Self-care (illustrative)

Self-care can be a key strategy in tackling the global crisis of non-communicable diseases that are responsible for three-quarters of premature deaths globally and 86 percent of early deaths (before age 70) in low- and middle-income countries (LMICs). Moreover, dentists, pharmacists and community health workers are trained professionals who can provide innovative forms of self-care advice and guidance – reaching communities and individuals that are often beyond the reach of mainstream medicine, noted experts at a recent Global Self-Care Federation (GSCF) webinar held in the leadup to September’s High-Level meeting on NCDs.

Through these groups, countries are finding innovative ways to deliver informed self-care knowledge and tools to individuals and commnunities, which could help prevent many NCDs related to unhealthy diets and lifestyles – as well as making other disease conditions easier to diagnose and treat.

“I think it is important that society understands that the healthcare profession consists of physicians, pharmacists, dentists, and the nursing sector. It’s not just a focus on one of those four groups,” explained Greg Perry, GSCF director general. He added that it is important to look at how community health workers and other skilled health professionals can work together with individuals to expand access to self-care tools and encourage their use.

Stimulating such innovation around self-care is critical as the global health community prepares for the 2025 Fourth High-level Meeting on NCDs in New York this September, said experts from Africa CDC, patients organisations and the private sector at the recent GSCF webinar.

Inconsistent progress on self-care issues

Progress on integrating self-care into broader global strategies on NCDs has so far been inconsistent. The World Health Organization (WHO) has published a series of guidance on self-care strategies in various domains.  But so far, neither the WHO Global NCD Action Plan (2013–2030), nor the NCD and Universal Health Coverage aims of the UN Sustainable Development Goals, have sufficient emphasis on self-care strategies, critics say. At the same time, the world remains far from reaching the goals for reducing NCDs set forth in the UN SDGs or WHO action plans, and health systems, particularly in LMICs, are struggling to meet the growing demand for NCD care. GSCF has highlighted that a siloed approach to healthcare has failed in many regions.

In a new policy paper, GSCF makes the case for prioritizing self-care as a central pillar of the global NCD response. In that context, it calls for three key actions: Member states need to recognise self-care as a vital tool for easing the global burden of NCDs and reduce pressure on healthcare systems, including formally integrating certain self-care tools and tactics into national health coverage plans. Secondly, the 2025 High Level Political Declaration on NCDs should explicitly highlight the role of self-care in reducing NCD risks and improving prevention and management. And thirdly, self-care should be acknowledged as essential to empowering individuals and improving health outcomes.

According to Orajitt Bumrungskulswat, a board member of the International Alliance of Patients’ Organisations, several barriers hinder the greater integration of self-care into NCDs management. These include a lack of knowledge and skills about NCDs and self-care practices. Financial constraints also play a role, limiting access to affordable, high-quality self-care products and services. In addition, many communities face insufficient health education and a lack of supportive environments, networks, and peer groups.

Thailand’s campaign for healthier habits

In Thailand, there are 6.5 million people living with diabetes, 40 million with high blood pressure, approximately 1 million with kidney disease at various stages, 140,000 cancer cases per year, and up to 10 million people dealing with mental health issues, Bumrungskulswat said, citing Ministry of Health estimates.

“This is mainly because of individual behaviours and because people are not really aware of how to practice self-care,” Bumrungskulswat said.

To change this trajectory, the ministry launched a campaign aimed at encouraging healthier habits—such as reducing salty, oily, and sugary foods and increasing physical activity – particularly in southern Thailand’s more urbanised regions, where unhealthy diets and sedentary lifestyles are more prevalent. The campaign includes distributing prevention guidelines on social media and in communities and strengthening support networks and patient groups. These groups now collaborate closely with professionals and local healthcare centres to promote prevention and self-care education. Thailand is already beginning to see the impact of these efforts, Bumrungskulswat said.

Ireland’s dentists take the lead

In Ireland, dentists have been empowered to innovative forms of self-care guidance on topics like vaccination as well as smoking cessation.

Expanding the network of care providers is also proving to be a key strategy in the fight against non-communicable diseases. Dr Dympna Kavanagh, chair of the Platform for Better Oral Health, shared how Ireland has leveraged its dental professionals to support this goal.

“Embedding oral health into wider self-care and prevention frameworks, we can achieve better outcomes, not just for individuals, but for healthcare systems, populations and societies as a whole,” Kavanagh said.

In Ireland, Kavanagh’s program has redefined the free dental examination for lower-income patients to include oral check-ups, risk assessments, and lifestyle advice. Payments for delivering these services were increased by more than 25% to reflect dentists’ expanded role.

“We do see that there has been an increase of over 8,000 patients attending per month seeking treatment since introducing this change,” Kavanagh said.

Advice on smoking cessation and vaccination in oral health exams

And the same oral health checkups also support other preventative health measures, he noted, pointing out that:  “Dentists remain amongst the top three healthcare professionals providing tobacco cessation advice in Ireland.”

According to Ireland’s “Healthy Ireland” surveys, smoking rates have plateaued at 17%.

In recent years, oral health professionals have also been empowered to take on a role in advocacy around vaccinations.

Vaccination, a critical component of self-care, became a focal point during the COVID-19 pandemic. Ireland achieved high vaccine uptake in part by passing emergency legislation that authorised dentists and hygienists to administer vaccines. This policy has since been made permanent.

Today, Irish dentists are also supporting HPV vaccination efforts, which play a crucial role in preventing oral – as well as cervical – cancers.

“In our population campaigns, we are fortunate to see an uptake of 80% in girls and 76% in boys,” Kavanagh said.

She emphasised the need to keep oral health front and center in discussions about NCDs: “We must continue to amplify oral health as part of the global NCD agenda. We must remind policymakers and governments that prevention doesn’t begin with policy alone and doesn’t end with policy alone. It begins with empowered individuals who are supported to care for their own health by reducing tobacco and alcohol use, improving their diets, accessing vaccination and maintaining consistent oral hygiene.”

Expanding access through pharmacies

Purchasing drugs at a pharmacy in Johannesburg, South Africa.

Pharmacists are another group of caregivers who can play a vital role in guiding self-care strategies and choices, according to Mfonobong Timothy, Disease Prevention and Self-Care program coordinator for the International Pharmaceutical Federation (FIP). She explained that pharmacies are widely recognised as first-line healthcare providers—personal healthcare professionals who are knowledgeable and highly accessible.

“Pharmacists are also playing a crucial role in promoting the role of vaccination in good health and wellbeing,” Timothy said. “In 56 countries and territories, we now have pharmacy-based vaccination, and we continue to advocate for this to ensure policymakers know that this is a form of self-care that we can provide to individuals towards having good health and wellbeing.”

In addition to their role in vaccination, Timothy emphasised that pharmacists provide essential hands-on guidance for using medical devices—a key part of supporting patients in their daily self-care routines.

“Without the strong support system, individuals may not feel motivated,” Timothy noted.

Community Health Workers can support shift from treatment to prevention of NCDs

Community Health Workers attend a training session on HIV prevention in Kirehe, Rwanda.

In some low and middle-income countries, there has been a shift away from the traditional medical model toward a community- or society-based model of care, often led by Community Health Workers. This shift is helping societies move from treatment toward prevention – and along with that, more informed self-care practices, explained GSCF’s Perry.

“In high-income countries, we have the drugs, we have the guidelines, we have the digital tools, yet we still see that healthcare-associated costs are increasing along with life expectancy,” said Dr Adelard Kakunze, lead for the NCDs, Injuries and Mental Health Program at the Africa CDC. “The question is why? Why, if we have all the knowledge and tools, are we not able to really control these conditions?”

Kakunze believes the answer lies in the lack of personal engagement with self-care. In most countries, he said, health systems have failed to encourage citizens to practice the daily discipline required for self-care—what he describes as the “invisible work” that begins after the clinic door closes. This can include checking one’s blood pressure, adjusting one’s diet, or going for a walk – before resorting to drug-based treatments.

In Africa, however, this approach is gaining traction, he maintains. With limited access to specialists and resources, countries on the continent have been forced to innovate. At the core of this innovation is community. Kakunze noting that many African countries have strong networks of community health workers (CHWs), embedded in nearly every neighbourhood.

“We have learned that those specialized services are too expensive, so we need to rely on communities,” he said.

“We also now have a political commitment to deploy and equip 2 million community health workers on the continent, and what we’ve been seeing in many countries [is] that they have really embraced this with a contextualized, adapted training curriculum now that integrates NCDs,” he said. “Now, those community health workers can screen, counsel, and follow thousands of patients at home.”

