SDG Goal 3 in Vietnam During the U.N. Summit for 2015, world leaders decided on 17 goals that they would like to track around the world. These goals would help motivate changes for a better future and identify where these changes were most needed. Titled, the Sustainable Development Goals (SDGs) — these goals range from conserving and creating a sustainable industry in the ocean (SDG goal 14) to ending poverty in all forms (SDG goal 1). Moreover, the U.N. rates the status of a country and its ability to achieve a certain SDG by 2030. This article will provide a brief update on SDG goal 3 in Vietnam.

Vietnam, a country located in Southeast Asia, has achieved several of the goals. For instance, Vietnam has achieved the goals for quality education (SDG 4), responsible consumption and production (SDG 12) and climate action (SDG 13). One of the goals, however, the “Good Health and Well-Being” (SDG 3) has been rated as the furthest from achievement with the “major challenges remain” status.

SDG 3: A Deep Dive

The description of SDG 3 is simple but will require a great effort to achieve; “Ensure healthy lives and promote well-being for all at all ages.” Some of the sub-scores — specific statistics that have led Vietnam to the depleted state of wellness and well-being goal include the high incidences of tuberculosis, traffic deaths and the percentage of surviving infants who received two Word Health Organization recommended vaccines.

Some of the greatest identified challenges include the control of communicable diseases, such as the aforementioned tuberculosis score, creating healthcare equality and accessibility. These issues share a strong connection because some new policies that have improved the control of communicable diseases in one sector are not established in others.

Improvements to SDG 3

Though the scores may be an indicator of a national problem in Vietnam, they have led to great improvements. In response to the inaccessibility score, the health service delivery has improved greatly. For example, there has been an increase in investment for healthcare facilities that are accessible to all Vietnamese. Also, the ability of Vietnamese to pay for healthcare is increasing as the coverage from insurance rises. In 2017, 86.4 % of Vietnamese had health insurance. Moreover, the National Tuberculosis Control Programme helps identify those who need treatment. This has continued to reduce the incidence over the years.

Traffic accidents are another low score for SDG goal 3 in Vietnam — something unique to the country. Accidents, injuries and deaths are all counted into the well-being score for SDG 3 in Vietnam. While the number of incidences has decreased, an estimated 14,000 people continue to lose their lives due to traffic accidents each year. The National Traffic Safety Committee and WHO have started a road safety project that works on reducing the number of deaths and accidents. The initiative holds a large focus on motorcycle safety and the prevention of drinking while driving.

What is Currently Being Done?

The inequality and inaccessibility for healthcare and sources of well-being, such as nutritious and reliable sources of food are especially culpable concerning child mortality statistics. The national statistics show a hopeful decreasing trend but have revealed stunning discrepancies between ethnic and regional groups. Highlighting this — child mortality in some mountainous regions in the Northwest and Central Highlands are four times as high as the national average. To create a way in which all children can be treated equitably, the Sustainable Health Development Center (VietHealth) has developed many programs to help mobilize primary care, screenings and disability care.

Vietnam is currently facing several different challenges in reaching the SDGs for 2030. However, with the help of (among others) the National Tuberculosis Control Programme, the road safety programs and VietHealth, much progress can be made in the next decade. Vietnam and the U.N.’s SDGs have proved to be a valuable resource for highlighting severe issues and motivating organizations and governments to improve conditions for citizens around the world.

Jennifer Long
Photo: Flickr

Water Services to the Poor
Water services to the poor are severely lacking around the globe. The World Health Organization estimates that 2.1 billion people lack access to safely managed drinking water services. Moreover, more than twice as many people lack safe sanitation. Consequently, 361,000 children less than the age of five die from diarrhea, every year. Of the people who do not have safely managed water, 844 million do not even have basic drinking water services. These conditions compel 263 million people to collect water from sources far from home — a process that takes over 30 minutes per trip. A further 159 million people still drink untreated water from surface water sources, such as streams or lakes.

At the current pace, the world will fall short of meeting the United Nations’ Sustainable Development Goal (U.N. SDG) of universal and equitable access to safe and affordable drinking water for all by 2030. Accelerating efforts to meet this goal will cost as much as $166 billion per year for capital expenditures alone. It seems that to achieve this U.N. SDG, something must change and soon.

A New Funding Approach

Private finance could play an important role in expanding access to improved, reliable water services to the poor. However, most providers that serve the poor are not privately financeable in their present state and will continue to require subsidies. Hence, development assistance and philanthropic funds are of utmost importance to protect the global poor.

A global funding model, known as a conceptual Global Water Access Fund (GWAF), has been established in other sectors to raise additional funds for targeted interventions. It pools resources in a way that provides incentives for access and utility performance for poor households.

This method is tried and tested. Gavi, the Vaccine Alliance, received $15 billion in pledges and yielded a net increase in funding. Unitaid, an organization that accelerates access to high-quality drugs and diagnostics in developing countries, generated more than $1 billion through a levy on airline tickets.

Investments in the poor are often perceived as having low or even negative returns. Therefore, pro-poor utilities face challenges entering financial markets. This also explains why profitable utilities are hesitant to expand their services to the global poor. GWAF changes this by bridging the funding gap and placing pro-poor utilities in stronger positions to attract capital for further service investments.

