Chhattisgarh health workers on strike

CHHATTISGARH, India — Nearly 16,000 staff employed under India’s National Health Mission (NHM) have been on an indefinite strike since 8 August. In early September, the dispute escalated dramatically when the state government dismissed 25 union leaders, prompting the mass resignation of  more than 14,000 health workers.

The mass resignations have raised alarm about the stability of healthcare in Chhattisgarh, a heavily forested, predominantly rural state that is home to 32 million people.

While clinics and outreach programs are still functioning in some areas, experts warn that if the strike persists, immunisation, maternal health services, and disease control programs could face severe disruption, leaving patients in remote tribal districts without access to even the most basic care.

“We were called COVID warriors during the pandemic. We reached villages no one else could,” said a health worker from Raipur, speaking on condition of anonymity. “But what are we getting in return?”

At the centre of the standoff are demands for permanent contracts, pay parity with regular staff, and improved benefits. Union leaders say the dispute in Chhattisgarh is not an isolated battle, but a symptom of deeper structural problems in India’s health system – problems that resonate globally.

Demands behind the strike

Health workers under NHM, the country’s flagship public health program launched in 2005, are technically “contractual staff.”  They receive lower pay, fewer benefits, and no job security compared to state-employed counterparts, despite often performing identical roles.

“We have 10 demands, and our top priority is regularisation or at least grade pay equal to permanent health workers,” said Hemant Kumar Sinha, leader of the trade union, Chhattisgarh Pradesh NHM Karamchari Sangh, in an interview with The Indian Express.

Other demands include the creation of a dedicated public health cadre, annual performance evaluations, a 27% salary hike, cashless medical insurance worth at least one million rupees (around $12,000), and expanded leave and medical benefits. 

In mid-August, the executive body of the State Health Committee accepted four of the 10 demands raised by contractual NHM employees, but trade union leaders insist that all their demands must be accepted and implemented.

Chhattisgarh health workers say they deliver services in hard-to-reach villages that permanent workers do not service, yet have no job security or pay parity.

Precarious national workforce

The unrest in Chhattisgarh highlights a paradox: India has rapidly expanded its health workforce in recent years, but much of this growth rests on insecure contracts.

Between 2021 and 2024, more than 1.2 million professionals – including medical officers, specialists, nurses and public health managers – have been inducted nationwide under NHM, according to official data. 

The number of community health officers alone rose from 90,740 in 2021–22 financial year to more than 138,000 by 2023–24.

“Yet we continue to work without security or parity,” Sinha said. “Our services are treated as dispensable, even though the system cannot function without us.”

Similar grievances have flared across India. Earlier this year, NHM staff in Maharashtra staged protests after going without pay for three months. Workers in Bihar, Uttar Pradesh and Madhya Pradesh have launched strikes over delayed wages in the last few years , lack of insurance coverage, and stalled promises of regularisation.

Health policy analysts warn that the over-reliance on contractual staff is not just a labour issue but a systemic risk.

“Primary health care in India is essentially running on precarious contracts,” Ankita Verma, a Delhi-based public health researcher told Health Policy Watch. “When those workers withdraw, the entire rural delivery chain collapses.”

The situation is particularly critical in Chhattisgarh, where tribal populations in remote forested areas depend almost entirely on NHM workers for services ranging from maternal health to malaria control. Prolonged disruptions, experts say, could roll back years of progress in child immunisation and communicable disease surveillance.

Chhattisgarh health workers are sticking to their 10 demands.

Global temporary worker crisis

The crisis in Chhattisgarh is not unique. Around the world, governments have leaned on temporary or flexible contracts to stretch health budgets and scale up ambitious programs, often with similar results.

In Kenya, nurses employed under the Universal Health Coverage (UHC) programme in coastal counties have staged repeated strikes over short-term contracts, unpaid allowances, and lack of permanent status. 

Workers in the Kenyan towns of Mombasa, Kilifi, Kwale, Lamu, Tana River, and Taita Taveta demanded conversion to permanent and pensionable terms, arguing that constant uncertainty undermines service delivery.

In Nigeria, doctors in public hospitals walked out in September 2025 over unpaid salaries, wage arrears, and insecure postings. The strikes disrupted services in Abuja and other cities, adding pressure to an already strained system.

Labour analysts say these parallel struggles expose a global fault line. “The pandemic briefly highlighted the indispensability of frontline health workers,” said a global labour rights advocate while talking to Health Policy Watch. “But once the emergency faded, many governments reverted to treating them as expendable.”

Health toll mounts

For now, the standoff shows little sign of resolution. Health workers say they will not return to work unless their demands are met, while the government has so far doubled down by dismissing union members.

But the human toll is mounting. If the condition persists in the districts, people  may have to walk miles to private clinics and pay for services. Pregnant women in rural areas have to be referred to distant hospitals, often beyond their means to reach.

The state, in the centre-east of India, has a tropical climate that is one of the most climate-vulnerable states, experiencing extreme weather events,  including floods, heatwaves and droughts, according to the India’s Ministry of Health and Social Welfare. 

“Chhattisgarh is a state with the highest mines and mineral-based industries and air pollution is one of the biggest threats to the health of the population,” according to the Ministry. Heavy metal contamination of the soil is also a problem.

Malaria and dengue are prevalent in the hilly north and south, while other zoonotic diseases are increasing due to climate change.

Health advocates warn that if the strike drags on, Chhattisgarh could see rising maternal and infant mortality rates, surges in preventable diseases, and widening inequities in care.

“This isn’t just about wages,” said Verma, the Delhi-based public health researcher Verma. “It’s about the sustainability of India’s healthcare model.”

Test case for India 

The crisis poses a test not just for Chhattisgarh but for India’s approach to public health delivery. Can the country sustain an expanding workforce without offering stability and parity? Or will repeated cycles of protest and disruption continue to erode public confidence?

Globally, the lessons from Chhattisgarh may be equally pressing. As governments grapple with growing health burdens, many have opted for contract-heavy models that prioritise flexibility and cost-saving. But the fragility of such systems becomes apparent the moment workers walk away.

For the health worker from Raipur, the issue is less abstract. “We don’t want to abandon our patients,” she said. “But if the government treats us as disposable, how long can we keep going?”

Image Credits: Chhattisgarh Pradesh NHM Karamchari Sangh.

A happy homeowner with her cleaner cooking stove.

NAIROBI, Kenya – The morning light filters into Alice Siamanta’s home in Nalepo on the outskirts of Nairobi. Her kitchen walls are clean, her pots shine, and free of soot. Her children are busy doing their homework, seated near her. 

The house is quiet. There is no coughing. Siamanta cooks on a stove purchased through her savings in a women’s savings group.

“I never believed cooking could be this easy,” she says, smiling while lifting a pot of simmering beans. “No more tears in my eyes, no black smoke.”

In a neighbouring tin-roofed home in Nalepo, 36-year-old Mary Nasieku used to crouch over a three-stone fire. Smoke curling around her, stinging her eyes as she fanned the flames beneath a pot of maize and beans. The acrid haze clung to her hair, her clothes, and her lungs. 