Examples in mental health

A lay counsellor sits with a community member on the Friendship Bench in Zimbabwe.

In the mental health arena, one example is the Friendship Bench project, developed in Zimbabwe and cited by recent WHO guidance as a global model of community-based mental health support.

Using a cognitive behavioural therapy-based approach, trained community volunteers—affectionately called “grandmothers”—deliver structured problem-solving therapy to people suffering from common mental health conditions like anxiety and depression. Patients meet with the grandmothers for six 45-minute sessions on discreet wooden benches at local clinics, creating a safe and welcoming space for healing.

Since its launch, the Friendship Bench has shown impressive results. A 2016 study published in JAMA found a significant reduction in depressive symptoms amongst participants. The model’s success has inspired adaptations beyond Zimbabwe, including in Malawi, Zanzibar, and even New York City—showing how solutions developed in low-income countries can transform mental health care around the world.

More recently, community health workers have been paired with primary healthcare centres or general practitioners who can provide supervision and standardised health checklists.

“We have seen the impact of those community health workers when they are supervised; the impact is really increasing a lot,” Kakunze said.

Looking ahead, the Africa CDC is now exploring the use of advanced technologies and tools to support community health workers and enhance their effectiveness.

Kavanagh echoed similar sentiments. She noted that Europe has taken a “very siloed, very narrow” approach to the healthcare workforce, defining it strictly as doctors, dentists, pharmacists, and nurses. She suggested countries should also consider tapping into their ageing populations to broaden that workforce.

“Talented people retire, and then the country loses their wealth of knowledge,” she said.

Kavanagh also proposed that older medical professionals could be engaged to play a meaningful role in community healthcare, helping fill workforce gaps while contributing valuable experience.

Private-sector partnerships

Six out of ten smokers, or 750 million people globally want to quit tobacco use.

Finally, experts say the private sector also has a vital role to play in advancing self-care.

Dr Vinayak Mohan Prasad, head of the No Tobacco Unit at WHO, noted that there are 1.25 billion tobacco users worldwide—and more than 60% of them want to quit. To address this, WHO established a consortium that brings together private companies, non-state actors, and state actors to collaborate on tobacco cessation.

“We have a pharma pillar, so all the pharma companies can come in. We have a digital tech pillar, and we have a couple of very powerful tech companies already in the consortium,” he said. “We also have a health system group. We have the research group because there are a lot of research gaps still existing.”

This collaborative model is being applied beyond tobacco control. Tamara Rogers, chief marketing officer for Haleon, highlighted how private and public actors can also partner to improve access to healthcare.

She explained that while private industry can drive innovation and develop affordable health products and solutions, non-governmental organisations can play a key role in ensuring these tools reach the people who need them most.

“I think building trustful, stable, multi-year partnerships is really pivotal in making sure that we can best maximize all of the collective resources, expertise and innovation,” Rogers said.

–Part of a supported series in collaboration with the Global Self-Care Federation

Image Credits: Caroline LM/ Unsplash, Wikimedia Commons, Cecille Joan Avila / Partners In Health, Sarah Johnson.

MSF Nurse Gatwech Tuoch immunizes a child against measles at the MSF Mobile Clinic in Bulukat, Upper Nile State South Sudan.

During this World Immunization Week (24-30 April), Médecins Sans Frontières (MSF), shares recommendations for how Gavi – which is developing its new five-year strategy amidst looming funding cuts – can strengthen collaboration between governments and humanitarian organisations to ensure that more children up until the age of at least five, especially those living in fragile and humanitarian settings, get their routine vaccinations.

On 10 January 2024, South Sudan declared a measles outbreak in its Western Equatoria state. With an alarming number of people in Western Equatoria never having been vaccinated against measles, there was an urgent need to start a large-scale measles vaccination to curb the spread of the disease in the area and its surroundings, protect people from contracting measles and, ultimately, save as many lives as possible.

However, obstacles around getting and using the measles vaccine in-country meant that it took almost four months for any measles vaccinations to begin in Western Equatoria. In the interim, thousands of people fell ill and at least thirteen people died, seven of whom were children under five years old.

For over five decades, MSF (Doctors without Borders), a medical humanitarian organization working in over 70 countries has been vaccinating people through routine vaccination, preventive vaccination campaigns, and in response to disease outbreaks in some of the world’s most challenging settings. Sometimes, we – and other humanitarian, non-governmental organisations – are the only providers of vaccination for people who are not reached by government-led vaccination activities. This can happen for various reasons, including security constraints, geographic and infrastructural challenges, and sometimes, deliberate exclusion.

Our years of experience have taught us invaluable lessons about vaccinating in humanitarian settings, and it’s because of this that we know the delay in South Sudan was not exceptional. Often, getting access to vaccine supplies requires months of negotiations around how and when they can be accessed – negotiations which often start anew each time there is a need. Such slow-moving coordination wastes valuable time and risks lives.

Delays don’t have to be the norm

But we don’t think it has to be this way.

Right now, Gavi, The Vaccine Alliance – an organisation which supports governments of the world’s poorest countries vaccinate children against some of the world’s deadliest diseases – is preparing its strategy for the next five years. As part of this, Gavi is designing a “Fragility and Humanitarian Approach” to reach communities that consistently miss out on immunization.

In fragile and humanitarian settings, such as war zones, refugee camps, and hard-to-reach areas cut off from health care, it is often more difficult for people to access routine vaccination services, and ‘zero-dose’* children are disproportionately found in these environments. For example, as of July 2024, 31 World Health Organization member countries with fragile, conflict-affected settings accounted for 55% of unvaccinated children.

Gavi’s effort to address this is therefore much welcomed. However, it must include the recommendations of non-governmental, humanitarian organisations – like us – that have spent years working in and understand these settings.

Returning to South Sudan’s Western Equatoria, a flexible system allowing for rapid access to vaccines could enable faster and smoother emergency vaccination responses. One way to make this happen, would be for Gavi to work with governments and humanitarian organisations together, to ensure a closer collaboration: we don’t operate in a void, and effective cooperation with country governments allows us to better support them and work where they are not.

Developing standing agreements

The MSF Mobile Clinic in Bulukat Transit Centre, Upper Nile State in South Sudan. Bulukat hosts over 5,000 people who fled the conflict in Sudan.

Specifically, instead of having to negotiate with governments on a case-by-case basis, Gavi should help develop standing agreements to allow humanitarian organisations rapid access to existing in-country vaccine stockpiles in order to complement national immunisation efforts by vaccinating the children that fall outside of national immunisation programmes.

We’ve seen how this can work. In South Sudan’s Upper Nile State, MSF set up mobile clinics to screen and vaccinate displaced people, preventing outbreaks. This relatively simple intervention allowed people outside of national immunisation programmes to receive healthcare, and was successful because of sufficient vaccine supplies and space to work.

There is another critical part to getting vaccines to as many children as possible in hard-to-reach places, which is making sure that when we do vaccinate, including in targeted campaigns, we reach all children who previously missed out on their basic childhood vaccines, regardless of their age. Unfortunately, due to national policies, age-limited Gavi support and – therefore – limited vaccine supplies, children over the age of two often are left out of  vaccination drives. This leaves older children who are still at an increased risk of falling ill from vaccine preventable diseases unprotected and makes any future response to an outbreak even tougher.

In our experience, missing out on vaccinations can have devastating impacts. In last year’s response to the measles outbreak in Western Equatoria, 20 per cent of children treated for measles at MSF-supported facilities were over five. While the Big Catch Up – an initiative by Gavi, UNICEF and WHO – aims to reach zero-dose children up to the age of five with vaccination, this effort will come to a close at the end of this year. Going forward, we urgently need country policies that allow for vaccination until at least the age of five matched with dedicated financial support from an ambitiously funded Gavi.

Of course, sustainable funding for immunisation is essential. And due to logistical and geographic challenges that often exist in fragile and humanitarian settings, the delivery of vaccines can be more expensive than in “stable” settings. That’s why it’s especially critical for all institutional and government donors to ensure the effort to reach children in humanitarian settings with immunisation is ambitiously supported, both financially and politically.

It’s abundantly clear that we in global health must work better together to reach every child in a fragile or humanitarian setting with lifesaving childhood, routine, or emergency vaccination. Health systems need to be strengthened so that country-led responses remain at the core of immunisation efforts, with humanitarian partners able to support where children are not reached.

This means the learnings and recommendations of humanitarian organisations must be reflected in the policies and practices that aim to reach children in humanitarian settings with vaccination. Actively dismantling the barriers in getting timely access to and using vaccine supplies is a particularly key part of ensuring that children up until at least age five will have a better chance of being protected from vaccine preventable diseases, and getting a real shot at life.