Making Individual Change

Though funding seems like a larger issue, there are ways for individuals to support clean water for all. Many nonprofits focus on bringing clean water services to the poor. Here are three organizations that are dedicated to the proliferation of clean water services to the world’s poor.

3 Nonprofits Tackling Global Water Services for the Poor

  1. Pure Water for the World works in Central American and Caribbean communities. The organization aims to provide children and families with the tools and education to develop sustainable water, hygiene and sanitation solutions. They directly connect fundraising dollars with impact, which immediately helps potential supporters see how their donation or peer-to-peer fundraising campaign will make a difference for the people they serve.
  2. Blood:Water is another nonprofit that works to bring clean water and HIV/AIDS support to over 1 million people. They partner with African grassroots organizations to make a change in 11 countries. Blood:Water works to provide technical, financial and organizational support to grassroots organizations. In this vein, they aim to help strengthen their effectiveness in their areas of operation.
  3. Drop in the Bucket’s mission is another organization that works towards water sanitation. They build wells and sanitation systems at schools throughout sub-Saharan Africa, enabling youth to fully harness the life-changing power of education. They teach the importance of clean water, hands and living spaces. Furthermore, the organization encourages girls to go to school, instead of spending hours fetching water.

Remaining on Track

Although sustainable development goals seem a difficult achievement to reach, innovative techniques such as GWAF and individual efforts through donations take steps in the right direction in ensuring water services to the poor. With nonprofit organizations such as the aforementioned as well as assistance from international organizations and governments like, there is still hope in reaching the U.N. SDGs.

Elizabeth Qiao
Photo: Pixabay

Disability and Poverty in Madagascar
In 2014, Madagascar partnered with the World Health Organization to implement the Disability Action Plan. While there are no specifics on the number of disabled persons in Madagascar, an article in the Journal of Rehabilitation Methods estimates that about 2.8 million persons with disabilities exist in the country. The goals of the Action Plan are to increase access for persons with disabilities to healthcare services and programs, extend support services and rehabilitation, and strengthen data collection on disability so it can be compared internationally. Organizations such as Humanity and Inclusion have also been working to improve the correlation between disability and poverty in Madagascar.

Access to Rehabilitation

The regions around Madagascar have about 1.6 physicians for every 10,000 people, whereas Madagascar has about 1. Eight rehabilitation specialists were trained by “A Rehabilitation Training Partnership in Madagascar” in 2015, contributing to the now 10 total specialists in the country. This means limited access to medical professionals trained in rehabilitation for persons with disabilities

Rehabilitation for people with disabilities can span from fitting them with orthopedic limbs and hearing aids to providing people with mental disabilities education on how their disability affects them as well as how to work with it in their daily lives. Sufficient rehabilitation for persons with disabilities was low in 2011, with The World Health Organization reporting that about 3% of people received it globally. People often view disability and poverty in Madagascar, and globally, as a cycle. A 2017 study called “Poverty and disability in low- and middle-income countries: A systematic review” reported that poverty and disability appear to exist in a cycle in lower and middle-income areas, where poverty can lead to disability and disability can lead to poverty.

How Disability Impacts Poverty

According to “A Survey of World Bank poverty Assessments” by Jeanine Braithwaite and Daniel Mont, when receiving the same income as persons without disabilities, persons with disabilities will have a lower standard of living. This is due to the different needs of persons with disabilities. Braithwaite and Mont’s studies into disability in developing countries revealed that households with persons with disabilities were slightly more likely to be in poverty.

How Poverty Impacts Disability

Poverty has been shown to limit access to healthcare in Madagascar. About 75% of Madagascar’s population lives below the international poverty line, according to The World Bank. The cost of healthcare, and transportation to healthcare centers, can be barriers for people in poverty to accessing treatment. USAID reported that less than 40% of Madagascar’s population lives within an hour’s walk, or 5 kilometers, from a healthcare center, meaning many people face additional transportation costs when they need to access healthcare.

A study about the barriers to implementing the Disability Action Plan in Madagascar stated that of “disability-adjusted life” in 2004, 29% was caused by non-communicable diseases. The report concluded that the data correlates with limited access to treatment, revealing a link between disability and poverty in Madagascar through the way that poverty impacts healthcare access.

Solutions

Madagascar has previously passed the Law on Disability, which promoted the freedoms and equal rights of persons with disabilities. The National Decade of Disabled Persons, a time frame in which the government would work to improve conditions for those with disabilities, was ratified in Madagascar in 2002 and ran from 2003-2013. Since passing those pieces of legislation, Madagascar has been working to implement The World Health Organization’s global Disability Action Plan since 2014. Expectations have determined that it will wrap up in 2021.

The country has already made some strides toward completing the program and impacting disability and poverty in Madagascar. In 2015, Madagascar ran a workshop and training program in partnership with Leeds Teaching Hospitals NHS Trust, which the Rehabilitation Medicine in Madagascar and a counterpart in the United Kingdom then delivered. This workshop trained and licensed eight new doctors. The doctors have now created the Association of Physical and Rehabilitation Medicine of Madagascar (AMPRMada), which has created a database for Madagascar rehabilitation centers to use. Today, according to an AMPRMada report, its database greatly helps rehabilitation planning nationally because it provides a single place to access all the rehabilitation centers’ data.