“My mother cooked like this, my grandmother too,” she said. “We never thought the smoke could kill us.”

Millions of Kenyans are still trapped in smoky kitchens where poverty and tradition keep families tied to firewood. But it comes at a cost: the hidden danger of household air pollution is a silent, daily assault on their health.

Deadly indoor pollution

Indoor air pollution is a global killer. ­It is one of the world’s least discussed but deadliest health risks. According to the World Health Organization (WHO), it causes 3.2 million premature deaths every year, mainly from pneumonia, chronic obstructive pulmonary disease (COPD), heart disease, and lung cancer. Some  3.2 million people die every year from exposure to household smoke, including over 237,000 children under five.

In Kenya, research based on the Global Burden of Disease (GBD) study estimates that around 23,000 people die annually from household air pollution, making it the eighth leading cause of premature death nationally.

This is more than outdoor air pollution. The youngest are most vulnerable: pneumonia remains the leading killer of children under five.

The culprit is familiar: household use of solid fuels such as wood, charcoal, dung, and crop residues, burned in open fires or inefficient stoves. 

A three-stone kitchen in Kenya

In Kenya, about 70% of households still cook with these fuels, according to World Bank data.

In rural and peri-urban communities like Kibiko and Nalepo, kitchens are often poorly ventilated. The smoke levels inside can reach 10 times higher than the WHO’s recommended safe limits for fine particulate matter (PM2.5). 

Kajiado County records respiratory diseases as among the top outpatient cases, according to Kenya’s Ministry of Health.. 

Kenya Medical Research Institute (KEMRI) scientists have linked prolonged smoke exposure to heightened risks of acute respiratory infections in children and chronic respiratory disease in adults. 

Wesley Mochama, a nurse at Oletepes Health Centre, sees the toll daily: “Children come in with persistent coughs and wheezing. Mothers suffer from headaches and burning eyes. Almost every time, the root cause is the same – smoky kitchens.”

Women and children worst affected

Indoor air pollution is not an equal-opportunity killer. Women and children bear the heaviest burden. Women like Nasieku spend long hours each day tending fires in kitchens that double as smoke chambers. 

Children, often strapped to their mothers’ backs or playing nearby, breathe in the same toxic air. Studies show children under five are at the highest risk of pneumonia from indoor smoke. The economic burden is also gendered. Women lose time collecting fuel, and families spend money on hospital visits that could have been prevented.  

The energy poverty trapping women in smoky kitchens also perpetuates cycles of poor health, missed school days for children, and lost productivity for families.

Smoke and soot from the three-stone cooking stove affect the health of residents.

Despite the risks, a slow transformation is underway in Nalepo and Kibiko.  A handful of households have shifted from three-stone fires to clean cooking stoves, a simple innovation that burns fuel more efficiently and produces far less smoke.

The difference is visible. Kitchens once blackened by soot now have clearer walls, mothers no longer cook with streaming eyes, and children cough less. Families are also saving money on firewood. Yet adoption remains stubbornly low.                       

The barriers are complex: affordability, durability concerns, and cultural habits. For stable foods like ugali and githeri, many believe only a three-stone fire achieves the right taste and consistency.

Solutions are within reach

According to the Ministry of Energy’s Bioenergy Strategy (2021–2027), only a small percentage of rural households have transitioned to modern cooking solutions. 

The government’s goal is to reach universal access to clean cooking by 2030, but progress is slow, hampered by cost, infrastructure gaps, and cultural resistance.

Kenya’s Ministry of Energy and Petroleum launched the National LPG Expansion Programme, known as the Mwananchi Gas Project, aiming to give free 6 kg gas cylinders and burners to low-income families, a bold recognition that clean cooking is both a health and energy imperative. 

Schools are also being transitioned from firewood to LPG, reducing deforestation and protecting health.

The government’s Last Mile Connectivity Project, backed by the African Development Bank, is delivering over 150,000 new rural electricity connections in 45 counties.

Within it, the Kenya Electric Cooking Market Development Initiative (KEMDI) aims to expand Electric Cooking from 49,000 to 500,000 users in three years, subsidising electric pressure cookers and induction stoves. 

Kenya Power is piloting 47,000 subsidised cookers in Kiambu, Machakos, and Kajiado — cutting household reliance on biomass.

Complementing this, the Green Entrepreneurship and Empowerment Program (GEEP) supports youth-led enterprises in clean energy, focusing on solar lights and improved cooking stoves.

Last-mile entrepreneurship

The Naserian Women Group’s last mile entrepreneurs promote cleaner stoves to their communities.

Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) Kenya is a central player in the country’s clean cooking transition, aligning its work with the Kenya National Cooking Transition Strategy (KNCTS), which targets universal access by 2028. Beyond simply distributing stoves, GIZ is strengthening the ecosystem needed to sustain long-term adoption.

“We are not only distributing stoves but building a clean cooking sector, strengthening supply chains, financing, and awareness. Clean cooking is about dignity, climate resilience, and creating jobs,” says Venice Makori of GIZ Kenya.

GIZ has also flagged last-mile entrepreneurship projects, training women and youth to become clean energy champions and distributors in their villages. These initiatives are supported by innovative financing tools, including results-based financing (RBF), carbon credit schemes, and partnerships with county governments.

“Last-mile entrepreneurs are the backbone of the clean cooking transition,” says Ezekiel Moseri, a clean cooking expert at GIZ.

“They are the ones who reach the villages, explain how the stoves work, and build trust with households. Without them, even the best technology will remain in shops in Nairobi. 

“We are investing in women and youth at the community level, helping them become distributors and technicians, so that clean stoves are not just available, but truly accessible.” 

At the policy level, GIZ provides technical advice to the Ministry of Energy and supports Kenya’s participation in global climate initiatives. 

“Clean cooking is not just about health – it’s about livelihoods, dignity, and climate resilience,” Moseri says.

Subsidies and microfinance

Officials from the Ministry of Energy and GIZ officials launching trucks and tuktuks to support the clean cooking project.

According to experts from the Ministry of Energy and GIZ Kenya, other solutions include subsidies and microfinance, facilitated through Savings and Credit Cooperative Organisations and women’s groups. 

These financing options can make stoves accessible through pay-as-you-go models, loans, or community savings groups.

Some of the pathways to clean cooking in Kenya include cultural adaptation to provide stove designs that align with traditional cooking.

Community-led education, especially through community health workers, can also raise awareness of smoke-related risks, improve trust, and increase people’s willingness to adopt clean stoves.

The government of Kenya could integrate clean cooking into national health and energy priorities to reduce disease burden and support global Sustainable Development Goals (SDGs) relating to health, gender equity, clean energy and climate action.

The government could also offer subsidies and tax incentives to lower household barriers.

Finally, donor-driven models involving results-based financing, carbon credits, and last-mile entrepreneurship could make clean stoves affordable, strengthen supply chains, and support sustainability.

‘Smoke doesn’t have to be part of our lives’

The clean cooking projects stove still uses firewood, but it lasts longer and smoke is channelled out of the house.

This is not just a local crisis; it is a global one. The women of Kibiko and Nalepo in Kenya represent millions worldwide who continue to cook in smoky kitchens. 