Victorine de Milliano is a vaccine policy and advocacy advisor for Médecins Sans Frontières/Doctors Without Borders (MSF).

 

 Pamela Onango is medical coordinator in South Sudan for Médecins Sans Frontières/Doctors Without Borders (MSF).

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*’Zero-dose’ children are defined as children who haven’t received a single dose of diphtheria, tetanus and pertussis-containing vaccine (DTP3).

Read MSF’s full recommendations on how Gavi can do more to reach people outside of government vaccination activities here, and for more information on Vaccination Barriers in complex settings, see here.

Image Credits: Gale Julius Dada/MSF, Gale Julius Dada/MSF.

Africa CDC headquarters, Addis Ababa, Ethiopia.

Uganda is set to declare an end to its Ebola outbreak on April 26 if no new cases emerge, Africa’s top public health agency announced Thursday. The country’s 83% recovery rate among confirmed cases significantly exceeds the typical 30-40% survival rate for Ebola outbreaks, with Uganda managing to contain the disease while simultaneously responding to mpox cases.

“We really keep our fingers crossed,” said Professor Yap Boum, Executive Director of the Institut Pasteur of Bangui, during the weekly Africa Centers for Disease Control and Prevention briefing. “The country will declare the end of Ebola.”

Boum, who delivered the briefing on behalf of Africa CDC Director John Kaseya, who was attending IMF-World Bank Spring meetings in Washington, also reported “promising news” on mpox, citing declining cases in several countries despite the disease’s continued spread.

“We can see a decrease in the decline in number of suspected cases, but also the confirmed cases,” Boum said. “This is due partly to Burundi, but also to some other countries.”

However, Malawi reported its first four cases of mpox on April 16, including a 2-year-old child. None of the patients had a recent travel history, indicating local transmission. The child’s case highlights what Boum called an “important opportunity” for countries to approve mpox vaccination for children between the ages of one and 12.

The Democratic Republic of Congo remains “the epicenter” of the continent’s mpox outbreak, though intensified community surveillance shows some positive trends, Boum said. Contact tracing has increased from an average of 1.7 to 7 contacts per case in recent weeks, indicating authorities’ surveillance of the outbreak is improving. 

“The Kivus are the place that carries the highest burden in internal number of cases,” Boum noted, adding that implementation of vaccination and other measures in this conflict-affected region of the Democratic Republic of Congo – where mpox has been endemic since at least the 1970s – would be “the turning point to the response in DRC and therefore in the continent.”

Boum also highlighted progress on a rapid diagnostic test for mpox that could deliver results in 15 minutes without requiring electricity, potentially replacing the current system that can take up to 30 days for results to reach patients, nullifying their efficacy to contain outbreaks. Africa CDC expects to receive updates on the performance of the rapid diagnostic tests in the second week of May, and anticipates improvement from the previous 23% sensitivity rate for accurate diagnosis, Boum said. 

As the continent slowly gets mpox under control, Africa CDC’s Emergency Committee will meet on May 17 to evaluate whether to maintain the Public Health Emergency of Continental Security declaration for mpox that was issued in August 2024.

The updates came as Africa CDC leadership attended IMF-World Bank Spring Meetings in Washington to discuss health financing amid funding cuts. Boum emphasized the need to increase domestic health financing, noting that only three of 44 African member states currently meet the Abuja Declaration target of allocating 15% of GDP to health.

Angola’s recent $5 million pledge to Africa CDC was cited as an example of “championing the Africa-led financing strategy,” particularly amid what Boum described as “an era where we need to do more with less” amid vast funding cuts from the largest supporter of the continent’s health systems – the United States – during Donald Trump’s first 100 days in office.

“This is an opportunity for our countries to follow the example of Angola, to increase the expenditure on health, especially considering the new era that we are in,” Boum said, adding Africa CDC leadership’s conversation in Washington will center on “how we should navigate considering the cuts that are happening.”

“Next week, when the Director-General will be back, we’ll have more outcomes on how Africa CDC, and the continent will benefit from this challenging environment,” Boum said.

Image Credits: Africa CDC.

A teacher at a school in Mozambique teaches local students about the health benefits of contraception.

The World Health Organization (WHO) has issued its first update in 13 years to guidelines aimed at preventing adolescent pregnancies, identifying child marriage as a primary driver behind millions of early pregnancies that endanger girls’ lives and futures.

The document published Thursday by the UN health agency pinpoints uptake and access to safe contraception, barriers to girls’ right to education, child marriage laws and access to sexual and reproductive health services broadly as fundamental to reducing early pregnancies, which endanger adolescents around the world.

“Early pregnancies can have serious physical and psychological consequences for girls and young women, and often reflect fundamental inequalities that affect their ability to shape their relationships and their lives,” said Dr Pascale Allotey, Director of Sexual and Reproductive Health and Research at WHO.

The global crisis affects millions of girls, with devastating health consequences rippling across generations, particularly in regions torn by conflict and instability. Pregnancy and childbirth complications rank among the leading killers of girls aged 15-19 worldwide.

Over 21 million girls between 15 and 19 become pregnant annually in low and middle-income countries, the WHO review found. Half of those pregnancies are unintended, while 55% lead to abortions—often performed in unsafe conditions, carrying life-threatening risks.

Maternal conditions are among the top causes of disability-affected life years and mortality globally, according to UNICEF.

Health dangers from pregnancy are intensified for mothers aged 10-19, who face significantly higher risks than women in their twenties, including dangerous high blood pressure conditions like eclampsia, post-childbirth uterine infections and systemic infections.

The health consequences extend to their infants as well. Babies born to adolescent mothers have higher rates of low birth weight, premature birth and serious neonatal conditions compared to those born to older mothers. 

“Adolescents who give birth face higher risks of maternal and infant mortality compared with older women, while early pregnancies can restrict adolescents’ choices, limiting their educational and economic prospects,” Allotey said. “These limitations often perpetuate cycles of poverty and inequality.”

“Tackling this issue means creating conditions where girls and young women can thrive—by ensuring they can stay in school, be protected from violence and coercion, access sexual and reproductive health services that uphold their rights, and have real choices about their futures,” Allotey added. 

Child brides: one every three seconds

One in five young women worldwide were married before their 18th birthday. Levels are highest in sub-Saharan Africa.

An estimated 12 million girls marry before age 18 annually — approximately one every three seconds — according to Girls Not Brides, a coalition of over 14,000 international and human rights organizations. In low- and middle-income countries, nine out of ten adolescent births occur among girls married before turning 18.

“Early marriage denies girls their childhood and has severe consequences for their health,” said Dr Sheri Bastien, Scientist for Adolescent Sexual and Reproductive Health at WHO.

Though child marriage rates declined from 25% in 2010 to 19% in 2020, progress remains slow and is reversing in conflict zones. The prevalence has increased by 20% in Yemen and South Sudan amid ongoing conflicts.

About 650 million women alive today were married as children, with one in 20 girls worldwide wed before age 15.

The situation is most dire in fragile states, where Save the Children reported last year that a girl is married every 30 seconds. Global humanitarian crises from Sudan to Yemen, Gaza and Myanmar have only accelerated since that report, leaving millions of girls at heightened risk of dangerous pregnancies.

Child marriage not only leads to early pregnancies before girls’ bodies are fully developed, but also often restricts their access to adequate healthcare. Girls who marry before 15 are 50% more likely to experience intimate partner violence than those who marry later, creating additional health complications.

The issue forms part of a broader pattern of gender inequality. In regions where both female genital mutilation and child marriage are common practices, girls face compounded health risks. Countries including Sudan, Somaliland, Sierra Leone, Burkina Faso and Ethiopia report the highest rates of girls subjected to both practices.

Stark global divide in adolescent pregnancy crisis 

Girls living in rural areas are more likely to marry in childhood than girls in urban areas.

Progress region to region remains starkly uneven. Sub-Saharan Africa has far and away the highest prevalence of births to girls aged 15-19, with over six million occurring in 2021 alone, in addition to 332,000 births for girls between 10 and 14 years old. The best-performing region, Central Asia, saw just 68,000 adolescent births that same year.

This divide is also reflected in maternal death rates. Seventy percent of global maternal deaths in 2020 — over 200,000 — occurred in sub-Saharan Africa, where girls who reach age 15 face a one in 40 chance of dying from pregnancy-related complications in their lifetimes. In Chad, the country with the highest rate of maternal mortality, a 15-year-old girl has a one in 15 chance of dying of maternal causes.