Humanity and Inclusion have also been working to improve the lives of persons with disabilities in Madagascar. The organization has been in Madagascar for 30 years. One of its ongoing projects focuses on ensuring persons with disabilities have access to adequate rehabilitation by:

  • Examining barriers to accessing rehabilitation services
  • Assessing the related economic areas
  • Setting up and improving rehabilitation services and “orthopedic fitting,” which means ensuring things like prosthetic limbs and metal braces fit patients correctly
  • Looking into increasing “education, training, and networking” in order to increase the number of rehabilitation workers
  • Improving funding for rehabilitation services
  • Keeping track of how the “National Rehabilitation Plan” progresses
  • Raising awareness

A report that details the progress of ongoing Humanity and Inclusion projects estimated that, when it is completed, its rehabilitation project will benefit 5,000 people, 47% of whom are children with disabilities.

It can sometimes be hard to calculate the effects of disability in Madagascar due to a lack of data. Research studies have, however, been able to estimate the number of disabled persons and the link between disability and poverty in Madagascar. Through the country’s legislation and partnerships with outside organizations, such as The World Health Organization, Madagascar is continuing to address and attempt to improve access to healthcare and rehabilitation for persons with disabilities. Organizations like Humanity and Inclusion have been contributing to those changes with ongoing projects that address access to rehabilitation services for persons with disabilities.

– Melody Kazel

Photo: Flickr

Healthcare in TunisiaThe North African country of Tunisia is sandwiched by two relatively unstable nations, Algeria and Libya. However, Tunisia has had consistent development in human wellbeing for the past couple of decades, ranking among the best nations in Africa. In part, this success can be attributed to Tunisia’s relatively strong healthcare system. According to a World Health Organization report, Tunisia possesses a “national health strategic plan” as well as a relatively high life expectancy at 75 years. Healthcare in Tunisia is a promising sign that the country can adequately support its population and promote longer, healthier lives for its citizens. Here are six facts about healthcare in Tunisia.

6 Facts About Healthcare in Tunisia

  1. More than 90% of the population is covered by health insurance. While some citizens use private insurance, others are covered by programs in place to assist the most disadvantaged in society. However, Tunisia still lacks truly universal coverage. One of the top complaints about healthcare in Tunisia is gaps in payment for important medical procedures, which can burden families.
  2. Tunisia’s 2014 constitution granted healthcare as a human right. The government is still working to make this a reality and provide universal, effective healthcare in Tunisia. Specifically, the government is trying to improve the dilapidated health infrastructure in the south of the country. This manifested in a 9% increase in the healthcare budget in 2016, which went toward improving infrastructure in remote areas.
  3. Private healthcare in Tunisia is booming. In recent years, before the COVID-19 pandemic, the number of private clinics built in the country was expected to surge. Seventy-five new facilities are set to be completed by 2025, doubling the number of hospital beds in the country. These improvements should help make access to quality healthcare more readily accessible to the general population.
  4. Tunisia successfully combated many diseases in the past. Most importantly, Tunisia has been able to eradicate and control many deadly diseases that put a strain on its healthcare system. Malaria, polio and schistosomiasis are well under control. In addition, Tunisia’s healthcare system has worked to address HIV/AIDS.
  5. During the COVID-19 pandemic, Tunisia has done relatively well. Sitting at 1,327 confirmed cases and 50 deaths as of July 2020, the country is positioned to recover economically from the virus, which is devastating in other parts of the world. Though it is still early in the pandemic, it appears that the healthcare system in Tunisia was able to absorb the influx of cases in order to slow the death rate.
  6. Robust preventative measures enabled Tunisia’s positive response to COVID-19. Seeing the potential for a rise in cases early on, the government, as advised by healthcare experts, quickly went into a rigorous lockdown that lasted for months. This was especially difficult considering that tourism accounts for 10% of the country’s GDP. According to a WHO spokesman, a strong sense of community and respect for the lockdown measures eased the country’s caseload and death toll. Because the Tunisian population was willing to make sacrifices for the broader community, they are now in a comparatively better place than some other nations around the world.

Healthcare is a critical issue for any nation. While there is always room for improvement, Tunisia has succeeded in using its available resources to ensure medical coverage for its people.

Zak Schneider
Photo: Pixabay

Healthcare in Suriname
The Republic of Suriname is an upper-middle-income country located on the northeastern coast of South America. Around 90% of the country’s population lives in urban or rural coastal areas. Healthcare in Suriname is accessible for both the public and private sectors. Here are eight facts about healthcare in Suriname.

