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Community Health Workers in Sierra Leone Save Mothers’ Lives

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

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

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

How CHWs Work

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

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

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

Partners In Health’s Work in Sierra Leone

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

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

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

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

Measured Gains in Maternal and Newborn Care

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

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

Traditional Birth Attendants and Emergency Referrals

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

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

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

Expanding Capacity in 2026

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

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

Why the Approach Matters

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

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

– Kira Dosanjh Rai

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

Photo: Flickr

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How Nutrition Policy Shapes Health Equity in South Africa

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

How Economic Pressure Fuels Food Insecurity in South Africa

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

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

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

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

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

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

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

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

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

National and International Initiative To Improve Health Equity in South Africa

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

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

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

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

Final Thoughts

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

– Yuhan Rong

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

Photo: Unsplash

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Reclaiming Health Care for Indigenous Communities in Canada

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

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

The Barriers

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

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

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

The Case of Joyce Echaquan

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

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

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

Indigenous-Led Initiatives

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

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

– Brittany Buscio

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

Photo: Flickr

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Women’s Cooperatives in Guatemala

Women’s Cooperatives in GuatemalaIn the highlands of Guatemala, women’s cooperatives are writing a tale of defiance against poverty. Historically marginalized groups of women have united through cooperatives to become the lifeblood of their local economies. The benefits are cascading in metamorphic ripples, transforming entire communities in their wake.

Economic Independence

The most immediate impact is a dramatic rise in household income. Cooperatives like the Cojolya Association guarantee members more than twice the local market rate, shattering legacies of exploitation and establishing women as primary economic actors. This empowerment was a product of necessity, born from the ravages of a civil war that left countless women widowed.

Survivors, now solely responsible for the welfare of their families and the rehabilitation of their communities, founded cooperatives like Trama Textiles, which has grown into a network of more than 400 weavers. Cooperatives like Ixoq Ajkeem demonstrate the power of a collectivist approach with their strategy of pooling resources, leveraging bulk orders and constructing common storefronts. In this way, women’s cooperatives in Guatemala integrate vulnerable and disparate artisans.

They unite them under a single, resilient organizational model. This structure protects families from economic volatility. It also shields individual producers from the unpredictability of the market.

Investing in Health and Nutrition

This economic power creates a direct second ripple: improved family health and nutrition. As primary earners, women consistently reinvest in their families’ well-being, marking a critical shift in a country where a severe poverty crisis drives chronic malnutrition. Through cooperatives, this care becomes institutionalized.

UPAVIM, for instance, has channeled its collective resources into a medical and dental clinic while also initiating targeted campaigns, like a soymilk program, to combat child malnutrition. The women of rural Guatemala continue to teach a lesson in ingenuity by using the cooperative model to transform earnings directly into community health care, ensuring the windfalls of their work are felt throughout their entire locality.

Keeping Children in School

The third ripple and perhaps the most foundationally transformative, manifests in education. Protection from poverty enables children to return to the classroom instead of toiling away in the workforce of manual labor. This commitment is structurally embedded in cooperatives like UPAVIM, which operates its own school.

It also provides members’ children with scholarships for school supplies and meals. These efforts significantly reduce costs and make education accessible to many more families. The result is both tangible and visible. Children in school uniforms are now a common sight.

This change reflects their mothers’ success in securing a right to education denied to earlier generations by poverty. It also signals systemic transformations capable of breaking long-standing cycles of deprivation.

Building Skills and Confidence

The impact of women’s cooperatives in Guatemala transcends material gain, mounting to a fourth ripple of personal empowerment. Beyond the loom, women receive vital training in financial literacy, business management and leadership, highlighting cooperatives as institutions for holistic human development and collective self-sufficiency. This newfound expertise fuels a powerful shift in communal identity. As one weaver from the Aj To’ooneel cooperative asserted, “Women today are entrepreneurs.”

This transformed identity is reproduced at home, reshaping the perceptions of forthcoming generations. “The children of the artisans are seeing that women also have an important role or they occupy the same position as men in the family,” observed Lidia Garcia of Mercado Global. This cycle of empowerment, once begun, becomes self-perpetuating.

Strengthening the Entire Community

These individual ripples converge into a fifth: community fortification, transforming cooperatives into vital civic institutions. Aside from its school, UPAVIM established a health clinic and bakery, establishing a grassroots community support system. This role as a community pillar becomes most evident and most critical during crises.