Divides by income, culture and class can also occur within countries, undermining the representativeness of national-level statistics. The WHO cites examples of Zambia, where adolescent pregnancy rates vary from 14.9% in the capital region of Lusaka, to 42.5% in its Southern Province.

According to Save the Children’s 2024 Global Girlhood Report, the ten countries with the highest child marriage rates are either fragile or extremely fragile states. Eight of the top ten “fragility-child marriage hotspots” are in Africa, with Central African Republic, Chad, and South Sudan facing the most severe crises. In extremely fragile countries, almost 558,000 girls give birth before their 18th birthday, often without access to skilled birth attendants who could save their lives if complications arose. 

While worldwide adolescent birth rates have declined, the overall birth rate remains high. In 2021, an estimated 12.1 million girls aged 15–19 years and 499,000 girls aged 10–14 years gave birth globally, according to WHO.

“Ensuring that adolescents have the information, resources and support to exercise their sexual and reproductive health rights is not only a matter of health – it is a matter of justice,” concluded Allotey. “All adolescents need to be empowered to make choices that lead to healthier, more fulfilling lives.” 

Despite the heightened risks for girls worldwide, only 0.12% of all humanitarian funding between 2016 and 2018 was directed toward addressing gender-based violence, according to Save the Children.

Education as a shield

The WHO identifies education as a crucial human right and shield against adolescent pregnancies.

Among the WHO’s strongest recommendations is removing gender barriers to education, with evidence showing each additional year of secondary education reduces a girl’s likelihood of marrying as a child by six percentage points. 

Multiple randomized controlled trials from Kenya, India and Zimbabwe reviewed by WHO present strong evidence that that life skills curricula and support to remain in school effectively reduce child marriage rates.

“Quality education represents our strongest defense against early marriage and pregnancy,” WHO researchers noted in the guidelines. 

“These limitations often perpetuate cycles of poverty and inequality,” said Allotey. “In many parts of the world, adolescents – whether married or unmarried – lack access to the information and resources necessary to make informed decisions about their sexual and reproductive health. This leaves them vulnerable to early pregnancies and unprepared to navigate the physical, emotional and social changes that follow.”

While 50 million more girls enrolled in school between 2015 and 2023, completion rates for secondary education lag significantly behind primary education, with only 61% of girls finishing upper secondary school worldwide compared to 89% completing primary education.

Economic interventions also show promise according to the WHO guidelines. Programs focused on improving livelihood skills, financial literacy and economic autonomy demonstrated significant impact on reducing child marriage while increasing girls’ employment and control over resources.

“Education is critical to change the future for young girls, while empowering adolescents – both boys and girls – to understand consent, take charge of their health, and challenge the major gender inequalities that continue to drive high rates of child marriage and early pregnancy in many parts of the world,” Bastien said.

Beyond Legal Solutions

Child marriage–fragility hotspots where girls face high rates of child marriage and the challenges associated with fragility. / Save the Children 2024

The WHO also conditionally recommends implementing laws restricting marriage before age 18, though with important caveats. Criminalizing child marriage can produce unintended consequences, potentially driving the practice underground, which can make reporting more difficult for the child brides who are victims of sexual assaults, the guidance suggests. 

The evidence reviewed by WHO on worldwide child marriage laws suggests that legal restrictions show inconsistent results in reducing marriage rates without addressing underlying social factors.

“Laws alone are insufficient without addressing root causes,” concludes the report, citing the need for comprehensive frameworks tackling gender inequality.

Both the UN Convention on the Elimination of All Forms of Discrimination Against Women and the Convention on the Rights of the Child call for eliminating harmful practices affecting children’s health, but organizations like Girls Not Brides warn that punitive approaches without corresponding social support can harm the very girls they aim to protect.

“Progress is uneven,” Allotay said. “We must sustain efforts to ensure that the most vulnerable groups of adolescent girls are not left behind.” 

Image Credits: The Hepatitis Fund.

A rollout of the malaria vaccine in Western African countries with a special focus on immunising children is an important step towards eliminating the disease.

After the World Malaria Report 2024 was published, the global community confronted an undeniable and uncomfortable truth: while malaria affects entire communities, its burden is not equally distributed.

Women, particularly in malaria-endemic regions, are disproportionately impacted. Their physical, social and economic health suffers more than others’ as they bear the brunt of caregiving responsibilities, suffer barriers to accessing healthcare, and face the compounding effects of climate change on disease transmission.

Malaria is a preventable and treatable disease, yet the global tally of malaria deaths has risen in recent years. In 2023, the death count reached 597,000, up from 574,000 in 2018, in part due to antimalarial drug resistance, health systems weakening during COVID-19, and funding shortfalls.

But the hardship that malaria causes goes beyond countries grappling with staggering death counts. The disease leaves profound and lasting indirect impacts on communities –  falling disproportionately on women and girls.

The hidden costs of malaria on women and girls

Pregnancy weakens malaria immunity, increasing infection risk. For expectant mothers, malaria can cause severe anemia, pregnancy loss, premature birth, underweight newborns, or maternal death. / World Malaria Report 2024.

The fight against malaria is hindered by deeply rooted gender inequalities.

Women spend four times as many days on caregiving compared to men – a stark reality exacerbated by recurring malaria infections within families as poverty traps women in cycles of economic dependency and limits opportunities for education and employment.

Women’s contributions to the global health system are estimated to be around 5% of global GDP. But around 50% of this work is unrecognised and unpaid. In malaria-endemic regions, this labour often takes the form of informal caregiving, as women provide care in up to 83% of malaria cases.

For community health workers, 70% of whom are women, the imbalance is even larger. Female health workers spend significantly more unpaid hours than their male counterparts, despite forming the backbone of malaria detection, treatment, and prevention efforts in rural areas.

Women and girls often lack decision-making power in their households, preventing them from accessing life-saving interventions like insecticide-treated nets or seeking timely healthcare. Cultural norms can dictate who uses a bed net or who receives care first, often leaving women and girls at greater risk.

Malaria is a leading cause of death amongst adolescent girls in malaria-endemic countries. Many are forced to leave school to care for sick family members or themselves, disrupting their education and increasing their vulnerability to early marriage or exploitation. Without targeted interventions, these gendered gaps will continue to undermine global malaria eradication efforts.

Climate change is catalysing inequality and disease

Number of internally displaced people by endemic malaria region. Women and children face higher vulnerability during conflicts, natural disasters, and humanitarian crises. / World Malaria Report 2024

The accelerating effects of climate change are making the fight against malaria even harder.

Rising temperatures and shifting rainfall patterns are expanding the habitats of malaria-transmitting mosquitoes, bringing the disease to new regions and intensifying its prevalence in existing hotspots. These environmental changes disproportionately harm women, who already face barriers to health information and services.

Pregnant women are particularly vulnerable. In 2023, in 33 moderate-to-high transmission countries in the WHO African Region, there were an estimated 36 million pregnancies, of which 12.4 million (34%) were infected with malaria.

Malaria during pregnancy exponentially increases risks to both mother and child, including anaemia, stunted growth, and severe illness. The consequences ripple across generations, perpetuating cycles of poor health and poverty.

A gendered approach to malaria elimination

Four-year-old Aitano Valentina of Guatemala City proudly holds her health booklet after receiving DPT and Polio vaccination. For the first time in history, the number of under-five deaths has fallen below 5 million.

To accelerate progress against malaria and address these inequities, we must adopt a gender-responsive strategy that empowers women and girls as agents of change. Investing in women has far-reaching benefits – not just for malaria elimination but for broader health, economic, and societal outcomes.

When women are empowered with resources, time and decision-making agency, malaria outcomes improve. Research shows that households where women have greater bargaining power are 16 times more likely to use mosquito nets effectively, reducing malaria transmission.

It is equally important to address the structural barriers limiting women’s participation in the health workforce. Only 25% of women in the global health sector hold senior roles, despite making up 70% of the workforce. Providing pathways for professional advancement and fair compensation is essential to sustaining their contributions and ensuring a resilient healthcare system.

Change won’t happen by itself

WHO-recommended malaria vaccines are in the process of being rolled out across Africa, with over 10 million doses delivered in the first year of routine immunisation programmes in 2024.

Addressing the impact of malaria on women and girls can contribute to both malaria eradication efforts and gender equality progress. Action is overdue.

But if we commit now to putting economic resources in the hands of women, challenging gender norms, power imbalances and discriminatory laws, we can achieve a double dividend.

This should see us increase women’s economic ability to take charge of their health, the representation of women in leadership roles within malaria programs, research, and policymaking, ensuring interventions reflect the realities faced by women and girls.

Fair wages, adequate training, and professional development opportunities for female health workers are equally critical to building a robust and sustainable health workforce.