8 Facts About Healthcare in Suriname

  1. Infant and Maternal Mortality: Suriname’s infant mortality rate in 2013 was around 16 deaths per 1,000 live births. The most prevalent reasons for mortality reported in children under 1 year of age were respiratory problems, fetal growth retardation, congenital diseases, neonatal septicemia and external causes. The maternal death ratio averaged 125 deaths per 100,000 live births from the years 2000 to 2013. For mothers, the most prominent causes included gestational hypertension and hemorrhage. In 2010, prenatal checkup coverage was around 95%, and more than 65% of pregnant women had had four prenatal checkups. In addition, almost 93% of births happened in a health center, and trained health workers carried out around 95% of births.
  2. Life Expectancy: In 2016, the average life expectancy of a male was 69, while the average life expectancy of a female was 75. These estimates are slightly below the average male and female life expectancies in the rest of South America.
  3. Mosquito-borne Illnesses: In late 2015, the preliminary issue of Zika virus was found in Suriname. The disease spread quickly throughout the country’s 10 districts, but there are no current outbreaks. Conversely, Suriname has eradicated malaria from all but one district of Suriname. However, the rate of new imported cases (principally among gold miners from French Guiana) increased by more than 70% in 2015.
  4. HIV and Tuberculosis: By 2014, Suriname’s human immunodeficiency virus (HIV) rate among the 15-49 age group was 0.9%. HIV/AIDS caused 22.4 deaths per 100,000 people in 2010, decreasing to 16.4 deaths per 100,000 people in 2013. From 2012 to 2014, the estimated tuberculosis diagnosis rate increased from 58% to 71%. To combat the disease, the country started the direct implementation of observed treatment, resulting in higher treatment success from 61% in 2010 to 75% in 2013.
  5. Government Contribution and Coverage: Suriname experienced vast economic growth from 2010 to 2014. During this period, healthcare in Suriname received increased funding for various services and facilities. It expanded and decentralized private laboratory diagnostic services, private primary care, dental care and paramedic practices. In 2015, vaccination coverage was almost 90% for DPT3 and above 90% for the trivalent vaccine (MMR1). In 2014, the total estimated health expenditure as a percentage of GDP was 6%. For health insurance, employees’  premium rate is 50%, and employers pay the other half. For low- or no-income citizens, the government subsidizes health coverage.
  6. Hospitals: Of Suriname’s five hospitals, two are private and three are public. The Academic Hospital in Paramaribo has recently renovated and expanded its facilities and invested in equipment and staff for specialty care like gastroenterology, oncology, intensive care, renal dialysis and more. In 2013, government and external funds also helped other hospitals invest in new facilities and healthcare worker training programs.
  7. Sanitation: Suriname’s lack of an integrated waste management policy has created illegal dumps and caused refuse to accumulate on roadsides and in open waters. This infrastructure problem results in health risks and environmental hazards. According to the Pan American Health Organization (PAHO), Suriname does not have facilities for storing or eliminating hazardous waste, nor does it regulate the safe use or storage of pesticides.
  8. Accessibility: In 2014, Suriname passed its national basic health insurance law. It provides access to a basic package of primary, secondary and tertiary care services for all Surinamese citizens. In 2013, all people under the age of 16, as well as people aged 60 and over, had the right to free health care that the government paid for. Universal access to healthcare for pregnant women and newborns remains a challenge for healthcare in Suriname.

Persistent voids in access to healthcare in Suriname are related to drawbacks in funding. The healthcare system has seen an expansion in the past decade, but there are still plenty of health challenges to confront and improve.

Anuja Kumari
Photo: Flickr


The country of Oman (officially know as Sultanate of Oman), located on the Arabian peninsula, can provide an example of a recovered and thriving healthcare system. Since 1970, Oman has been developing a highly esteemed healthcare system that is based on an efficient three-tiered system. The primary care model has produced a considerably healthier population compared to 50 years ago.

Oman’s Healthcare Progress

The progress of healthcare in Oman is represented in the statistics. Before His Majesty Sultan Qaboos first sat on the Omani throne in 1970, only 13 doctors were working for the 724,000 citizens of Oman. Since then, the number of doctors, as well as the number of hospitals, have grown tremendously. In 1958 there were only 2 hospitals while today there are 70 hospitals that are world-renowned for their medical treatment. There was also a significant growth in life expectancy from around 50 years in 1970 to over 76 years today.

At the beginning of his reign, His Majesty Sultan Qaboos made universal healthcare a goal, pushing for additional resources and policies to create accessible healthcare. The commitment of the government, including a law that ensures that the government will invest “in health care as a means of ensuring citizens’ well-being,” proved to be the momentum that the healthcare system needed to expand. With this commitment, a large amount of the government’s revenue from gas and oil, one of Oman’s largest exports, provided the healthcare sector the funding it needed to build hospitals, and improve medical staff and policy. By 2000, healthcare in Oman was ranked number eight in the world by the World Health Organization.

Moving Toward Universal Care

In addition to funding, healthcare needs policies to create a strong and lasting infrastructure. The platform on which Oman would grow its healthcare sector toward universal care was the focus on free primary care for all citizens. The aforementioned three-tiered healthcare system implemented in the Oman consists of primary care (hospitals at a local level), secondary care (care from a regional and district level), and tertiary care (any national care a citizen might receive.) By funding and creating ubiquitous accessibility for primary care, citizens can access healthcare in their community and be directed into a higher level or specialty if needed. Free primary healthcare for all has increased the quality and efficiency of healthcare in Oman.