Naomi Parpai, 38, a mother of six in Kibiko who has been using a three-stone fire, says it has been affecting her.

“Every day, I cough. My chest feels heavy. I thought it was just dust. Then I learnt it’s the smoke. But what choice do I have? We use what we can find: wood, sometimes maize cobs.”

Her 12-year-old son can’t do homework because the smoke burns his eyes. Sometimes it forces him outside, even when it is raining.

Parpai’s neighbour, Beatrice Mpeti, says her last born child was infected with pneumonia. She now feels helpless.

Back in Nalepo, Nasieku reflected: “The smoke has always been part of our lives. But maybe it doesn’t have to be.”

Nasieku’s neighbour told her how she was able to buy an improved cookstove through a local women’s savings group. It was a basic model — a rocket stove — priced at KES 2,500, paid in three monthly installments.

“Her kitchen has no black soot anymore,” Nasieku observes. “She said her firewood now lasts twice as long.”

Encouraged, Nasieku joined the Naserian Women Group, a community-based organization that partners with GIZ Kenya and the Clean Cooking Alliance to distribute affordable stoves and make briquettes from farm waste. 

Through a pay-as-you-go model, Nasieku also received her own improved stove within weeks.

“It felt strange at first. But my eyes don’t sting any more, and my children stopped coughing at night,” she says. “I use half the firewood now, and spend less time gathering it,” she said.

Health and energy goals

Since Alice Siamanta started cooking with gas, her house is smoke-free and her children have stopped coughing.

Change is possible. You can see it in homes where clean stoves have been adopted, healthier families, brighter kitchens, and empowered women. But for that change to reach everyone, it will take sustained effort, affordable access, and the belief that no meal should come at the cost of someone’s lungs. 

The smoke may be an old companion in these kitchens, but the community is ready to leave it behind. The question is whether the rest of us policymakers, innovators, donors, and citizens will help clear the air.

Siamanta’s children, doing homework beside her smoke-free stove, represent a brighter future. The battle against household air pollution is about more than clean kitchens. It’s about health, dignity, gender equality, and climate resilience.

The clean cooking stove isn’t just a metal object — it’s a tool of empowerment, a health intervention, and an economic equaliser. Women save time, protect their health, and gain control over household energy decisions.

But for this transformation to reach everyone, barriers like cost, credit access, and cultural beliefs must be addressed systematically.

Global struggle 

Kenya isn’t alone in tackling smoky kitchens. In Ethiopia, a World Bank–backed program has supplied improved stoves to more than 10 million households.

Rwanda integrates clean cooking into its climate adaptation financing, linking every stoke to carbon accountability (Climate and Clean Air Coalition, 2021) 

Meanwhile, India’s Ujjwala Scheme distributed free LPG connections to over 80 million rural households, although many still struggle to afford refill costs.

In Kenya, tackling indoor air pollution aligns with national health goals, environmental sustainability, and gender equity. For the world, it contributes to climate commitments and the SDGs. It is also a question of justice. Why should women pay with their lungs to put food on the table?

But Kenya’s path to clean cooking needs stronger political will, better financing options, public-private partnerships, and grassroots innovation. Local women’s groups like Naserian are already leading the way by making fuel briquettes, promoting clean stoves, and organising group purchases of these stoves.

This story was produced as part of a collaboration between Health Policy Watch and the KEMRI Health Journalism Programme.

Image Credits: Ezekiel Moseri/ GIZ.

China’s Ambassador to Nigeria, Yu Dunhai, announcing the deal.

A deal with China will enable Nigeria to join Egypt and South Africa as a producer of insulin, the drug that is essential to control diabetes.

Diabetes is increasing exponentially on the continent, and is projected to affect almost 60 million people by 2050 – a massive increase from the 2.5 million estimated cases in 2000.

The memorandum of understanding between Nigeria’s National Biotechnology Research and Development Agency (NBRDA) and Shanghai Haiqi Industrial Company Limited of China was announced last week.

“Chinese companies are in talks with Nigeria to build Africa’s first local insulin production facility, potentially ending Nigeria’s reliance on imported insulin and positioning it as a hub for African biotechnology,” Chinese Ambassador to Nigeria Yu Dunhai said.

However, two other African countries are already making insulin. Egypt’s EVA Pharma began producing insulin in 2024 in partnership with Eli Lilly, which supplied the active pharmaceutical ingredients (API) at reduced cost alongside free technology transfer. 

This has enabled EVA Pharma to formulate, fill and finish insulin vials and cartridges aimed at low- and middle income countries (LMICs).  

The local insulin, called glargine, received regulatory approval from the Egyptian Drug Authority in December 2024.

“Less than two years after the initial announcement, EVA Pharma has completed a new biologics manufacturing facility, finalized insulin formulations and stability testing processes, engaged with the local regulatory authorities to obtain approval of the insulin glargine injection, and released the first batch of the locally manufactured insulin drug product,” the company announced at the time. 

Meanwhile, the South African generic company Aspen signed a deal with Danish company Novo Nordisk to fill-and-finish insulin vials, although details of the deal are not public.

However, Novo Nordisk and Sanofi are facing investigation in South Africa after the for anti-competitive activity in the insulin pen market. This follows the refusal of Novo Nordisk, Sanofi and Eli Lily, which produce 90% of insulin pens on the continent, to tender to supply the South African government with insulin pens. 

 

Recruiting semi-nomadic people from West Pokot, Kenya, in a clinical trial meant those running the trial needed to know where to find them when they went in search of water and grazing for their animals.

Engaging people from a nomadic community in rural Kenya in a clinical trial involved employing community mobilisers on motorbikes and understanding seasonal and cultural practices.

Geographic touchpoints such as waterholes and schools were mapped as places to find trial participants as they searched for grazing and water for their cattle and goats.

This was a lot of work, but for Luke Kanyangareng, a nurse based in rural West Pokot, adjacent to the Ugandan border, the community is the main stakeholder in clinical trials.

“Clinical trials are about getting a solution to their health problems, so we need to recruit and keep rural patients in the trial,” said Kanyangareng, who recently won an international award for his role as a patient advocate.

“Understanding their life setup is also very important, because when you are doing recruitment, you should know where this patient is coming from, and where you expect to find this patient at different seasons of the year.” 

Kanyangareng was addressing a September 16 webinar on patient and community engagement in clinical trials.  The webinar, hosted by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA)  was the first such event in a series of four, comprising this year’s African Regulatory Conference.  The online conference focused on advancing the clinical research ecosystem continues this autumn until 25 November. 

‘Not optional’

Dr Tariro Makadzange

Dr Tariro Makadzange, the CEO of the Africa Clinical Research Network, described community engagement in clinical trials as “fundamental not optional”. 

“Africa has not been a key player in clinical trials. We currently only participate in 3% of global trials, and yet, we’re 18% of the global population,” said Makadzange.

The Africa Centres for Disease Control and Prevention (Africa CDC) is trying to improve this statistic, according to Dr Mosoka Fallah, acting director of the body’s Science and Innovation Directorate.