Throughout the COVID-19 pandemic, cooperatives like Multicolores, Kakaw Designs and Mercado Global leveraged their networks to facilitate emergency food baskets, hygiene supplies and public health information when state aid was insufficient. Ultimately, these women’s textile cooperatives in Guatemala amount to something far greater than the sum of their parts; they weave a stronger, more resilient social fabric for the future.

Final Remarks

The story of Guatemala’s cooperatives is a testament to how women’s empowerment creates a cascade of change. From individual economic independence to healthier families, educated children and resilient communities, the ripple effect is lifting rural communities in Guatemala out of poverty. These cooperatives demonstrate that the most sustainable path to development is not through top-down aid alone, but by empowering those at the heart of communities to become the architects of their own futures.

– Georgio Moussa

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

Photo: Wikimedia Commons

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ONE Campaign: Tackling Inequality in Africa

Tackling Inequality in AfricaAfrica is the most impoverished continent in the world, with economic insecurity, political instability and disease worsening the hardships and exacerbating the inequality faced by its population. However, while these economic and social challenges can paint a bleak picture, many organizations and campaigns are dedicated to tackling inequality in Africa. For example, the organization ONE is dedicated to improving the lives of those living in the region using a combination of resources to drive policies that create essential and lasting change.

ONE

ONE is a global, strictly nonpartisan organization that uses activism, expert data and analysis and public campaigning to pressure lawmakers to support essential policies for Africa. Bono, lead singer of U2, co-founded ONE and its sister organization RED in 2004. Since then, ONE has secured $1 trillion in investments and taken 25 million actions to create more economic opportunities and improve the lives and health of those living in Africa.

ONE’s recent work focused on the reauthorisation of the African Growth and Opportunity Act and the Development Finance Corporation.

Economic Insecurity

Africa is the second-fastest-growing region in the world in 2025, with the African Development Bank predicting a 4.3% growth rate in the economy. However, there are still 464 million people living in poverty on the continent. Furthermore, there has been a slight decrease in the number of people living in extreme poverty (less than $3 a day) in the last few years in some regions.

For example, in sub-Saharan Africa, 46% of the population faced extreme poverty last year, a slight decrease from 46.4% in 2022. However, these persistently high rates can be partly attributed to widespread economic insecurity. According to the U.N. Trade and Development, the “high debt, trade imbalances and inflation” experienced by some countries in Africa lead to more vulnerable economies and, therefore, higher poverty rates.

Economic insecurity is, of course, an extremely concerning and pressing issue and has been exacerbated by the recent reduction in foreign aid. A spokesperson from ONE states that “U.S. foreign aid cuts have been devastating to the African continent.” They explain that “when donor countries step back, domestic governments pay more to borrow, forcing painful trade-offs in national budgets.”

This ultimately results in reduced workforce capacity, slower economic growth and continued inequality. However, the ONE Campaign is tackling inequality in Africa by supporting “economic development policies that empower partnership, trade, power access and entrepreneurship between Africa and the global economy.” These efforts offer hope for a more economically stable future for the continent.

Health

Health care infrastructure across Africa often fails to meet population needs because of chronic underfunding. High disease rates place even greater strain on these systems, causing the most vulnerable to suffer disproportionately, deepening poverty and slowing economic growth as the workforce weakens. While many diseases remain pressing issues in Africa, the rising rates of HIV/AIDS are among the most alarming.

According to UNAIDS, 5.2 million people in Central and Western Africa and 240,000 people in the Middle East and North Africa were living with HIV in 2024. ONE’s spokesperson says the recent foreign aid cuts have placed additional strain on Africa’s health care systems, particularly amid the resurgence of the HIV/AIDS epidemic. According to them, the cuts have led to reduced disease testing and tracing, long delays in accessing medications and support and limited communication to rural and other vulnerable communities.

They also report a rise in babies born with HIV and an increase in HIV-related deaths. However, according to ONE, while Africa urgently needs stronger health care infrastructure, hope lies in the continent’s growing innovation. One major breakthrough, according to ONE’s spokesperson, is a game-changing HIV drug, lenacapavir, which has shown nearly 100% effectiveness in preventing transmission.