Preventative Care

Healthcare in Oman has been effective in increasing life expectancy, decreasing child mortality and detecting diseases because there is a focus on preventative care. Preventive care is intertwined with the idea of accessible primary care because it encourages early detection of disease as well as easy and unburdened emergency care. Citizens can access the care they need without worrying about the cost of visiting a hospital in an emergency. In addition, the increasing amount of doctors who have an international perspective allows citizens to be better informed about their health issues and for doctors to take proactive measures in stopping development.

The progress made by Oman’s healthcare sector has caused significant positive change. From the efficient use of oil and gas revenue in the funding of hospitals to free primary healthcare for all, healthcare in Oman has arranged a secure and community-based framework that promises even greater future progress towards exemplary healthcare for all citizens. As the country continues to grow its investment in preventive care as well as the expansion of privatized healthcare, other healthcare systems can learn from Oman’s effective resource and policy implementation that has greatly improved healthcare for its citizens.

– Jennifer Long
Photo: Flickr

Healthcare in Somalia
Many challenges come with being one of the poorest countries in the world. In Somalia, a country located on the Horn of Africa, garnering a quality healthcare system for everyone is a major struggle. With a population of over 12 million, the people of Somalia have one of the lowest life expectancies in the world. Grappling through years of civil war and natural disasters, it has been difficult to overcome widespread disease, malnutrition and an overall lack of healthcare resources. Thankfully, organizations have noticed the absence of a healthcare system and many efforts are going towards improving healthcare in Somalia.

United Nations Development Program

According to the United Nations Development Program (UNDP), 58% of Somalis are without healthcare. Recognizing this issue, the UNDP set the goal to have complete universal healthcare in Somalia by 2030. Since the COVID-19 global pandemic, the UNDP has realized how destructive a pandemic can be in all facets of life in a developing nation. In addition to the goals for universal healthcare, it aims to set up structures to strengthen resilience to any future disasters. The UNDP created a blueprint proposing a multi-step initiative to improve healthcare and ensure that it does not leave anyone behind. The program would provide basic healthcare consisting of two tiers of costs and services to choose from. However, the core service will involve the implementation of telemedicine. This will be an immense advancement, considering that most Somalis have to walk miles to get to their nearest healthcare facility.

The UNDP has also been addressing HIV/AIDS issues in the country since 2004. It has implemented investment programs totaling $5.4 million between 2005 and 2009. Its work includes creating knowledge and awareness programs, increasing testing for Somalis and lobbying for HIV/AIDS legislation. The impact of the program’s efforts is notable. As of 2019, there were approximately 11,000 children and adults living with HIV in Somalia in comparison to the approximate 22,810 in 2008.

For immediate attention to the fight against COVID-19, the UNDP is supporting an emergency call center that the Somali government runs. The UNDP contributed by offering transport to volunteers, office equipment and staff. Anyone needing advice on COVID-19 or feeling ill can simply call the center and find assistance from volunteers comprising of medical students, doctors and other health professionals. Additionally, if a patient has severe symptoms or is sick with underlying health conditions, an ambulance can transport them to their local hospital. The center helps roughly 8,000 people a day.

The World Health Organization (WHO)

The World Health Organization (WHO) pledged to assist health authorities in Somalia in increasing the number of healthcare workers and stabilizing primary healthcare services in the country. In September 2019, the organization assisted in launching the plans for universal health coverage (UHC) for the time period of 2019-2023. The WHO understands the importance of improving health systems in the country and hopes to develop powerful health systems to prevent future epidemics. Thus, the UHC initiative aims to give all Somali people improved protection from healthcare emergencies.

The WHO has declared maternal health one of its priorities and advocates for maternal health as a human right. About one in 20 women die during labor due to an overall lack of health resources, which gives Somalia one of the highest maternal mortality rates in the world. The WHO is bolstering investments in the issue, mobilizing health resources and strengthing healthcare systems to decrease maternal mortality rates.

UNICEF

UNICEF is also fighting to improve healthcare in Somalia. One focus has been to develop safe motherhood and child healthcare programs. The organization worked with Somali health authorities to provide the Essential Package of Health Services (EPHS). Predictions determine that these packages will aid 4.2 million Somalis. The EPHS structure is an extensive range of free health services that will help establish a medical standard for the country. The goal is to provide essential medicines, supplies and equipment as well as train and expand human resources. The program includes aid for neonatal and reproductive health, child immunizations and treatment of widespread diseases like HIV.

Somalia has one of the highest child mortality rates in the world. Due to the lack of sanitation, medical resources and vaccinations, one in seven children will not make it past age 5. Since 1990, deaths among children under 5 have reduced by half. Deaths have decreased thanks to the vaccine initiative that UNICEF and WHO launched in 2013. The program consisted of 1.3 million doses of an innovative “five-in-one” vaccine for the prevention of the top fatal childhood illnesses along with a parental awareness campaign.

The Integrated Community Case Management (ICCM) that UNICEF and WHO organized has also improved healthcare systems. This community-based approach brings experienced and supervised health professionals to the area to help decrease the common childhood illnesses contributing to the high child mortality rate. The system plans to continue developing a solid staff of health leaders and administrators to manage future health disasters.