Malaria interventions must also account for gender dynamics, ensuring equitable access to tools such as insecticide-treated nets and addressing the unique barriers faced by pregnant women and adolescent girls. Closing the gender data gaps is another essential step to enable a deeper understanding of malaria’s full impact on women and girls, and to facilitate more effective and targeted solutions.

The fight against malaria is at a crossroads. With intentional investment in gender-focused strategies, we can eliminate this disease within a generation while empowering women and girls to lead healthier, more prosperous lives.

The World Malaria Report 2024 leaves no room for doubt; achieving this vision will require bold leadership, innovative solutions, and an unwavering commitment to leaving no one behind.

By placing women and girls at the centre of the malaria response, we can create a ripple effect of positive change that extends far beyond health, building stronger, more equitable communities worldwide.

About the authors

Dr. Jemimah Njuki is the Chief of Economic Empowerment at UN Women.

Lizz Ntonjira is the co-chair of the Zero Malaria Campaign Coalition & Author, #YouthCan. 

Image Credits: WHO, UNICEF 2024 , WHO.

Dr Monika Kosinka, WHO lead on the economic and commercial determinants of health.

KUALA LUMPUR, Malaysia – The healthcare sector in India produced 32 billionaires in 2022 – more than any other sector in an extraordinary demonstration of corporatisation, according to Abhay Shukla, co-convenor of Jan Swasthya Abhinyan, the People’s Health Movement in India.

Massive investment in healthcare by private companies since the 1990s, particularly in “corporate, profit-driven hospitals”, has sent non-essential procedures and treatments skyrocketing. 

For example, 48% of births in private hospitals are now Caesarian sections, in comparison to 14% in public health in India, said Shukla. The World Health Organization (WHO) recommends a rate of 10-15%.

“Two out of three Caesareans taking place in India are medically unnecessary. This is huge. We’re talking about hundreds of millions of women,” said Shukla, addressing a symposium on the growing influence of powerful private actors (PPAs) on global health, convened by the United Nations University International Institute for Global Health (UNU-IIGH) and Third World Network in Kuala Lumpur.

Unnecessary thrombolysis for stroke patients, additional cancer treatments and getting higher-paid consultants to perform basic procedures that could be done by frontline ER physicians to enable higher billing, are other examples of what the corporatisation of health has done to Indian healthcare.

Private equity and venture capital (PEVC) investment in Indian healthcare (as a percentage of PEVC total investment in India) doubled from 5% during 2017-2019 (pre-Covid years) to almost 10% during 2020-2023, with a record 18% in 2023.

Initially focused on pharmaceutical investment, investment in healthcare services has boomed since 2006, when the government made it easier for foreign direct investment in Indian companies. Healthcare investment boomed during COVID-19, rising to $413 million in 2021 (vs $160 million in 2019/20).

Private equity and venture capital (PEVC) investment in India’s health sector.

“The treating doctors are like spare parts in a big machine. They can be replaced at will by the corporate management. If they fulfil targets and if they are generating profits, they stay. If they are not generating profits, they go,” said Shukla.

Deaths driven by four industries

While India provides a jarring example of how corporate interests are subverting health services, the negative impact of a range of industries on health is better known.

One-third of global mortality is caused by four industries: tobacco, fossil fuel (air pollution) alcohol, and big food, said Dr Monika Kosinka, WHO lead on the economic and commercial determinants of health.

“For the region that we are in, the Western Pacific, the figure goes up to 48% mortality  attributable to these four interests,” she added.

“While businesses and private markets play a key role in producing and supplying the goods and services we consume every day, powerful corporations with commercial interests have also played a key role in driving consumption of health-harming products, blocking regulations to protect health or the environment and aggravating health inequalities between and within countries,” said Kosinka.

WHO Malaysia Representative Dr Rabi Abeyasinghe added that many corporate interests wanted the WHO to focus narrowly on medical concerns rather than taking a holistic view of health.

“They want us to be the World Medical Organization not the World Health Organization,” said Abeyasinghe.

Concentrated power and health

Prof Sharon Friel of the Australian National University mapping the influence of the fossil fuel industry.

“Looking at powerful private actors in global health governance and accountability is both important and necessary,” stressed conference co-convenor Dr David McCoy of UNU-IIGH. 

“Many people working in global health will perhaps find it odd that we’re looking at powerful private actors and accountability. They’re more used to having conferences that talk about HIV or universal health coverage, or global health financing. 

“But what you’ll be hearing throughout this symposium is the evidence that demonstrates the link between concentrated power and wealth and its impacts on health and health governance,” stressed McCoy 

“Whether it’s about the unethical and deceitful marketing of commercial milk formula or challenging the abuse of intellectual property rights to keep essential medicines out of the reach of millions of people with HIV, or the truth around the causal relationship between fossil fuels and global warming, there is a long history of public health having to engage with the politics of the world,” said McCoy.

The growing influence of private actors, including big philanthropy, on the UN and its organisations was also raised.

Barbara Adams pointed to how the increase in voluntary contributions by countries and donors, rather than member states’ assessed contributions, has slanted financial allocations to earmarked issues rather than core funding.

UNU-IIGH director Dr Revati Phalkey emphasized the urgency of the situation: “This symposium comes at a critical juncture. While painful budget cuts are being made to the WHO and many vital health programmes, private entities with commercial interests appear to be gaining more influence in the health sector. This raises urgent questions about accountability.”

‘Tax the rich’

Oxfam mapping of the increase in billionaires’ wealth.

“The extreme concentration of wealth in the hands of so few in today’s global economy is itself an existential threat to good global health governance,” said Oxfam’s Anna Marriott.

She pointed out that taxing the ultra-wealthy appropriately would provide enough money to address global health and poverty needs.

“In 2022, the 10 richest men in the world doubled their fortunes during the pandemic while the incomes of 99% of humanity fell,” said Marriott.

“In 2023, the richest 1% grabbed nearly twice as much new wealth as rest of the world put together, while poverty increased for the first time in 25 years,” she said. This year, billionaire wealth has “surged three times faster in 2024”.

“This much wealth and power in the hands of so few is intolerable,” Marriott stressed, urging participants to support “global movements’ and multilateral efforts from the global South to tax extreme wealth to raise urgently needed revenue for health”.

The symposium concluded with a powerful call for accountability in the system of global health governance, demanding that systems be established to prioritise public interest and hold powerful private actors responsible for their impact on health. 

Suggestions include greater transparency, stronger regulatory frameworks, more monitoring of private actors and greater collaboration between governments, civil society, and international organisations. 

Petroleum-based dyes will be removed from popular cereals, drinks and other foods, the US Department of Health and Human Services has announced.

The US Health and Human Services has reversed course on an earlier decision to slash funding to the widely acclaimed Women’s Health Initiative, supported by the National Institutes of Health. An HHS spokesman Thursday said that the Trump Administration would restore the support to the widely-acclaimed initiative, which has been responsible for a range of landmark studies on women’s health in its 24 years of activity, including findings in 2002 that hormone replacement therapy is associated with a higher risk of breast cancer.   

“These studies represent critical contributions to our better understanding of women’s health,” said Andrew Nixon, a spokesman for the Department of Health and Human Services, in a media statement.

The news came in another tumultuous week of Trump Administration executive orders and decisions affecting the nation’s health research endeavors including: new guidelines banning NIH grants to research institutions with diversity and equity policies as well as a historic agreement with the food industry to remove synthetic, petroleum-based dyes from the U.S. food supply by the end of 2026.

Agreement to phase out artificial dyes framed as “voluntary”

The agreement on food dyes, announced Tuesday by the Department of Health and Human Services is the first significant move by new HHS Secretary, Robert F. Kennedy Jr. to address an epidemic of obesity and chronic diseases in his “Make America Healthy Again” (MAHA) movement. 

During an HHS press conference, new US Food and Drug Administration (FDA) Commissioner Marty Makary said that HHS had reached an agreement with major food producers to remove about eight petroleum-based dyes voluntarily, saying, “I believe in love, and let’s start in a friendly way and see if we can do this without any statutory or regulatory changes.” 

However an HHS press release later said that the FDA would be “establishing a national standard and timeline” for the food industry to transition from petroleum to natural dye alternatives. 

It also stated that it would be “initiating the process to revoke [FDA] authorization for two synthetic food colorings—Citrus Red No. 2 and Orange B—within the coming months,”  while “working with industry to eliminate six remaining synthetic dyes, FD&C Green No. 3, FD&C Red No. 40, FD&C Yellow No. 5, FD&C Yellow No. 6, FD&C Blue No. 1, and FD&C Blue No. 2—from the food supply by the end of next year.