They add that with sustained global investment, this drug has the potential to help end the epidemic. To continue tackling inequality in Africa, it is clear that while the continent is not short on health innovations, it urgently needs consistent funding to sustain progress and improve lives.

The Future

Speaking regarding the future, ONE’s spokesperson states, “Africa is an incredibly diverse continent. Every country and every region within each country faces its own unique challenges, which must be addressed through political, cultural and socially relevant lenses,” rather than grouping all countries under a single “challenge set.” ONE is working to move perception away from a generalist view and challenge “prevailing negative stereotypes…that suggest Africa is ‘bad for investment,'” instead highlighting the promise and opportunities that investment in Africa can bring.

By supporting organizations like ONE in addressing inequality, there is hope for stronger public health systems, greater economic opportunities and reduced poverty across the continent.

– Victoria Adrados

Victoria is based in London, UK and focuses on Good News and Technology for The Borgen Project.

Photo: Flickr

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Clean-Air Schools in Cairo Offer Hope for Low-Income Children

Clean-Air SchoolsIn Egypt’s crowded capital, children living in low-income neighborhoods face an invisible threat every day: air pollution. According to the World Bank, Cairo ranks among the world’s most polluted cities, with vehicle emissions, industrial pollution and desert dust contributing to hazardous air quality that disproportionately harms vulnerable communities. Children from impoverished districts, where schools sit near congested roadways and factories, face an elevated risk of developing asthma and other respiratory illnesses.

The World Health Organization (WHO) notes that children breathe faster than adults and are more vulnerable to fine particulate matter, which can become trapped in developing lungs.

Pollution and Poverty Reinforce Each Other

Across Cairo, environmental health and economic inequality are closely linked. According to UNICEF, children in low-income communities experience higher exposure to environmental hazards and have less access to quality health care. For many families, chronic respiratory illness creates additional financial hardship, including missed school days, lost wages for parents caring for sick children and recurring medical costs.

The Egyptian Ministry of Health reports that asthma is among the most common chronic illnesses affecting Egyptian children, with higher prevalence in densely populated urban areas.

Clean-Air Schools Take Root

To address this challenge, NGOs and parent-led coalitions have begun implementing “clean-air schools” initiatives in the most polluted districts of Cairo. These programs equip classrooms with portable air purifiers, increase natural ventilation and plant trees and shrubs around school grounds to trap airborne pollutants. Environmental groups, such as Greenish, a Cairo-based nonprofit, partner with schools to “provide workshops focused on environmental awareness.”

According to the American University in Cairo’s Center for Applied Research on the Environment, urban greening has been shown to lower particulate matter levels, improving both air quality and student well-being.

Health and Education Benefits

Cleaner indoor air is more than a health measure; it is a tool for improving educational outcomes. Research cited by the U.S. Environmental Protection Agency (EPA) indicates that air purifiers in schools can reduce respiratory symptoms and absenteeism, two key factors that hinder academic performance in children with asthma. In Cairo’s low-income areas, where asthma-related absences can lead to learning delays and higher dropout rates, clean-air classrooms provide an opportunity to break the cycle of disadvantage.

Government Policies and Future Expansion

National efforts reinforce local programs. Under the National Air Pollution Reduction Plan, Egypt aims to reduce particulate pollution by 50% by 2030, supported by upgrades to public transportation, stricter emissions monitoring and urban greening projects. Egypt’s National Climate Strategy 2050 also includes expanding electric buses and increasing green spaces in urban centers, measures expected to improve air quality in commuting corridors near schools.

A Breath of Relief for Cairo’s Youngest Learners

While systemic improvements will take time, clean-air schools in Cairo are already beginning to reduce asthma symptoms and improve student well-being in participating districts. For families in Cairo’s most impoverished communities, where health and education resources are limited, these small interventions can mean the difference between chronic illness and opportunity. As Egypt invests in cleaner transportation and environmental protection, community-driven school programs ensure that the most vulnerable children benefit today, helping them breathe more easily, learn better and envision a healthier future.

– Katie Williams

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

Photo: Unsplash

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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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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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Dependency on Foreign Health Care Workers in Ireland

Health Care Workers in IrelandIreland has long been a source of high net emigration, with an estimated 10 million emigrants leaving the western European island since 1800. However, the past two decades have seen an unprecedented increase in the number of foreign health care workers in Ireland. The Irish health care system has experienced notable growing pains in its attempts to retain domestically-trained doctors, who often follow a decades-long trend of looking abroad to Australia, Canada and the U.K. for hire.