Moving Forward

Some organizations are making great progress in improving healthcare in Somalia. Since the efforts to create an overall healthcare infrastructure, the country has seen improvements in how it controls widespread diseases. In 2004, the average life expectancy was 50, but as of 2018, it was 55. Life expectancy should increase as chronic malnutrition, infant mortality rates and the spread of preventable diseases decrease with improved healthcare systems. Thanks to these resolutions, overall health and wellbeing in Somalia should be on the horizon.

Tara Hudson
Photo: Pixabay

Healthcare in Chile
Healthcare in Chile primarily comes from the state-funded insurance National Health Fund (Fondo National de Salud – FONASA) or from private companies collectively known as Las Instituciones de Salud Previsional (ISAPRE). According to a 2019 report from the Organization for Economic Cooperation and Development (OECD), 78% of the population participate in FONASA and around 17-18% enroll in ISAPREs, while 3-4% receive coverage from the armed forces insurance program. A number of newly implemented government reforms in Chile have challenged healthcare inequity to ensure universal healthcare for all.

Morbidity and Mortality

In the 1980s, a series of successful reforms decreased infant mortality rates (from 33 per 1,000 live births in 1980 to only eight per 1,000 in 2013) and improved communicable disease rates, nutrition and maternal and child health. While the health status of Chileans consistently fell below average among OECD nations in recent decades, the life expectancy in Chile in 2015 rose to 79.1 years in the last 40 years, nearly on par with its OECD peers. Determinants of health status include life expectancy, avoidable mortality rates, morbidity rates from chronic diseases and percentage of the population in poor health.

Non-communicable diseases (NCDs), such as high blood pressure, diabetes and heart diseases are identified as the burden of disease in Chile, accounting for 85% of all deaths. Key risk factors include high obesity rates, heavy tobacco use and increasing rates of alcohol consumption. The infant mortality rate is improving but remains high, as are mortality rates from cancer compared to cancer incidence.

Some Effective Government Measures

The Chilean government has undertaken effective measures to address the nation’s most urgent issues through a multi-intervention strategy that targets different population groups and settings:

  • Obesity: According to a 2016 WHO report, 39.8% of the Chilean population was overweight, and another 34.4% was obese. Childhood overweight and obesity rate is particularly problematic at 45%, with no reduction in prevalence over the past 15 years. Chile has implemented nationwide policies to tackle behaviors that cause obesity, especially inadequate physical inactivity and unhealthy diets. At the national level, mass media, such as websites, Twitter, TV and radio adverts, educates the public on healthy food choices and emphasizes the consumption of vegetables and fruits. The government has also mandated labels on packed foods that indicate high caloric content in salt, sugar and fat.
  • Tobacco Use: Tobacco consumption rates in Chile in 2016 stood at 37% (41% among men and 32% among women) of the adult population. Adult smoking rates have declined from 45.3% in 2003 and 39.8% in 2009, a percentage below average in comparison to other nations. Since joining the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2005, Chile has implemented various tobacco control policies, such as prohibiting smoking in public spaces, requiring health warnings on tobacco products and raising taxes on these products.
  • Cancer Care: The OECD projected that cancer could soon become the leading cause of mortality in Chile. Among men, prostate, stomach, lung, colorectal and liver cancer have the highest mortality rates. In women, breast, colorectal, lung, stomach and pancreas cancer account for high mortality rates. To lessen the burden of cancer, Chile has reinforced its cancer care system and launched nationwide programs focused on cervical and breast cancer and cancer drugs for adults and children. From 2011 to 2015, Chile reduced cancer by 4.1%.

Challenging Inequity

The establishment of the National Health System (NHS) in 1952, subsequent expansions and reforms together enabled Chile’s move towards universal coverage with more than 98% of the population having some kind of health insurance. However, inequality remains one of the main challenges in Chile’s two-tier healthcare system, mainly due to the unequal distribution of resources between the underfunded public facilities and the elitist private clinics. Equity monitoring shows less insurance coverage for less educated people, low-income quintiles, residents from rural areas and those with state insurance.

Significant inequalities due to socioeconomic position and residence area persist. According to a study that PLOS Medicine published, the infant mortality rate among the highest educated women was 2.3 times lower than the least educated, while the ratio was 1.4 between urban and rural residence. Risk factors like obesity, alcohol use disorders and cardiovascular risks also disproportionately affected the least educated segment of the population.

Moving Forward

Despite tremendous challenges, healthcare in Chile has improved thanks to the government’s effort to prioritize health reforms. In 2005, Chile launched Universal Access with Explicit Guarantees (AUGE) program that sought to improve access, timeliness and quality of care in the public sector. The OECD assessed that the system of healthcare in Chile is overall “well-functioning, well-organized and effectively governed,” with a particularly robust public healthcare program that operates efficiently on both the central and regional levels. Although challenges such as rising rates of certain NCDs and inequities between sectors and populations persist, the country’s ambitious reforms demonstrate its preparedness to tackle these issues.

– Alice Nguyen
Photo: Flickr

Like Cambodia and Vietnam, the country of Laos is located in Southeast Asia. Being a landlocked country means that much of its water resources come from the Mekong River. Water sanitation has been an issue in the past, and now widespread action is being taken. There are many organizations that are coming together to bring clean, usable water throughout Laos. Here are 10 facts about water sanitation in Laos.