HHS also is asking food companies to remove FD&C Red No. 3, a recognized carcinogen, sooner than the 2027-2028 deadline previously set by the government.

Dyes are familiar to consumers in  Froot Loops ®  and other brand name foods 

Tumeric is one example of a plant-based food dye with anti-inflammatory properties – although it can also have blood-thinning effects.
Mars M&Ms®

Artificial dyes are used in brand name foods like M&Ms® chocolate, Kellog’s Froot Loops ® breakfast cereal, and Gatorade ® drinks. 

The HHS said that it would be authorizing four new natural color additives in the coming weeks, while also accelerating the review and approval of other natural dye alternatives, to expedite the transition. 

And it said that it would be partnering with the National Institutes of Health (NIH) to conduct more comprehensive research on how food additives impact children’s health and development.

“For too long, some food producers have been feeding Americans petroleum-based chemicals without their knowledge or consent,” said Kennedy, in the HHS announcement.  “These poisonous compounds offer no nutritional benefit and pose real, measurable dangers to our children’s health and development. That era is coming to an end. We’re restoring gold-standard science, applying common sense, and beginning to earn back the public’s trust. And we’re doing it by working with industry to get these toxic dyes out of the foods our families eat every day.”

“We have a new epidemic of childhood diabetes, obesity, depression, and ADHD,” added Makary. “ADHD is not a genetic problem and our obesity epidemic is not a willpower problem, it’s something adults have done to children,” he said. 

Prior research has found links between childrens’ consumption of synthetic food dyes and behavioral problems, as well as links between some dyes and cancer in animals. In 2023, California became the first state in the US to ban four leading food additives, including carcinogenic red dye No.3.

Food experts said that the HHS ruling on food dyes was a positive step but doesn’t go far enough: 

“This is certainly a good thing for consumers and public health but it doesn’t address the underlying problem, which is the FDA’s system for regulating food chemicals is broken,”  Thomas Galligan, a food additives scientist at the Center for Science in the Public Interest, told STAT News. “What we’d like to see the MAHA shift toward is addressing these systems-level failures.”

Women’s health initiative funding cuts left legacy research in jeopardy  

The initial announcement of the plans to dramatically reduce NIH funding for the Women’s Health Initiative (WHI) was made on Monday, included a notice defunding 40 WHI regional centers as of September. The regional centers have been critical to the long-term research by WHI that has followed cohorts of women through decades.

However, on Thursday, HHS said that NIH had exceeded the Trump administration target for a 35% reduction in contract spending by federal agencies, and therefore WHI’s support to the regional centers as well as its headquarters at the Fred Hutchinson Center Center would continue at current levels.

“We are now working to fully restore funding to these essential research efforts,” said HHS spokesperson Nixon.

WHI logo

Since 1991, WHI has studied more than 161,000 women, following the health of thousands for years or even decades. Along with its findings on HRT and breast cancer, the WHI has  also found that calcium supplements don’t prevent fractures and low-fat diets don’t prevent breast or colorectal cancer.

“We are thrilled to learn about this news,” Jean Wactawski-Wende, told National Public Radio, after hearing about the reversal.  She leads one of the project’s regional centers that were slated to lose their funding.

Slashing the support would have affected older women, in particular, WHI said, noting that they are “one of the fastest-growing segments of our population.”  

NIH bans grants to research institutions with DEI policies 

The NIH funding cuts coincide with new guidelines banning the award of future NIH grants to researchers or research institutions that practice “diversity, equity and inclusion” (DEI) policies.  Institutions or grant recipients that have policies of diversity, equity, inclusion and accessibility (DEIA) would also be barred from new grants and would face termination of existing grants, stated the new NIH directive, issued on Monday, 21 April.     

Researchers at institutions that boycott Israeli companies would also be barred from applying for grants, or obtaining grant extensions, the NIH directive issued on Monday stated. 

While the directive is targeted to “domestic institutions” academic centers abroad, and most notably in South Africa, have also reported on the termination of certain NIH grants – because they practice DEI policies, or address LGBTQ+ populations or other vulnerable groups.    

Health research in South Africa is facing an unprecedented crisis due to the termination of funding from the United States government,” reported the South Africa Medical Research Council, in mid-April. “Though exact figures are hard to pin down, indications are that more than half of the country’s research funding has in recent years been coming from the US.”

Confusion about new rules 

The new, nationwide NIH rules on grant awards also follow a series of recent Trump administration moves targeting half a dozen elite universities with freezes of billions of dollars in federal grants, including research support to dozens of vital health research initiatives. 

I saw firsthand the impact of stop-work-orders/terminations at USAID & now Harvard. My new @NewYorker piece is on the serious implications for the lives of millions across the world and the US – including for my own family and very possibly your own. 🧵
www.newyorker.com/news/the-led…

[image or embed]

— Atul Gawande (@agawande.bsky.social) April 22, 2025 at 5:01 PM

NIH had already been instructed to suspend awards to those elite schools that have had other federal funds frozen by the Trump administration, due to alleged anti-semitism on campus or their DEI policies, STAT news reported on 18 April, citing an internal email that originated with HHS. 

The schools named in the email were Columbia, Harvard, Brown, Northwestern, Cornell, and its affiliated medical school, Cornell-Weill Medicine. 

The evolving government, NIH and US Centers for Disease Control rules regarding DEI have been the focus of considerable confusion as US researchers have also reported problems with grant suspensions, payment delays and approval of manuscripts for publication due to their use of common terms like “female” or “sex” or references to “health equity” in their work. 

“I find it ironic that an administration that insists there are only two biological sexes seemingly wants us to pretend there are no differences between them,” observed John Quackenbush, chair of the Department of Biostatistics at Harvard’s T.H. Chan School of Public Health, in a STAT news op-ed about how a series of recent research proposals he had initiated to study the relationships between sex and aging have been caught in a web of NIH dead-ends and delays.

Updated Friday, 25 April 2025 with news of the HHS reversal of its decision to slash funds to the Women’s  Health Initiative. 

Image Credits: Flickr/ShellyS, arthritiswa.org.au, wikipedia/Mars, WHI.

Dr Tedros Adhanom Ghebreyesus on 10 April – facing tough budget cuts.

A new, and near final iteration of WHO’s reorganization will shrink its programme divisions even further than previous drafts – from 10 to only four – with health systems emerging as one key pillar of the revamped organization. 

At the same time, disease control departments and preventive health teams – such as health promotion and environment, climate and health, will all fall under one division – for the first time in years, according to a copy of the plan, obtained by Health Policy Watch.   This is in contrast to a previous “straw draft” that that had etched out five divisions, including health systems and health workforce rolled into a division with environment and health promotion. 

New WHO Organizational plan reduces the existing 10 divisions at headquarters to just four.

And along with the four mainstream divisions – the office of the Chief Scientist and “Chef de Cabinet, i.e. external relations,” would be retained as separate entities. 

The new plan for WHO’s headquarters, which boasts 34 departments as compared to nearly 60 now, was presented by WHO Director General Dr Tedros Adhanom Ghebreyesus to both WHO staff as well as to WHO member states at separate, closed sessions on Tuesday. 

Key takeaways from the latest plan include the combining of HIV and TB operations – two political powerhouses with deeply interlinked patterns of prevention, diagnosis and treatment that could generate co-benefits from a merger. There’s also the apparent disappearance of the health and migration department, which had been preserved in earlier iterations, under the now-extinct division of Healthier populations. Antimicrobial resistance (AMR), previously paired with One Health as a department in Healthier Populations, is now in Health Systems, on its own. One Health is relegated to yet another team or unit in the Department of Environment, Urban Health and Climate Change.  Critics will find that the decision to treat AMR strictly as a health sector issue ignores mounting evidence about the deep interlinkage between AMR prevention, One Health and environment – including the urgent need to address animal health – particularly the livestock sector – which consume the lion’s share of the world’s antibiotics.  

No projection about numbers of staff to remain in Geneva

Tedros made no projections as to how deeply WHO’s staff at headquarters, now numbering 2,600 people, would have to be slashed – although observers have said it could be by more than 40% in light of the fact that WHO’s Geneva-based operations also have the highest costs and the deepest deficit.

The new plan also does not relate explicitly to the possibility, discussed previously, of relocating some headquarters departments or teams wholesale to a WHO regional office. Polio eradication, however, remains a separate department under the Office of the Director General, leaving relocation as a possibility, at least in theory. And WHO’s head of Business Operations, Raul Thomas, also affirmed at the Town Hall meeting that regional relocation remains a possibility – even if the functions remain under a headquarters-based division. 