“Africa is very vulnerable to disease outbreaks due to the fact that our research and development (R&D) capacity is very limited,” said Fallah. “We have developed a clinical trial R&D blueprint, working along with many other partners.”

Dr Janet Byaruhanga, from the African Union’s development agency, AUDA-Nepad, spearheads a programme aimed at ensuring the continent can produce certain priority medical products by 2050???

“The Pharmaceutical Manufacturing Plan for Africa is the blueprint for advancing local capabilities on the continent to produce medicines for the diseases of concern,” said Byaruhanga.

“We have prioritised a list of 24 medical products that we want the continent to be self-reliant in producing,” she added, engaging in a product-by-product approach.

Producing paediatric Praziquantel to treat schistosomiasis and medicines to address post-partum bleeding in women after birth are some of the priorities.

“We support the member states and the regional economic communities to create an enabling environment for the manufacture of these producta, and provide advisory services to industry.

“It will be very important for us to ensure that our community health care programme is linked with the local manufacturing programme to engage communities,” she added.

‘People First’ approach

Joy Malongo is the access manager at Drugs for Neglected Diseases Initiative (DNDi), the non-profit organisation that develops affordable treatments for neglected tropical diseases (NTDs), particularly for marginalised communities. 

DNDi’s approach involves “systemic community engagement” across all R&D phases, guided by a “people first” approach, said Malongo.

“Patient and community engagement helps identify and respond to barriers faced by marginalised groups, encourages a team approach that reduces disparities in access and outcomes, and empowers communities to advocate for their health rights.”

Norest Beta, the coordinator of clinical trials and community engagement at Africa Clinical Research Network, says communities need time to “understand, process and accept” clinical research. 

“Rather than rush engagement, we need to give them time to ask questions, question the research agenda, and hold us accountable,” said Beta.

But, as Waila Mukulu from Science for Africa Foundation says, theer often isn’t the budget to engage with communities.

“When there’s a need to cut down on the budget, community engagement activities are usually the first ones to go because there’s a feeling that the interest is the science,” said Makulu.

“We really emphasize to our researchers that it is important to ensure that we are actually meeting the needs of the African continent in whatever we are doing, and you will only be able to do this if you engage communities meaningfully and ensure that any research that we are conducting, is actually a reflection of their needs and priorities.”

Early engagement

Dr Huwaida Bulhan, scientific operations lead at Roche, said that patient and community engagement is” embedded throughout the clinical journey” at her company.

“We’re really engaged with patients and patient advocacy groups right from the study design stage,” said Bulhan, who also represented the IFPMA at the webinar.

“They advise us on endpoints that actually matter to patients”, said Bulhan, including how to make trial procedures less burdensome, especially for under-represented groups like women and young people. 

“Decentralised trials, hybrid trial models, and digital tools have worked very well in sub-Saharan Africa, with practical support like transport, care conditions and flexible scheduling for patients,” she added.

Dr Huwaida Bulhan

“We work very closely with local patient organisations, healthcare providers and community leaders, and these trusted networks help us understand the cultural context, how to reduce stigma, and how to create the right engagement strategies that resonate with people where they are.”

Roche also invests in health literacy for patients and healthcare providers to demystify clinical trials.

“We look at community engagement as a long-term commitment that does not stop when the trial ends,” Bulhan stressed.

“We share trial results with participants and communities where we’re able to do so. We also work to ensure that patients can access the innovations that emerge from this research. 

“The research is not effective if it’s not actually reaching the patients who need them,” added Bulhan.

“It really is about moving from that transactional relationship that a lot of people have in mind when they think of private industry, to a long term partnership that is rooted in trust and shared benefit.

“Patient and community engagement is what transforms clinical research from being about data collection to being about people, and when we do it well, then everyone benefits. Patients feel respected and communities see the lasting value of everything that we do.”

The IFPMA is hosting a four-part Africa Regulatory Conference webinar series from September to November 2025 that is open to all who are interested. The next webinar, on 2 October, deals with underrepresented populations in clinical trials.

Image Credits: UNFPA.

WHO Headquarters in Geneva where planned staff cuts are the focus of significant unrest.

Staff unrest at the World Health Organization’s Geneva headquarters reached a new milestone this week, as the WHO Staff Association (HQSA) adopted three resolutions challenging the fairness and legitimacy of the Organization’s ongoing restructuring process, which has already led to post abolitions, reassignments, and widespread anxiety.

In two meetings, Monday and Friday, attended by some 800 members of Geneva’s WHO staff, members expressed a vote of “no confidence” in the downsizing process, endorsing demands for greater transparency.  Key components of the demands call upon WHO senior management to:

  • Disclose all criteria and decision-making logic used in departmental staff cuts, including pre- and post department structures;
  • Freeze abolitions and recruitments tied to the restructuring pending independent review;
  • Launch an independent review within four weeks with meaningful staff participation; 
  • Issue a savings and impact statement showing what has been cut, what has been protected, and where further efficiencies are expected.
  • Report corrective actions not just to staff but also to Member States.

WHO is in the process of eliminating some 600 jobs at its Geneva headquarters, where nearly  2,800 people were employed as of June 2025, as part of a restructuring triggered by the withdrawal of United States funding for the global health agency in January. The withdrawal of the US, WHO’s largest donor, has left a massive $1.7 billion hole in the upcoming 2026-2027 budget cycle. WHO’s worldwide workforce is set to be trimmed by about  20% down to 7,525 staff from 9,463 as of December 2024.

Vote of No Confidence

The Friday meeting of the “Extraordinary General Assembly” (EGA) carried a motion of no confidence in the prioritization exercise and review process (ARC) of the cutbacks, citing widespread reports from staff, HR insiders, and even some directors that the process was “fundamentally unfair and flawed,” with evidence of both of inconsistencies as well as allegations that the abolition of posts, in some cases, was used as a retaliatory measure against staff who had previously acted as whistleblowers. 

The final text  sidestepped criticism of elected Staff Association representatives themselves, who have also come under fire for allegedly failing to defend staff interests more assertively throughout the restructuring process, which began at staff level in June.  

Freeze on Abolitions and Recruitment

Another measure approved called on the WHO administration to temporarily freeze further post abolitions/discontinuations and new recruitments directly linked to the prioritization exercise “until completion of an independent review” within four weeks time. Supporters argued this measure was essential to prevent further damage before an independent review could be conducted, overriding concerns by some critics that freezing action indefinitely could worsen WHO’s financial crisis and obstruct urgent recruitment.

Independent Review

Finally, the Staff Association called upon WHO management to urgently establish an independent review of the process and its outcomes, with direct engagement of staff, to document issues of concern and present proposed corrective actions to staff, administration and Member States.

The resolution calls for a tight, four-week deadline for  the review, which could be conducted by an external body such as the International Labour Organization, which maintains a judicial process for individual staff-administration disputes, or  by an internal panel with staff-elected members, insiders suggested.

A fourth resolution, which would have authorized collective legal action challenging the restructuring, was deferred due to the fact that collective staff appeals have limited standing before the ILO Administrative Tribunal, whose purview mainly involves the review of individual staff-management disputes. 