As Irish doctors continue to move abroad, internationally trained medics bridge the gap. Here is a look at the path ahead as Ireland copes with shortages in professional health care and works toward a more accommodating workplace for Irish doctors.

Brain Drain: Doctors Leave Ireland Behind

A telltale shift in the Irish health care industry came in the late ’90s, when rapid economic growth and demand for nursing services outpaced Ireland’s supply of workers. Since 2000, Irish doctors, most of whom depart from Ireland during or after their training, have remained similarly scarce. This period of economic expansion marked an inflection point in Irish health care, where Ireland’s historical role as a major exporter of Irish nurses reversed.

Ireland’s trend in poor doctor retention seems to mirror a similar trend affecting northern and western Europe as a whole.

Unstable Working Conditions Disillusion Doctors

Most doctors born and trained in Ireland intend to work domestically. Yet, various factors keep these workers looking for work abroad. Notably, a 2018 survey of Irish training doctors found that only 45% intended to find work domestically, hinting at an underlying push factor in the Irish medical field. A 2021 study accredits Ireland’s exodus of domestically-trained doctors to short staffing and poor training, which catalyze stressful conditions in the workplace.

The fulfillment that Irish doctors don’t find in their work environment at home, they pursue abroad. About 72% of emigrant Irish doctors prefer employment in the U.K., Canada and Australia. Naturally, international recruitment programs call on foreign-trained health care workers to compensate for Irish staffing shortages.

Foreign health care workers in Ireland must bridge the gap that Irish emigrant doctors leave behind. Nevertheless, recent assessments of Ireland’s health care system indicate that this international recruitment practice is neither sustainable for foreign-trained workers nor the communities they serve.

Challenges for Foreign Health Care Workers in Ireland

A 2025 World Health Organization study assessing nine European countries (including Ireland) found that the number of foreign-trained nurses increased 67% in these regions from 2014 to 2023 alone. Higher wages and more benefits than are available in a foreign health care worker’s home country incentivize such high immigration trends. However, a significant disconnect exists between foreign workers’ expectations and the working conditions they receive upon arrival in Ireland, perpetuating brain waste in the Irish medical field.

This occurs as foreign doctors trained in a specific setting are assigned arbitrarily to any position lacking staff, thus depriving both their origin country and their receiving country of their talent. A study interviewed foreign health care workers in Ireland and found such instances of dissonance between the position to which individuals apply and the actual role to which they are called. Due to the costly financial and emotional investment of choosing to migrate, many cannot withdraw their commitment in pursuit of a better opportunity.

Thus, many foreign doctors bear the brunt of the poor working conditions that prompt Irish-trained doctors to go abroad.

Local Implications of Sending and Receiving Health Care Workers

Local communities, either on the sending or receiving end of foreign doctors, become more vulnerable as professional health care access is redistributed across international borders. Subsequently, Ireland’s understaffed health care force leaves marginalized and low-income communities, domestic and abroad, under strain. In attempts to compensate through international recruitment, the community in Ireland outsources for doctors and the spread is thin.

Foreign health care workers in Ireland become more vulnerable to poverty as they pay the exorbitant costs associated with migration. Consequently, individuals seeking health care may not have the financial means to compete for a spot in their health care provider’s overbooked schedule. Ireland has introduced noteworthy doctor retention programs, seeking to break this cycle, with varying results.

The Path Forward for Strong Doctor Retention in Ireland

To promote universal access to quality health care, Ireland has to sustain an equitable, stress-reduced working environment for its domestically trained doctors. A shift away from brain drain in Irish health care is an uphill battle. This is largely due to systematic flaws such as hostility from or poor connections with mentors and coworkers, which weakens a newly trained doctor’s support system.

Noteworthy doctor retention efforts began in 2015, when Ireland’s Strategic Review of Medical Training and Career Structures oversaw adjusted working conditions and training opportunities for doctors training domestically. However, a 2021 study revisiting the success of these doctor retention programs found them ineffective and out of proportion to the problem’s scale. Going forward, it will take increased investment in strong mentorship for Irish training doctors and more compatible training programs to see the Irish health care industry draw a greater appeal to its workers.