WHO staff salary gaps by region, as portrayed in slides circulated to WHO directors in mid-April.

“There is a committee that is looking into what programmes can be relocated, how we can make synergies across the organization, relocating a programme from x, to y, on the …basis that programme continues to be a headquarters progamme, it does not become regional, and what kinds of synergies regions can make in terms of technical support – and how regions can capitalize on the fact that they have that support closer to the countries, and with reduced travel costs, ” Thomas said. 

Globally, WHO faces a looming $600 million budget shortfall for 2025 and a $1.9 billion budget gap for the 2026-2027 biennium budget of $4.2 billion – following January’s announcement by US President Donald Trump that he intends to withdraw from the global health agency.  Although that withdrawal would not formally take effect until January 2026,  the United States has so failed to pay its dues for 2024, even before January’s change in administration, and is unlikely to do so now, WHO officials have conceded.  

Opportunity from crisis

Despite the stark shortfall, Tedros sought to put a more optimistic light on the crisis, noting that by 2030-31, member state assessed contributions to WHO would nearly double, from $895 million in 2024-25 to $1.7 billion in 2030-31 – even without the United States’ participation.   

“The refusal of the U.S. to pay its assessed contributions for 2024 and 2025, combined with reductions in official development assistance by some other countries, means we are facing a salary gap for the 2026–27 biennium of between US$ 560 and US$ 650 million,” Tedros said, addressing member states just after the staff Town Hall. 

“This is the reality we are facing, and which is driving the prioritization and realignment, the new structure, and the reduction in our workforce – although when we do this, we see it as an opportunity to change the organization. However, we need to realize that this reality would have been much worse if Member States had not agreed to increase assessed contributions progressively to 50% of our budget – and we thank you for that historic commitment.”

That’s providing that WHO member states continue to honour that commitment to gradually raise the level of member state assessments, as per a WHA decision reached in 2023.  At the upcoming World Health Assembly, May 19-27, WHA members will be asked to approve yet another stepwise increase in assessed contributions.  

Another report to go before this year’s WHA shows member states in arrears by more than $215 million on their payment of 2024 assessed contributions – of which the United States’ portion comprises only about one quarter, or $58 million.  Member states voting rights can be temporarily suspended, if payments aren’t made.

Contributions in arrears, as reported to the World Health Assembly, which convenes from 19-27 May in Geneva.

Along with that WHO remains heavily reliant on voluntary contributions, which amounted to some $2.5 billion in 2024, including $446 million in donations from the United States.

New senior leadership team by end April, directors in May

Timeline for WHO reorganization, including staff reductions and reassignments.

As next steps, the new division heads at Headquarters would likely be named by the end of April, Nicollier said. 

That would be followed by the appointment of directors of the surviving departments at headquarters and at Regional Offices over the course of May, in line with Division head recommendations and an Ad Hoc Review Committee.  Directors not retained at headquarters or in Regions would be offered reassignment elsewhere. 

In March, Health Policy Watch published an investigation of WHO’s dramatic expansion of high-level directors (D2) positions between 2017, when Tedros first took office and 2024, estimating that their costs amount to nearly $100  million annually, worldwide.  However, directors at headquarters whose posts are cancelled will have to be offered jobs found elsewhere, if they are on long-term contracts, as most are.  See related story.

EXCLUSIVE: Number of WHO Senior Directors Nearly Doubled since 2017, Costs Approach $100 million

Drilling down further over the course of June and July, detailed department organizational charts for each department would be developed – with a “matching and mapping” exercise to choose staff for the positions that remain. 

For rank and file staff, as well, Nicollier pledged to honor existing contract terms – which mean that staff on long-term (continuing) contracts or fixed-term contracts for more than 10 years would be offered reassignment and relocation options if their current post is abolished.  He also pledged to involve the WHO staff and its Staff Association in the next stages of the “matching and mapping” exercise. 

Senior Leadership – competency versus political balance? 

WHO Director General Dr Tedros Adhanom Ghebreyesus’ Senior Leadership Team will shrink from 11 to 6 members, not including the DG.

The new reorganisation, while seemingly radical, would in fact bring the agency’s core functions back to a template similar to the one that was left by WHO’s previous Director General Dr Margaret Chan, when she finished her 10-year tenure as head of the agency in July 2017.

But with senior leadership at headquarters being reduced from 11 to just six officials, not including the Director General, the next big question looming in the minds of WHO staff, member states and observers is who will remain? 

“There is no problem in merging and going back to a simpler organizational map, like at the time of [former WHO Director]  Margaret Chan. It’s a critical time, putting together prevention, control and response is not a problem,” said a WHO senior scientist, who spoke with Health Policy Watch on condition of anonymity.  “The problem is that we still don’t really know yet what functions or teams (out of nearly 60) will be prioritized or deprioritized.” 

“And now more than ever, with just seven senior staff, including the DG, Chief Scientist, Chief of Cabinet, and four Division heads, and in a time of crisis, we need to make sure that this new WHO leadership has the reputation and clout to represent WHO.   

“But because Tedros needs to go for a balanced team in terms of gender, geographical representation, etc, I’m afraid that the selection could wind up being one that doesn’t represent the organization as well – simply because some members of his existing team are  not perceived as strong leaders.”

WHO staff are also asking questions about why the Organization wasn’t able to anticipate the crisis earlier – given the fact that US President Donald Trump’s election occurred in November 2024 – and his hostility to WHO was a known factor even before the decision in January to withdraw. 

“There are many other questions about why we reached this point, without an earlier analysis of the situation.  What are the lessons that we need to learn?” said one staff member.  

“It’s been four months, and now what we have is just an organigram.” 

-Updated Wednesday, 23 April with the published text of the WHO Director General’s remarks to member states.

Image Credits: Salvatore di Nolfi/EPA, WHO, WHO , WHA78/A78_23, WHO .

A WHO field staffer talks to a woman fetching water in the Pacific Island nation of Kiribati. Can WHO’s pending reorganization and the deep budget cuts faced at headquarters actually strengthen staff presence on the ground?

The US-based Boston Consulting Group has been working with WHO’s senior leadership, under contract, to develop the major reorganization and cost-saving plan, now pending final presentation to staff and member states next week, Health Policy Watch has learned. 

Members  of the Staff Association Committee confirmed to WHO staff members on Thursday, that BCG has been involved in the strategic planning for dramatic cutbacks in the agency’s workforce. The cutbacks come on the heels of recent revelations of a $2.5 billion WHO budget gap between 2025-2027, including a $600 million shortfall in 2025, following the announced withdrawal of WHO’s largest donor, the United States, in January.     

The Staff Committee members were speaking at a Staff Association Open House, excerpts of which Health Policy Watch later heard.  

The Staff Association representatives did not confirm the amount of the BCG contract – although other informed sources suggested it was several million dollars, or more.  Asked to comment, a WHO spokesperson said, “What Staff Association President Corsini said is correct regarding earmarked funds for support to the restructuring.” 

Monies for private consultancy were earmarked 

The consultancy’s costs are being covered by a dedicated grant from the Bill and Melinda Gates Foundation, Staff Association leaders said, quoting WHO Human Resources officials, at the Open House.  

“These are voluntary and earmarked funding from Bill and Melinda Gates to HRT [WHO Human Resources and Talent Management] for restructuring,” asserted WHO Staff Association President Catherine Kirorei Corsini. 

“And this because it’s voluntary and earmarked, it cannot be used for anything else. And what they are doing now is a request of member states.  

She said WHO HR officials also assured the Staff Association “that a due process was followed. There was bidding…. There was a committee that sat down to review, because they were also questions of, how was this done? So they assured us that the usual detailed process of hiring someone on an LTA [long term consultancy agreement] was followed.”

Even so, some WHO staff have expressed dismay with the fact that large consultancy grants are being awarded to expensive private firms at a time of budget crisis. It was the expansive plans laid by outside consultancy firms during WHO’s 2019 “Transformation” that set the stage for the present crisis, noted one staff member, in a comment at the Open House.

“Why?… I do not have an answer, but the thing that we can say is that, again, this is not going to be a matter of core funds of WHO that could be used for staff being sent elsewhere,” Corsini answered.

Other staff were not so sure. 

“Why do we need a consulting firm?” one staff member asked, speaking anonymously to Health Policy Watch, noting that within the WHO’s 9473-strong global staff, including nearly 4000 professionals, there should be sufficient expertise to carry forward a reorganization plan.

“If you spend $6 million on a big consulting firm, then you have to let 20 people or more go. The money is spent in a matter of weeks, not in a whole year,” the staff member pointed out. 