Broader Implications

Together, the Assembly resolutions have poised  the Staff Association to play a more assertive role in the WHO downsizing process.  However,  it remains to be seen how WHO’s senior management might respond to demands by the group, which has never gone on strike and typically remained in the shadows of major WHO management moves.  Health Policy Watch could not reach a WHO spokesperson by the time of publication.  

For WHO, already facing a US$1.7 billion budget shortfall after the withdrawal of major donor funding, the challenge is acute. Leadership must balance cost-cutting imperatives with credibility, fairness, and staff morale. Headquartered in Geneva, WHO’s staff there is in the eye of the storm. 

A Call for Deeper Reform

Speaking to Health Policy Watch on condition of anonymity, staff members stressed that the criticism over the downsizing goes beyond budgetary pressures.

The process has exposed patterns of favoritism that risk creating an opaque, top-heavy structure that sacrifices more vulnerable junior and temporary staff disproportionately.

The process has also exposed structural gaps in WHO’s internal justice system and the absence of a truly independent mechanism to hold senior leadership accountable. 

“Moving forward, real accountability requires strengthening the internal justice system, with clear protections against retaliation for staff who speak out,” one staff member said. “This is not just an HR quarrel—it is a governance crisis,” echoed another staff member.

 “WHO staff are international civil servants, bound by an oath to act solely in the Organization’s interest, and management is bound to transparent, rule-based administration confirmed by the Executive Board. 

“When prioritization and realignment sever core public health functions without clear criteria; when decision review files, organigrams, and rationales are withheld; when decisions are perceived to be personalized rather than principled, the problem isn’t morale—it’s legality and legitimacy.”

Said another: “By adopting these resolutions, staff have sent a unified signal: austerity cannot override fairness, transparency, and due process. For an organization tasked with setting global standards, staff reminded management that those standards must begin at home.

“The coming four weeks will be decisive. If leadership implements the freeze, commissions a credible independent review, and engages staff meaningfully, trust may be restored. If not, the Organization risks deepening mistrust — with consequences not just for staff morale, but for the credibility of WHO’s governance itself.”

Image Credits: WHO .

Panelists  Nick Banatvala, Sean Maguire, Barbara Hoffmann, and Kjeld Hansen at the Lung Health Matters side event.

NEW YORK – Although chronic respiratory diseases (CRDs) are the third leading cause of death globally, there remains a ‘mismatch’ between impact and action, said a group of global health leaders and experts on the sidelines of the 80th UN General Assembly.

“There is a mismatch between the disease [impact] from CRD and the action against it. CRD lags behind in awareness and attention, and so far, we don’t have any specific targets,” said Barbara Hoffmann, Chair of the European Respiratory Society (ERS) Advocacy Council, at the event Wednesday, Lung Health Matters – Accelerating Progress towards UN NCD targets.”  

The high-level side event, sponsored by the Permanent Mission of Malaysia and the Government of Romania, focused on the enormous societal costs of CRDs and their main risk factors, and actions that can be taken to prioritize lung health and preventative measures, through political commitment, resource mobilization, and greater integration of lung health issues into environmental policies. 

Some of the most common CRDs are chronic obstructive pulmonary disease (COPD), asthma, occupational lung diseases and pulmonary hypertension.

“Lung health is absolutely essential to personal well being. It’s essential for our economies and for our ability to thrive as societies,” said Hoffmann.  In the WHO European Region, which includes some 53 nations extending from the British Isles to Central Asia and Russia, CRDs are the sixth leading cause of death.

Unveiling the Political Declaration on NCDs 

The event came on the eve of the Fourth UN High-Level Meeting on Noncommunicable Diseases (NCDs), where the United States blocked the consensus approval of a new Political Declaration for the Prevention and Control of NCDs, despite overwhelming approval by almost all other UN member states. The  declaration will now be brought for a vote in the UN General Assembly in October. See related story:

BREAKING: UN Declaration on Noncommunicable Diseases Fails to Win Approval After US Foils Consensus

Taking the long view, the lung health experts who gathered also noted the ‘missed opportunities’ within the declaration, especially in regards to respiratory health and air pollution. 

“While there are things to celebrate in the declaration, there’s also actually quite a lot of missed opportunities in that document. It’s not as strong as it could be, or it should be, around the challenges that air pollution presents to health and in particular, particular to respiratory health,” said Sean Maguire, Executive Director of Strategic Partnerships of the Clean Air Fund. 

In particular, Maguire called out the absence in the declaration of any reference to fossil fuels as a leading air pollution source. Nearly one-half of all deaths from COPD and 19% of deaths from lung cancer are attributable to air pollution exposures,  according to the latest Global Burden of Disease data from the Seattle-based Institute of Health Metrics and Evaluation. 

Deaths from lung diseases attributable to environmental risks (including but not only air pollution) as compared to behavioural and metabolic risks.

“Burning fossil fuels is really at the heart of what causes so much air pollution. So unless we’re honest about the challenges, we’re not going to succeed. We’re not going to meet our SDG targets, and we’re not going to reduce the health work of air pollution.” 

Lack of Defined Targets for CRDs Despite Being Preventable and Manageable 

Barbara Hoffmann speaking on results from the WHO Europe-ERS Report into CRDs in the WHO European Region

In addition, unlike other major NCDs, CRDs lack robust global targets, both in the new political declaration as well as in WHO global action plans, which are essential to supporting country prioritization, measuring progress, and benchmarking. This includes the recent landmark resolution, “Promoting and prioritizing an integrated lung health approach,” which was formally adopted at the 78th World Health Assembly this past May.

The lack of defined targets for CRDs also means that governments may not assign it sufficient priority in national health planning. 

In comparison, there are five global diabetes targets, three global targets on hypertension control, targets for reducing the burden of several types of cancers and three targets tackling HIV/AIDS, through increased access to prevention, diagnostics, and treatment. 

“These CRDs are largely preventable and manageable, yet no specific targets have been formulated, and the action to prevent and match them remains weak,” she says, citing a recently released WHO European Region report on CRDs, co-developed with the Respiratory Society.  

The report recommends that countries consider adoption of national-level targets for COPD and asthma to ensure advocacy, implementation and progress monitoring at country, regional, and global level.

“There is a need for setting targets and for starting disease surveillance, and we need further actions, national plans, awareness raising and education. CRD is largely preventable and manageable, and we know how to do it, and can do something about it,” said Hoffmann. 

Bringing Lung Health to the Forefront in Malaysia 

Muhammed Radzi Jamuludin, the representative of Malaysia and Ambassador to Cuba

Malaysia is one such country that has been making concerted effort in the fight for better lung health, both locally and globally.

“Lung health must be a shared priority,” said Muhammed Radzi Jamaludin, the representative of Malaysia and Ambassador to Cuba, in his opening remarks. 

He highlighted the recent WHA resolution, “Promoting and prioritizing an integrated lung health approach,” which was co-sponsored by Malaysia, together with 15 other WHO member states, which calls for a comprehensive and forward-looking agenda to strengthen prevention, early diagnosis, treatment and control of lung diseases.