Fortunately, a successful doctor retention policy, such as Romania’s, provides a hopeful template as Ireland pursues an equitable health care system benefitting workers and patients alike.

– Isla Hansen

Isla is based in Spokane, WA, USA and focuses on Good News and Politics for The Borgen Project.

Photo: Wikimedia Commons

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$28 Billion Pledge Boosts Childhood Anemia Prevention

Childhood Anemia PreventionIron deficiency anemia is the most prevalent, yet preventable, nutrient deficiency-related disease in the world. According to the World Health Organization (WHO), 269 million children younger than 5 are affected, primarily those in low-income countries. At the 2025 Nutrition for Growth (N4G) Summit, global leaders addressed childhood anemia prevention, pledging nearly $28 billion to address the crisis. This investment could change millions of lives; however, the challenge is turning commitments into actions that reach children who need it the most.

Childhood Anemia: Effects on Health, Education and Poverty

Iron deficiency anemia is primarily caused by inadequate nutrient intake. Children in poverty-stricken countries are most at risk as food insecurity prevents balanced meals. Excessive blood loss associated with malaria, a disease currently found in 83 countries, is also a compounding factor of anemia in children. The link between poverty and anemia highlights why it is essential to understand its impact on children’s health, education and future potential.

Anemia causes fatigue, weakness, compromised immunity and, if left untreated, heart problems. Beyond health issues, affected children struggle with attention and memory problems, impacting learning as well as social interactions. The result is poor school performance and increased absenteeism, which affects their access to future educational and career opportunities, further perpetuating the cycle of poverty.

Why Previous Efforts Fell Short

Previous N4G Summits prioritized malnutrition and childhood anemia prevention. Global leaders pledged $23 billion in 2013 to address global malnutrition and $27 billion in 2021 to invest in anemia and food fortification. Sadly, these pledges fell short as a result of weak monitoring, insufficient funding and implementation delays. COVID-19 disruptions additionally prevented 2021 programs from fully reaching target communities.

Based on previous tracking reports, the 2025 Summit has new priorities. With a historic investment of $28 billion, the WHO and global leaders aim to turn commitments into tangible results. The efforts emphasize accountability, targeted interventions and measurable outcomes, supported by data systems to track progress. These changes set the stage for this initiative to make a real difference.

How $28 Billion Supports Childhood Anemia Prevention

Building from previous frameworks, the WHO, in partnership with UNICEF and the Anemia Action Alliance, has developed a comprehensive strategy to address childhood anemia. Their four primary areas for intervention include:

  • Addressing root causes: Programs are being implemented to address the nutritional and infectious causes of anemia. Comprehensive care tackling iron deficiency, malaria and parasitic infections is paramount in reducing the prevalence of childhood anemia.
  • Supplement distribution: In collaboration with national ministries and outreach programs, the WHO and UNICEF will increase women and children’s access to iron and folic acid tablets.
  • Food fortification: Countries are enacting policies mandating the fortification of staple foods such as wheat, rice and salt, which make up the bulk of diets in low-income countries. Fortification with iron helps address the widespread deficiency that contributes to childhood anemia.
  • Health system improvements: The WHO and UNICEF are working with ministries of health to integrate anemia testing into routine health services, provide training to health workers and improve the delivery of supplies.

These efforts aim to create lasting systems that prevent childhood anemia rather than only treating it. When sustained, such progress improves health and boosts education, productivity and economic stability, helping break the cycle of poverty.

Turning Promises Into Progress: Why Transparency Matters

The impacts of anemia go beyond health; it impacts national growth, too. According to the World Bank, anemia in children reduces productivity and learning potential, costing low-income countries up to 4% of their GDP each year. To truly make a difference and reduce poverty across generations, commitments to improving health need to become actions.

That’s why the 2025 N4G Summit emphasizes trust and transparency. Past pledges faltered due to weak data collection and limited accountability. Organizations such as the U.N. and Global Nutrition Report are calling for stronger monitoring systems to ensure this doesn’t happen again. New tracking dashboards are in place to measure outcomes and ensure real progress is being made.

If governments and partners uphold their commitments, this unprecedented $28 billion pledge for childhood anemia prevention could finally create lasting change. It offers a once-in-a-generation opportunity to break the cycle of malnutrition and poverty for generations to come.

– Tina Kusal

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

Photo: Pexels