10 Facts About Water Sanitation in Laos

  1. The Creation of WASH FIT: In 2017, The World Health Organization partnered with UNICEF to create WASH FIT, which stands for “Water and Sanitation for Health Facility Improvement Tool.” Participants involved go into different hospitals to hold training programs and assess the current sanitation situation. The program provides information about safe water collection, along with supplies to build sanitation facilities. Through the WASH FIT program, sanitation in many Laos health centers and hospitals has increased by more than 50%. This has created a safer environment for both staff and patients.
  2. Increase in Safe Drinking Water: As of 2019, only 48% of schools in Laos had access to clean water. As more organizations – such as Abundant Water and Mercy Relief – continue to help better sanitation in Laos, the Lao PDR plan to keep increasing the percentage of individuals who have access to clean water.
  3. ICRC Brings Water to Urban Villages: Finding clean water and bringing it back to homes often requires strenuous work and a long trek. Of those traveling to get water, 79% are women. Many of the water sources that are used contain water-borne diseases, making much of the water in Laos dangerous to consume. The humanitarian group International Committee of the Red Cross (ICRC) aids these women by drilling boreholes, bringing clean water closer to homes.
  4. Laos is Home to Third Largest River in Asia: Though the water from the Mekong River is not suitable for drinking, it is the only source of water for many of the surrounding villages. Because of this, many people suffer from water-borne diseases, such as schistosomiasis. To decrease cases of schistosomiasis, The World Health Organization and The Ministry of Health are working together to bring clean water and sanitation facilities to villages. This will limit the need for water from the Mekong River.
  5. Hanwha Launches Project to Clean Mekong River: Like many rivers globally, the Mekong River contains an enormous amount of harmful pollutants. The Hanwha group in Vietnam started a campaign called Clean Up Mekong. They use solar-powered boats clean up trash as they sail down the river. Though the cleanup started in Vietnam, it will directly affect many places. The river flows not only through Vietnam and Laos, but much of Asia including Cambodia and China.
  6. Clay Water Filters are Used to Produce Clean Drinking Water: Thanks to an Australian organization called Abundant Water, clay water filters have been created and distributed to 12 different villages. These filters are used to produce clean drinking water. The organization then taught a five-week training program to local potters on how to create clay filters of their own. As a result of Abundant Water’s work, over 22,000 people have accessed safe drinking water.
  7. Increase in Access to Sanitation Facilities: In more rural areas of Laos, individuals may not have access to sanitation facilities, causing open defecation to be a major concern. The open defecation rate is the second-highest in the area. This has caused an increase in the spread of harmful diseases. Lao PDR and the World Bank have been working to supply rural areas with facilities to reduce open defecation. As of 2015, there is a 28% increase in the availability of sanitation facilities in urban areas and 39% in rural areas.
  8. Further Water Availability for Schools: Schools have suffered firsthand from the lack of water. Mercy Relief arrived in 2012 to install water filtration systems for schools throughout Laos. Through this work, more children have access to safe drinking water and sanitation facilities now. They also use the water to start gardens to grow fruits and vegetables for the children and school staff to take home or sell at local markets.
  9. More Than 40 Water-Gravity System Installations: World Vision International has aided in the effort to build water-gravity systems that bring fresh water to rural villages. As of 2014, World Vision has supplied local villages with 46 water-gravity systems to help improve sanitation in Laos and lower the spread of harmful diseases.
  10. Start of Water Management Committees in Rural Village: An organization called Plan International has gone into northern Laos, bringing water tanks, pipelines and other water supplies. The organization has also started water management committees that are in charge of maintaining the water facilities. By showcasing the great impact water management committees have had on this particular community, the hope is that companies assist as other villages carry out similar plans.

Though there is still a long way to go, progress has been made. Companies and organizations around the world are working together to improve water sanitation in Laos.

– Olivia Eaker
Photo: Flickr

Life Expectancy in Timor-Leste
Timor-Leste, also known as East Timor, is a nation that occupies the eastern half of the island of Timor in Southeast Asia. With a population of 1.26 million people, Timor-Leste is one of the least populated countries in Asia. The Portuguese originally colonized the country in 1520. After declaring independence in 1975, Indonesia invaded the nation, which occupies the western half of the island. The Indonesian invasion brought violence, famine and disease to Timor-Leste, resulting in a large loss in population. After a majority of the Timorese population voted to become independent in 1999, Indonesia relinquished control and Timor-Leste moved under the supervision of the United Nations. The nation officially became independent in 2002, making it one of the newest nations in the world. These 10 facts about life expectancy in Timor-Leste outline the rapid improvement the country has made since Indonesian occupation and the issues it still needs to overcome.