Malaysia has also launched the roadmap for the Lung Health Initiative 2025 – 2030, a holistic plan that covers various aspects of lung health, from prevention to treatment, and including palliative care and research. Other efforts to address lung health issues in the country also included nationwide awareness campaigns, stricter tobacco and vaping regulations, multi-sectoral collaboration to improve air quality, workplace safety, and enhancing screening/early detection.

Air pollution has multiple, cascading health impacts on children.

Jamaludin called on governments for even stronger commitments in order to accelerate progress and achieve UN NCD targets.  

“By firmly placing lung health within the global NCD and sustainable development agenda, we can reduce premature mortality, improve population health and build healthier and more resilient societies.” 

Stronger Governance for Multi-sectoral Action

Nick Banatvala, Head of the Secretariat for the UN Interagency Task Force on the Prevention and Control of Noncommunicable Diseases, also emphasized the need for lung health to be articulated at a national level, especially in development strategies, where multi-sectoral plans can be made. 

“[Lung health] now needs to be well articulated in national health and development strategies. I’m always pushing for development strategies, because that’s where I think we have a big opportunity, because so much of what we’re discussing requires action across a number of different sectors.”

However, this is easier said than done, and as it ‘becomes notoriously difficult to get action’ once other sectors are involved, says Banatvala, using the example of tobacco industry interference. 

The solution lies in stronger governance, he argues. 

“We need to take this political declaration back not to the Minister of Health, because they’ve heard it, but to parliamentarians and say, these are your communities. These are your people. You should be elected or fail to be elected, dependent on whether or not you are sorting out tobacco and air and health services and universal health coverage.” 

Investing in civil society and patient advocacy

Patients, those impacted by CRDs themselves, also need to become more involved in advocacy and policy debates in order to integrate lung health better into the NCD agenda, the experts agreed.

“Some of the best investment is investing in civil society organizations, in grassroots who can make their voice known, to try and get the voice of the patients,” Banatvala said.

Kjeld Hansen, Chair of the European Lung Foundation, spoke about his experiences working and advocating for patients with asthma and other CRDs as a person who himself has lived experience with lung disease. “I understood at that point that if I meet the right people with the right solutions, anything is actually possible,” he said. 

“Civil society actors will come together with the government to help set priorities on different issues. And once you hear it from your constituency, then it’s much harder to strike down the message afterwards. So I would say, bring them into the process.” 

Now the Real Work Begins 

José Luis Castro, WHO Director-General Special Envoy for Chronic Respiratory Diseases

While final UN approval of the political declaration will now be delayed for a few more weeks, it’s important to focus on the next stages in the process, ”when the resl will begin,” said José Luis Castro, WHO Director-General Special Envoy for Chronic Respiratory Diseases. 

“What matters now is implementation and advocacy at the national level, turning global commitments into cleaner air, into early diagnosis, into stronger primary care, into treatments for patients, for 650 million people affected by [CRDs].”

Patients impacted by CRDs must be at the heart of this work, “if we are to keep the momentum to ensure that patients see the change,” he emphasized. 

“Let us measure our progress not by the declarations adopted, but by the lives that will be extended and the dignity restored to patients everywhere.”

Image Credits: National Cancer Institute/Unsplash, Raisa Santos, Our World in Data, IHME.

People running
The World Health Organization sees physical activity as a “missed opportunity” in combatting non-communicable diseases.

The statistics are stark. Non-communicable diseases (NCDs), like heart disease, cancer, and diabetes, are responsible for a staggering 75% of non-pandemic deaths worldwide.

This isn’t just a challenge for high-income nations; it’s a crisis that hits low- and middle-income countries the hardest, where 85% of premature NCD deaths occur. It’s clear the traditional approach to healthcare isn’t enough. We need a new strategy, one that empowers individuals and strengthens health systems from the ground up.

This is the promise of self-care, a concept that is now rightfully at the center of the global health conversation. The World Health Organization (WHO) defines self-care as the ability of individuals, families, and communities to promote health, prevent disease, and manage illness. It’s a simple but powerful idea that focuses on empowering people to take an active role in their own health, from managing chronic conditions to getting vaccinated or using digital health tools to monitor blood pressure.

A smarter approach to health

United for Self-Care Coalition team at the sidelines of 80th UNGA.

At first glance, self-care might sound like an individual responsibility, but it’s a powerful public health strategy with benefits that ripple across entire societies. The “Health for All, by All” self-care manifesto launched by the United for Self-Care Coalition on the sidelines of United Nations General Assembly this week champions this very idea, aligning with the new 2025 UN Political Declaration on NCDs. The manifesto argues that by investing in self-care, we can make healthcare more accessible, more efficient, and more equitable.

Consider the potential impact. Self-care interventions can help 150 million more people gain control over their hypertension and help another 150 million more quit tobacco. The numbers aren’t just about saving lives; they’re also about saving healthcare systems from breaking under the strain. By empowering individuals to manage routine health needs, we can free up doctors and nurses to focus on more critical cases. This isn’t bypassing health systems; it’s strengthening them.

And the economic benefits are immense. We’re talking about billions of dollars in annual savings. By 2030, self-care interventions across the board could generate $179 billion in healthcare savings and free up 2.8 billion physician hours per year. In low- and middle-income countries, this could lead to $230 billion in potential gains, fundamentally changing the healthcare landscape.

Our call to action

Self-care isn’t a replacement for professional medical care. It’s an essential partner. It’s about creating a health ecosystem where people have the tools and knowledge to stay healthy, and where healthcare providers can use their expertise most effectively. The manifesto calls on policymakers and Member States to make this a reality by:

  • Providing dedicated investment in self-care infrastructure, including digital health tools, education campaigns, and equitable access to self-care products and tools, with a particular focus on women, youth, marginalized communities, and vulnerable populations.
  • Incentivizing self-care within financing models such as through value-based care, universal coverage schemes, and public-private partnerships.
  • Embedding self-care in health workforce planning allowing care teams to focus their expertise where it’s most needed, while individuals take more control over routine management.
  • Integrating self-care into primary care strategies enabling earlier intervention, better health outcomes, and reduced system strain.
  • Systematically involving patients and people with lived experience in designing, implementing, and evaluating self-care infrastructure, policies, products and tools.

The solutions are ready and realizable. Now is the time to embrace a new approach to global health – one that empowers us all to turn the tide on NCDs, together.

The United for Self-Care Coalition is a global alliance of like-minded organizations dedicated to the common goal: to achieve universal health coverage through codifying self-care as a critical component of the self-care continuum, particularly in the context of managing NCDs.

Image Credits: Gabin Vallet, United for Self-Care Coalition .

WHO Director General Dr Tedros Adhanom Ghebreyesus with UN Under Secretary General Amina Mohammed at Thursday’s  opening of the UN High Level Meeting on Noncommunicable Diseases.

NEW YORK CITY – A painstakingly negotiated Political Declaration on Noncommunicable Diseases with overwhelming support from UN member states failed to win formal endorsement at a special High Level Session of the General Assembly (GA) Thursday – after the United States torpedoed its adoption by consensus.

The last minute moves means that the draft declaration will have to face a vote in the GA – most likely next month, observers said. 