Final version of proposal for top-level reorganization due to be presented next week 

WHO Organization as of January 2025 boasted 10 divisions, and nearly 60 departments

A final draft of the top-level reorganization is due to be presented by WHO’s Senior Leadership to Staff in a Town Hall on Tuesday. Presentation of the proposed draft to member states was also reportedly delayed until next week, due to the long Easter weekend that begins Friday in Geneva, sources told Health Policy Watch.  

According to the two options on the table last week, the number of departments at Headquarters would be reduced by nearly half, from nearly 60 as of January to about 32. That would presumably also reduce the number of high-cost directors, who numbered nearly 80 at headquarters as of July 2024 – more than the departments they are supposed to lead.  Some headquarter functions would also be moved to lower-cost regional offices or other European cities where WHO also has a presence.  See related Health Policy Watch Story here:

EXCLUSIVE: WHO Poised to Halve Divisions and Directors at Geneva Headquarters in Response to Budget Emergency 

There were, however, reports that WHO Director General Dr Tedros Adhanom Ghebreyesus had this week presented his own plan to senior management – with significant variations in the existing drafts now circulating.

The final result, therefore, risks boosting the number of departments and directors upwards again – due to intense pressures from senior managers, some sources feared.   

The explosion in directors’ positions was the focus of a 10 March Health Policy Watch investigation – which found that the number of directors, in the most senior, D2 grade, had nearly doubled since 2017.  

Taken together, the cost of D1 and D2 directors, along with five regional directors and a 12-member “senior leadership team” at WHO’s Headquarters cost the organization about $92 million annually, the Health Policy Watch analysis found, basing its estimates on published WHO salary and salary-to-total cost scales. 

Already senior leadership is offering some of the directors facing cuts a relatively high-paying parachute – jobs as the WHO reprsentative in a country office.  An email sent by HRT to senior management this week sought to “draw attention to the career opportunities available at the country level, specifically for WHO Representative (WR) positions.”

The message cited opportunities in over two dozen WHO offices in Africa, the Middle East, Europe, Asia and the Caribbean – including Senegal and Nigeria; Bulgaria and Slovenia; Egypt and Palestine.  Although some of the posts on offer, such as in the violence-wracked Democratic Republic of Congo and the Demoratic People’s Republic of Korea (North Korea), could hardly be said to be plum positions.

Transparency, management structures, prioritizing internal staff talent 

WHO staff salary gaps by region, as portrayed in slides circulated to WHO directors this week.

Speaking at the Staff Association Town Hall, SA leadership sought to reassure staff that Association representatives were now  being engaged in some aspects of the Administration’s restructure planning – after initially being left largely in the dark. 

“Feedback has come through loud and clear from staff,” said Jerome Zanga Foe, a Staff Association vice president, who called for “involvement for the Staff Association and staff at the division and at the department level and at also the highest level in the organization –  not just updates after decisions are being made.

“The Staff Association was not brought into the initial prioritization meetings,” he acknowledged. “But at the same time, we have now been included in several key committees, and the DG has committed to another town hall, which we’re going to be having next week. We hope engagement will be more of a two-way engagement… early and transparent and structural.”

Cautious optimism on a slimmer management structure  

One of two options for the WHO’s reorganization, considered at the WHO senior executive meeting on Saturday.

Foe also expressed cautious optimism over the slimmed-down management structure reflected in the draft organigrams circulating over the past two weeks, saying: 

“The message was clear that any credible…effort needs to look at leadership structures too, and we have seen some movement there. The updated organigrams show a smaller senior structure, and the management confirmed that post abolition and reassignment rules apply equally to ADGs and directors. It’s a positive step.” 

Finally, he said that the Staff Association would press the WHO administration to “prioritize internal talent” in the process of cutbacks and reorganization – before turning to external hires or consultants.

“Management is developing a talent pool to help match affected staff with future roles,” he said. “We see that as an encouraging step, but how this works in practice is what will really matter, and we promise to follow up on that. We are continuing to advocate that wherever possible, roles currently held by consultants or left vacant should be made available to staff at risk.”

Consultants’ shouldn’t replace staff who are cut 

Sources: Tables 1 and 20 – July 2017 and July 2024 WHO HR Update – Workforce Data.

At the same time, other Staff Association leaders stressed that consultants also play a legitimate role in the organization: 

“There’s been a degree of consultant bashing, but consultants do have a proper role in the organization, and if anything, we would like to see some of these consultants be moving to staff positions,” said Anthony Fake, another Staff Association vice president. 

Holding any kind of staff post, per se, should not, de facto, guarantee first priority for a future job selection, said VP Lianne Gonsalves. 

“We want to see function and ideally performance factored in. … For this committee of staff members, current contract type, whether they be continuing fixed or temporary, is not a proxy for their respective performance in, or commitment to, this organization. 

At the same time, she reaffirmed that long-serving WHO staff should have first priority in global re-assignments, if their current functions are terminated. 

“What we will be doing is making sure that for continuing appointments and fixed term appointments [of 1-2 years] who have more than 10 years of continuous service with the organization, those folks are going to be entitled to global reassignment, and we will be part of that, making sure that those staff are looked over, looked after in that process.” 

Gonsalves added:   “I can assure you that we will be keeping a very close eye …that what we don’t see is a reduction in workforce, followed by an immediate outsourcing to have that same work completed by consultants.”

Since 2017 the number of WHO consultants has exploded, from an estimated 3200 full-time equivalent positions to approximately 7600 in July 2024 – approaching the number of regular WHO staff. 

Notes: Includes FTEs for APWs and Consultants; Assumes each SSA is a FTE because no other equivalent is provided in the HR reports.

At the Open House, Staff Association leaders also denied reports that they were considering a preemptive legal action against WHO to contest any potential violation of staff contract terms in advance – describing it as not feasible. 

“I don’t think you can file preemptive lawsuits,”  Gonsalves said. “So that’s not something that we are doing.”

Image Credits: WHO / Yoshi Shimizu, WHO, 2025, WHO .

Dr Jean Kaseya, Director General of Africa CDC.

New weekly cases of mpox across Africa have dropped to around 2,000 for the first time this year giving hope that the outbreak may be waning, according to Dr Jean Kaseya, Director-General of Africa Centres for Disease Control and Prevention (Africa CDC).

In the mpox epicentre of the Democratic Republic of Congo (DRC), new cases dropped to 1,453 – the first time this year that this has been below 2,000 – despite an increase in testing. 

Mpox in DRC, 17 April 2025

There has also been a decrease in confirmed cases in the DRC and a significant increase in contact tracing.

Mpox in health workers – a priority in the continental vaccination efforts – has almost halved since November when over 100 health workers were infected.

Seven countries are currently vaccinating against mpox, with over 595,000 people vaccinated so far.

However, mpox cases in Uganda continue to rise, with 271 cases confirmed over 247 the previous week.

China, Switzerland and the UK have all reported mpox cases in the past few weeks.

“I’m calling the emergency consultative group meeting on the 17 May. Our experts will analyse all data and all evidence, and they will tell us if we still need to continue with the public health emergency of continental security (PHECS) for mpox,” said Kaseya.

One human case of anthrax

One person has been identified with anthrax in Uganda. 

Meanwhile, in the eastern DRC – a hotspot for various disease outbreaks – anthrax has only been identified in animals, including hippos in Virunga Park in north Kivu.

Around 50 hippos as well as buffalo have died from the disease in the park, according to earlier reports from the park’s director, Emmanuel De Merode.

However, recent animal deaths in South Sudan and Uganda indicate the disease may have spread across the borders.

“We don’t have any evidence today that humans are affected, but will continue to follow what’s happening,” said Kaseya.

Anthrax is caused by bacteria in soil and animals can become infected when they inhale the spores in soil, plants or water.

Health financing

Over the past two weeks, Kaseya has been traveling internationally to try to drum up more funding for health on the continent to fill the huge hole left by departing aid – particularly from the United States.

The continent has lost 70% of its official development aid since 2023, down from $81 billion to $25 billion this year – and some countries are on the brink of running out of essential medicines including antiretroviral medicine to treat HIV.

“There are reports of people migrating to other countries just to get ARVs,” Kaseya disclosed.

He has met the CEO of Ethiopian Airlines Mesfin Tasew to explore the possibility of a levy on airline tickets that could be used for health programmes.

In addition, a meeting with the government of the United Arab Emirates (UAE) is likely to result in investment in local manufacturing, and the digital agenda, supply chain management and the health work force, Kaseya said.

“Emirates is one of the countries making huge progress in the health system by using AI, and we are moving toward a strong programme with this country for Africa,” he added, saying that details of this collaboration would be announced soon.