011 to 2013, helping to close service gaps created by stockouts and workforce shortages. Most notably, before these reforms, only 46% of rural Malawians were within 5 km of a health facility; outreach and mobile solutions have improved reach for both preventive and curative care.

Challenges

The persistent struggles to fully realize the health vision in Malawi are rooted in resource limitations, workforce gaps, infrastructure deficits and systemic inefficiencies. Although HSSP III’s eight-year implementation costs exceed $31 billion, the annual anticipated funding is just $690 million, which is only about 17% of what is needed. Human resource shortages remain acute: half of public sector health positions are vacant and high turnover rates, especially in rural areas, significantly impact service quality.

Drug stockouts and infrastructure limitations further impair consistent care; just few of local facilities in the 2012 Oxfam study had a full drug supply and deficiencies have persisted. Fragmented health data systems challenge proper planning and outcome monitoring, while noncommunicable disease rates have risen to account for more than 32% of deaths, stretching resources beyond infectious disease priorities.

Equity issues persist; rural and remote communities continue to face the greatest barriers to accessing care, despite the presence of mobile clinics and outreach services. Additionally, public-private partnerships have helped fill crucial gaps. However, sustainability constraints, including delayed payments, policy inconsistencies and financial pressures, threaten the long-term viability of the initiative.

Service utilization rates, while increasing in some areas, often strain limited facility capacity and staff morale. Transport, housing and food costs for patients and their guardians in remote regions still present significant obstacles, underscoring the need for more robust socioeconomic support.

Conclusion

The health care sector reforms in Malawi, anchored by HSSP III and supported by strong partnerships, have catalyzed substantial improvements in life expectancy, health care quality and poverty reduction. The government’s commitment to integrated care platforms, digital health solutions and financial protection has expanded the service reach and impact.

Yet, enduring challenges in funding, staffing, infrastructure and equity must be resolved for the country to achieve its universal health coverage goals. Continued investment, cross-sectoral collaboration and adaptive leadership are essential for building on these successes and ensuring lasting health gains for all Malawians.

– Akash Ramaswamy

Akash is based in Ontario, Canada and focuses on Global Health for The Borgen Project.

Photo: Flickr

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Elderly Poverty in Togo: The Fight for Dignity and Support

Elderly Poverty in TogoElderly poverty in Togo is a serious and often overlooked issue. Public discussions usually center on youth employment or general health, leaving out many older citizens, especially those who worked in informal jobs without retirement benefits. This article looks at the institutional and social factors behind elderly poverty in Togo and shows how reforms and local efforts can help restore dignity and support for this vulnerable group.

The Structural Drivers of Exclusion

The main reason many older people are poor is that the formal social security system leaves them out. More than 86% of Togolese workers are in the informal sector, and they do not have access to the National Social Security Fund (CNSS) retirement system. As a result, only about 20% of elderly people get a formal pension. This means that almost four out of five older citizens do not have a secure income in retirement. The problem is even worse in rural areas, where nearly 59% of people live in poverty.

Health Care Crisis: A Universal Gap

The income crisis is made worse by major problems in health care. More than 91% of elderly people do not have reliable health insurance. This lack of insurance significantly affects their overall well-being, contributing to multidimensional poverty. Health insecurities intersect with income disparities to limit their access to essential services and weaken their social voice and agency. When medical emergencies happen, families often have to spend their limited savings on care, which keeps the cycle of poverty going from one generation to the next. Without addressing these interconnected issues, focusing solely on income support will leave human development efforts incomplete.

Research in Lomé shows that more than half of older adults living in the community report poor health, and many have chronic illnesses. Because so few have insurance, there is an urgent need for policy changes to reduce suffering and financial hardship.

Government Action and Policy Impasse

The Togolese government recognizes the importance of universal coverage and has begun expanding social safety nets. During the COVID-19 pandemic, the Novissi program used mobile money to send targeted cash transfers to people in need. This showed that the country can deliver broad and efficient support, setting an example for future programs.

Local activists are lobbying the government to transition this successful model into a permanent, unconditional cash transfer program targeting the extremely poor and vulnerable. The government is also working to compile a Unified Social Registry and provide biometric identification to all citizens, which are indispensable steps for an accurate, scaled-up cash transfer policy.

However, progress toward universal coverage is stalled because there is no decision yet on how to fund the Assurance Maladie Universelle (AMU) for the most vulnerable people. Policymakers need to choose whether to fund this insurance through taxes, worker contributions or both. This choice will decide if the poorest people remain excluded.

Community Resilience: Local Safety Nets

Since there is no comprehensive safety net, community-led groups play a key role in providing financial and social support. Traditional savings and loan cooperatives, called tontines or Village Savings and Loan Associations (VSLAs), are an important local safety net. In Togo, these cooperatives make up most of the microfinance sector, serving 80% of clients — about 212,000 people — and providing access to credit and savings without requiring collateral. For example, in the village of Tomé, VSLAs with about 25 members help people save money together and take out loans. This allows them to invest in their farms or pay for urgent needs, such as emergencies.

Non-governmental organizations (NGOs) are also helping vulnerable people improve their farming. One project supported people with disabilities and small farmers by drilling additional wells for water and starting new activities, such as beekeeping. This helped about 22,000 people in Togo build a better future.

Looking Ahead

Ultimately, solving elderly poverty in Togo demands a dual strategy: institutionalizing successful digital cash transfers and securing dedicated funding for social benefits to protect the 80% of the elderly population excluded, while continuing to amplify community-led resilience efforts. Securing dignity and support for older citizens is not just a moral duty; it is a critical investment in the nation’s future stability.