Dozens of presidents, prime ministers and health ministers, speaking on behalf of the world’s largest blocs of both developed and developing countries, hailed the draft, saying it should be approved immediately, at the Fourth UN High Level Meeting on NCDs and Mental Health.  

But in a blustery statement, US Health and Human Services Secretary Robert F Kennedy Jr charged that the UN draft went too far in recommending measures like taxes on unhealthy products – while not going far enough on other chronic disease related issues. The US veto means the draft must be submitted to a formal member state vote to be endorsed as the declaration was supposed to be by consensus. 

Annalena Baerbock, UN General Assembly president, declares that the draft declaration will go before the UN General Assembly.

“Throughout the course of the plenary segment today, we have listened intensively to the position of member states regarding the draft political declaration,” said the current UN GA president, Annalena Baerbock, a German diplomat.

“While I understand that there remain objections by some member states, there is also broad support for the text. The document will be considered by member states in the General Assembly,” Baerbock concluded.

RFK Jr: Declaration ‘exceeds the UN’s proper role’

Robert F Kennedy Jr says the United States would ‘walk away’ from the political declaration.

Addressing the High Level Meeting,  Kennedy charged that the final draft text “exceeds the UN’s proper role while ignoring the most pressing health issues, and that’s why the United States will reject it. 

“More specifically, we cannot accept language that pushes destructive gender ideology,” Kennedy said. “Neither can we accept claims of a constitutional or international right to abortion. The WHO cannot claim credibility or leadership until it undergoes radical reform. The United States objects to the political declaration of non communicable diseases. 

“The draft declaration should not have been included in today’s agenda,” Kennedy insisted, adding it was “filled with controversy with provisions about everything from taxes to … management by international bodies of communicable diseases”.

However, the final draft text makes no reference to abortion, stating only that NCDs need to be mainstreamed into “sexual and reproductive health programmes” – a move to ensure the integration of health services. Cervical cancer is a substantial risk factors for women and can be picked up by simple screening.

The declaration’s single reference to gender calls for mainstreaming “a gender perspective” into NCD prevention and control as a critical lens for understanding and addressing the health risks of women and men “of all ages”.  Women are far more likely than men to be obese, while men are more prone to NCDs such as liver cancer.

Kennedy’s statement was also paradoxical as he has ostensibly made fighting chronic diseases, including risks like obesity an unhealthy foods, a cornerstone of his Make America Healthy Again (MAHA) agenda. 

“The United States will walk away from the declaration,” Kennedy concluded. “But we will never walk away from the world or our commitment to end chronic disease. We stand ready to lead to partner to innovate with every nation committed to a healthier future.”

Overwhelming support by other member states

Suriname’s President, Dr Jennifer Simons, a physician, stresses importance of mental health.

At the HLM meeting, the US role seemed to model anything but leadership.  The solid wall of statements by countries expressed support for the draft resolution as it was agreed to in early September.

Those included endorsements by:  the Group of 77 including China, the UN’s largest bloc representing 130 emerging economies; the Gulf Cooperation Council, representing a powerful group of Middle East oil-producing states; the Caricom alliance of Caribbean nations; the European Union; Pacific Island nations; and the Philippines, speaking on behalf of the Association of Southeast Asian Nations (ASEAN).  

The Philippines noted that it had deployed over 20,000 primary care providers to address NCDs and mental health at primary care level at a cost of about $518 million.

“The investment case is clear. NCDs cost the Philippines $13.5 billion annually through the health care cost and productivity losses,” said Secretary of Health Teodoro Herbosa. 

Suriname’s new President, Jennifer Simons, herself a physician, stressed the importance of addressing mental health, a theme echoed by many ministers as well as other heads of state and government.

“Our people are more and more confronted with the impact of mental health challenges. They feel lonely, depressed and often isolated. We will have to pay attention to the risk of social media and screen time in general, on the mental health of our children,” Simons said, adding that countries like hers also face “an escalating race of unhealthy lifestyles, which causes, of course, obesity among children, and adults.”

“The US seems to be trying to sabotage the process, but we don’t see how they can succeed at this point,” said Alison Cox of the NCD Alliance. “It is really short-sighted and reckless in the face of an urgent global crisis.”

In a subsequent statement the Alliance sounded an optimistic note: “while it is disappointing that a tiny minority of governments voiced their objection to the declaration, they stand isolated. The momentum for accelerated action is growing… The Declaration has been referred to the UN General Assembly. This means that it will now move forward through the formal UNGA process for adoption as a resolution in the coming weeks.” 

First political declaration to set clear NCD targets

The draft sets, for the first time ever, some defined, if modest, targets for combatting NCDs, stating that by 2030, there should be 150 million fewer people using tobacco; 150 million more people with hypertension under control and 150 million more people with access to mental health care. 

Testing a patient for hypertension. Two-thirds of Africans with high blood pressure are unaware of their condition.

Those targets are still far removed from aspirations of UN Sustainable Development Goal 3.4, established a decade ago, which calls for a reduction of premature NCD deaths by one-third by 2030. Since then, the NCD burden has only grown larger and chronic diseases now represent 74% of premature deaths worldwide. 

The final draft also saw language supporting national taxes on unhealthy products, one of the most potent tools for prevention, watered down under industry pressures. That text now recommends that member states: “consider introducing or increasing taxes on tobacco and alcohol to support health objectives, in line with national circumstances.”

WHO’s role in combating NCDs affirmed

The draft political declaration is the strongest appeal, to date, for access to mental health services.

Over earlier US objections, the draft declaration refers to WHO in half a dozen sections, recognising “the key role of the World Health Organization as the directing and coordinating authority on international health in accordance with its Constitution to continue to support Member States through its normative and standard-setting work, provision of technical cooperation, assistance and policy advice, and the promotion of multisectoral and multistakeholder partnerships and dialogues.” 

WHO “Best Buys” for prevention and control of NCDs are also cited. The Best Buys are a package of 16 key interventions to prevent and address smoking, excessive alcohol use, physical inactivity and obesity, as well as cancer risks.

“The political declaration before you is the strongest yet with ambitious, measurable and achievable targets,” said WHO Director General Dr Tedros Adhanom Ghebreyesus, speaking at the opening of the meeting. 

The political declaration, the fourth since 2011, also marks the first time that mental health risks are extensively addressed as part of the NCD paradigm, Tedros pointed out.

Examples of the 16 WHO Best Buys to prevent and control NCDs.

“For the first time, mental health is fully integrated into a political declaration. “It’s about time, in this declaration, you’re committing to expanding access to services for mental health care, but brick by brick, we must also tear down the walls of stigma that keeps so many people trapped.”

Indeed, the text not only makes reference to mental health conditions, including “anxiety, depression, and psychosis affect close to 1 billion people worldwide” but also to other neurological conditions, including “Alzheimer’s disease and other forms of dementia,” as well as substance abuse.

“It felt surreal that it was not expressely included before, when it is forecasted to be the 3rd leading cause of death overall, globally, by 2040,” remarked Paolo Barbarino, CEO of Alzheimer’s Disease International, one of many civil society groups celebrating this year’s breakthrough.