10 Facts About Life Expectancy in Timor-Leste

  1. Life expectancy in Timor-Leste increased from 32.6 years in 1978 to 69.26 years in 2018, matching that of South Asia. The consistent improvement in life expectancy in the past decade is primarily due to the Ministry of Health’s public health interventions. Such interventions include the reconstruction of health facilities, expansion of community-based health programs and an increase in medical graduates in the workforce.
  2. Life expectancy in Timor-Leste increased despite a drop in GDP, which decreased from $6.67 billion in 2012 to $2.6 billion in 2018. However, Timor-Leste’s GDP rose by 2.8% from 2017 to 2018. Continued improvement in GDP and economic progress in the nation will only serve to increase life expectancy by providing more opportunities for employment, education and improved quality of life.
  3. Tuberculosis was the highest cause of death in 2014, causing 14.68% of deaths. In 2014, estimates determined that Timor-Leste had the highest prevalence of tuberculosis in Southeast Asia, and 46% of people with tuberculosis did not receive a diagnosis in 2017. Maluk Timor, an Australian and Timorese nonprofit committed to advancing primary health care, provides a service through which team members visit Timorese households to locate undiagnosed patients and raise awareness about the severity of tuberculosis in the community. The organization collaborates with the National TB Program and aims to eliminate suffering and deaths in Timor-Leste due to diseases that Australia, which is only one hour away, had already eliminated.
  4. Communicable diseases caused 60% of deaths in 2006 but decreased to causing 45.6% of deaths in 2016. While diseases such as tuberculosis and dengue fever remain a public health challenge, the incidence of malaria drastically declined from over 200,000 cases in 2006 to no cases in 2018 due to early diagnoses, quality surveillance, funding from The Global Fund to Fight AIDS, Tuberculosis and Malaria and support from the World Health Organization.
  5. The adult mortality rate decreased from 672.2 deaths per 1,000 people in 1977 to 168.9 deaths per 1,000 people in 2018. Additionally, the infant mortality rate decreased from 56.6 infant deaths per 1,000 live births in 2008 to 39.3 infant deaths per 1,000 live births in 2018. While public health interventions and disease prevention contributed to the decrease in the adult mortality rate, Timor-Leste needs to expand access to maternal health services in rural areas to continue to improve the infant mortality rate.
  6. Maternal mortality decreased from 796 deaths per 100,000 live births in 1998 to 142 deaths per 100,000 live births in 2017. The leading cause of the high maternal mortality rate is poor access to reproductive health services, as only 43% of women had access to prenatal care in 2006. While the Ministry of Health continues to expand access to maternal health care through mobile health clinics that reach over 400 rural villages, only 30% of Timorese women gave birth with a health attendant present in 2013. Even as access increases, challenges such as family planning services, immunization, treatment for pneumonia and vitamin A supplementation remain for mothers in rural communities.
  7. The violent crisis for independence in 1999 destroyed more than 80% of health facilities. Despite rehabilitation efforts to rebuild the health system, many facilities at the district level either have limited or no access to water. However, the number of physicians per 1,000 people improved from 0.1 in 2004 to 0.7 in 2017. The capacity of the health care system is also improving, as UNICEF supports the Ministry of Health in providing increased training for health care workers in maternal and newborn issues and in striving to improve evidence-based public health interventions.
  8. Timor-Leste has one of the highest malnutrition rates in the world. At least 50% of children suffered from malnutrition in 2013. Additionally, in 2018, 27% of the population experienced food deprivation. USAID activated both the Reinforce Basic Health Services Activity and Avansa Agrikultura Project from 2015-2020 to address the capacity of health workers to provide reproductive health care and the productivity of horticulture chains to stimulate economic growth in poor rural areas. Both projects aim to combat malnutrition by addressing prenatal health and encouraging a plant-based lifestyle that fuels the economy.
  9. Motherhood at young ages and education levels are key contributors to malnutrition, as 18% of women began bearing children by the age of 19 in 2017. Teenage girls are far more likely to experience malnourishment than older women in Timor-Leste, contributing to malnutrition in the child and therefore lowering life expectancy for both mother and child. As a result of malnutrition, 58% of children under 5 suffered from stunting in 2018. Additionally, findings determined that stunting levels depended on the wealth and education level of mothers. In fact, 63% of children whose mothers did not receive any formal education experienced stunting, while the number dropped to 53% in children whose mothers received a formal education.
  10. Education enrollment rates are increasing, as the net enrollment rate in secondary education increased from 40.5% in 2010 to 62.7% in 2018. Completion of secondary education links to higher life expectancy, especially in rural areas. Since 2010, Timor-Leste has increased spending on education. Additionally, local nonprofit Ba Futuru is working to train teachers to promote quality learning environments in high-need schools. After Ba Futuru worked with schools for nine months, students reported less physical punishment and an increase in innovative and engaging teaching methods in their classrooms. The organization serves over 10,000 students and provides scholarships for school supplies for hundreds of students. With more programs dedicated to increasing enrollment and the classroom environment, students are more likely to complete secondary education and increase both their quality of life and life expectancy.

These 10 facts about life expectancy in Timor-Leste indicate an optimistic trend. Although malnutrition, disease and adequate access to health care remain prevalent issues in Timor-Leste, the nation’s life expectancy has rapidly increased since Indonesian occupation and has steadily improved its education and health care systems since its founding in 2002. To continue to improve life expectancy, Timor-Leste should continue to focus its efforts on improving public health access and community awareness in poor rural areas, and particularly to emphasize maternal health services to reduce both maternal and infant mortality rates. Despite being one of the newest nations in the world, Timor-Leste shows promise and progress.

Melina Stavropoulos
Photo: Flickr