– David Kohen

David is based in British Columbia, Canada and focuses on Global Health for The Borgen Project.

Photo: Unsplash

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AI health chatbots: Reaching Rural Patients in India

AI health chatbotsIn rural India, accessing health care often means a difficult journey. Only 10% of rural residents have access to health care within a 10-kilometer radius, while 90% must travel to different locations for specialized treatment. This distance translates to lost wages, transportation costs and delayed treatment that can turn minor ailments into life-threatening emergencies.

The health care gap in rural India is severe. Rural areas have a doctor-to-patient ratio of 1:11,082, nearly 11 times worse than the World Health Organization’s (WHO) 1:1,000 recommendation. Meanwhile, 71% of India’s population lives in rural areas, but only one-third of physicians practice there.

As of 2025, a technological revolution is bringing medical expertise directly to India’s villages. AI health chatbots developed by Indian startups are transforming smartphones into medical lifelines, offering instant guidance to millions.

Empowering Community Health Workers

ASHABot leads this transformation. Developed by Khushi Baby in partnership with Microsoft Research India, this WhatsApp-based AI chatbot empowers India’s ASHA workers—community health volunteers serving as the backbone of rural health care. The goal is to reach all 1 million ASHAs across the country, who collectively serve 800 million to 900 million people in rural India.

Launched in early 2024, the platform uses GPT-4 technology to provide multilingual support in Hindi, English and Hinglish. When an ASHA worker encounters a question about childhood immunization, breastfeeding or pregnancy complications, she can ask ASHABot through voice notes and receive evidence-based answers within seconds. The system draws from around 40 curated documents, including India’s public health manuals and UNICEF guidelines. The voice note capability also allows ASHAs to play responses aloud for patients who cannot read.

Since early 2024, more than 24,000 messages have been sent through ASHABot, and 869 ASHAs have been onboarded. Currently operating only in the Udaipur district, Rajasthan, the tool represents a pilot that Khushi Baby plans to scale nationwide.

ASHABot builds on Khushi Baby’s decade of work. The organization’s broader Community Health Integrated Platform, used by more than 75,000 community health workers across 48,000 villages, has tracked the health of more than 50 million people. In randomized controlled trials involving 3,200 mothers, the digital health intervention showed a 12% improvement in complete infant immunization.

Making Health Care Affordable

In Odisha and Chhattisgarh, CureBay has established more than 150 e-clinics across 32 districts. The organization focuses on areas where approximately 65,000 people within a 10-kilometer radius lack access to health care.

CureBay’s innovation lies in its affordability. For ₹599 annually—less than ₹2 per day—members receive free doctor consultations and 15% discounts on medicines. For individuals covered under government schemes or insurance, CureBay provides financial support with a daily allowance of ₹1,000 for each day of hospitalization, up to a maximum of 30 days. This membership model helps eliminate catastrophic health expenses that push millions of Indians into poverty each year.

The platform combines AI-powered diagnostic tools with human expertise. AI analyzes symptoms and medical images, providing preliminary assessments during teleconsultations with doctors. CE- and FDA-approved devices conduct diagnostic tests at the e-clinics.

Since 2021, CureBay has served 550,000 unique patients. The organization employs more than 1,000 Swasthya Mitras, community health workers, creating local jobs while expanding access. Around 90,000 people actively subscribe to preventive health programs, with a renewal rate exceeding 60%, showing sustained engagement.

In May 2025, CureBay raised $21 million in Series B funding led by Bertelsmann India Investments, Elevar Equity and British International Investment. Total funding reached about $37 million, with a post-money valuation of around $75 million.

Addressing Mental Health

Mental health remains deeply stigmatized in rural India, yet stress, anxiety and depression affect millions. Wysa, a Bengaluru-based startup, created an AI chatbot that provides mental health support through evidence-based cognitive behavioral therapy techniques.

Wysa launched its Hindi version in April 2024, making mental health resources accessible to Hindi-speaking rural populations. The app is available on smartphones and WhatsApp. The Hindi pilot showed strong engagement, with 80% of users returning for multiple sessions.

Clinical studies demonstrate Wysa’s effectiveness. Users experience an average 31% reduction in moderate anxiety symptoms and a 40% reduction in moderate depression symptoms, according to a study by U.K. health insurer Vitality involving 60,000 members. The platform has facilitated more than 550 million conversations across 65 countries, reaching 7 million users worldwide.

Wysa’s basic version is free, making mental health support accessible to those who cannot afford traditional therapy.

The Digital Foundation

This transformation builds on India’s expanding digital infrastructure. The Ayushman Bharat Digital Mission generated 442 million digital health accounts and linked 293 million health records. Out of 597,000 villages, 572,000 now have mobile or network connectivity, enabling digital health services.

With more than 425 million rural smartphone users and 504 million rural internet users projected by 2025, the foundation exists to scale these solutions nationwide. Rural internet users are growing at a rate of 26%, projected to exceed urban users for the first time.

The Future of AI Health Chatbots

AI health chatbots are not replacing doctors. Instead, they extend medical expertise to villages that never had access. They turn the 100-kilometer barrier into zero distance and transform smartphones into tools for health equity. For rural India, the future of health care has arrived, one conversation at a time.

– Jawad Noori

Jawad is based in London, UK and focuses on Technology and Politics for The Borgen Project.

Photo: Pixabay