Tedros called on countries to implement three measures in connection with combatting NCDs; more preventive measures; full integration of NCD diagnosis and care into primary healthcare systems; and more equitable access to medicines and treatments. 

“Health does not start in clinics and hospitals. It starts in homes, schools, streets and workplaces, in the food people eat, the products they consume, the water they drink, the air they breathe, and the conditions in which they live and work,” Tedros declared.  “So the number 1 [ask] should be addressing the root causes and helping people to lead a healthy life.

“Second, I ask all countries to integrate services for NCDs and mental health into primary health care at the foundation of universal health coverage.  

“Third, I ask all countries to deliver equity through access and accountability.  That means making essential medicines and technologies available and affordable to all with financing that reduces out of pocket payments or costs. 

Air pollution mentioned – but not its fossil fuel sources

Smoke billows from power plant in Poland – generating both air pollution and CO2 emissions.

The new declaration also mentions air pollution as a ‘fifth’ risk factor for NCDs, a position for which environmental health advocates have long argued. 

The text states that member states  “recognize also that the main modifiable risk factors of noncommunicable diseases are tobacco use, harmful use of alcohol, unhealthy diets, physical inactivity and air pollution and are largely preventable and require cross-sectoral actions;”

It also notes that an estimated 7 million people die prematurely every year from air pollution-related diseases – most of them NCDs. These include air pollution-related hypertension, heart and lung diseases, and cancers that develop as tiny air pollution particles travel through the bloodstream and into key organs of the body, including the brain. 

And the draft text recommends measures that can reduce air pollution and its related disease burden, including:  “clean, efficient, safe, accessible and expanded urban public transport options, and active mobility, such as walking and cycling;” as well as reduced open waste burning; more affordable clean cooking, heating and electricity generation; vehicle and industrial controls on pollutants, as well as reduced exposures, particularly for children, to lead and other hazardous chemicals. 

(Center) Jane Burston, CEO Clean Air Fund: omitting fossil fuels is ‘like pledging to tackle smoking without mentioning tobacco.’

However, the declaration doesn’t go far enough on the sidesteps any reference to fossil fuels as a major source of health-harmful air pollutants, noted Jane Burston, CEO of the Clean Air Fund, and it makes no mention of the co-benefits that can be gained from reducing air pollutants – particularly for climate. 

“It’s like pledging to tackle smoking without mentioning tobacco,” Burston said of the omission, in an appearance at a side event Wednesday evening, organized by the civil society group, the NCD Alliance. “We need to acknowledge where it’s coming from.”

Norway’s Minister of International Development, Åsmund Grøver Aukrust, said that “the declaration reflects also a challenging geopolitical climates. This has clearly influenced the outcome of these documents… We regret the removal of targets for taxes on tobacco, alcohol and sugar sweetened beverages. We must work harder to prevent the devastating consequences of climate change, air pollution and their impact on health. We must be clear on our commitment on air pollution. Let’s remind ourselves that 95 percentage of all premature death due to air pollution occur in low- and middle-income countries.”

US objections – not entirely a surprise

Ralph Gonsalves, Prime Minister of St Vincent and the Grenadines, tells the Assembly that the draft was the result of a painstaking negotiation.

The US objections were not a complete surprise.  A 3 September memo to the president of the UN GA by the political declaration’s co-facilitators, Luxembourg and St. Vincent and the Grenadines, declared that the draft represents “the broadest possible consensus” – but not full agreement amongst all member states: 

“On 2 September, we were informed by one delegation that it is not able to join consensus despite all our collective efforts,” stated the letter, obtained by Health Policy Watch. “While there is no unanimity of views, it is our firm belief that the finalized version of the political declaration we are submitting to you adheres to the principle of consensus because it reflects a general agreement among the membership and garners the broadest possible political acceptance by Member States. It represents the broadest possible consensus.” 

Then, in a 18 September memo, the US Mission to the United Nations raised the issue again, saying: “The most recent draft of the political declaration has not been agreed by consensus in advance, and thus the conditions stipulated by the modalities resolution have not been met. Therefore, the draft political declaration should not be brought before the high-level meeting for approval.”

Ralph Gonsalves, Prime Minister of St. Vincent and Grenadines, which co-facilitated the negotiations, told the HLM: “We recognize that it is not perfect, but perfection is not the standard in multilateralism, nor is it the measure of progress. What we have is a declaration that is robust, comprehensive enough to provide the necessary catalyst for action, and reflects the broadest possible consensus.”

‘Birthday checkups’ and other country commitments

Indonesia’s Deputy Director General on NCDs, Bonanza Perwira Taihitu.

In public and informal fora around the HLM, member states talked about what they are already doing to combat the global NCD epidemic – from higher taxes on items like sugary drinks and tobacco, to training health care workers to screen ‘at risk’ populations.

“We didn’t want to call them mandatory checks, so we are calling them ‘birthday checks’,” quipped Bonanza Perwira Taihitu, Indonesia’s Deputy Director General for NCDs,  at an event sponsored by the NCD Alliance before the HLM. The country’s drive to conduct health screenings for hypertension, high blood pressure and other NCDs, which began in February, has already reached 32 million people out of Indonesia’s population of some 280 million people, he said.

Indonesia is also investing heavily in new digital health systems, Taihitu added, echoing calls by industry forces to national health systems to expand their reach  “via health innovation systems” along with expanding Universal Health Coverage to combat the high cost of NCD diagnosis and treatment.

Jeremy Farrar, WHO Assistant Director-General of Health Promotion, Disease Prevention and Control (right) at a NCD Alliance panel event Wednesday evening.

Meanwhile, Jeremy Farrar, WHO Assistant Director General said that while the politics around the declaration is regrettable, what really matters is the momentum being seen at the national level.

“Although we need to say nobody’s happy with it, everybody is moving forward,” Farrar said, looking at the glass half-full.  “And ultimately, does anybody in Ho Chi Minh City or Jakarta or London really care what’s in that declaration? What matters is what the governments now go back to do in their own jurisdiction, and that’s what really matters.”

Image Credits: Hush Naidoo Jade Photography/ Unsplash, WHO, PAHO, Janusz Walczak/ Unsplash, E. Fletcher/Health Policy Watch.

WHO Director General Dr Tedros Adhanom Ghebreyesus at the launch of the hypertension report.

World leaders are expected to commit to 150 million fewer tobacco users, 150 million more people under hypertension management, and 150 million more people with access to mental care by 2030 at the United Nations on Thursday.

These targets are in the final draft of the political declaration set for adoption at the UN High-Level Meeting on Non-communicable Diseases (NCDs) and Mental Health in New York.

Earlier in the week, the World Health Organization (WHO) released its global hypertension report, which showed that 1.4 billion people lived with hypertension in 2024 – yet only around 20% (320 million) had their high blood pressure under control.

“Hypertension is a leading cause of heart attack, stroke, chronic kidney disease, and dementia. It is both preventable and treatable – but without urgent action, millions of people will continue to die prematurely, and countries will face mounting economic losses,” according to the report, released on the sidelines of the UN General Assembly.

WHO Director General Dr Tedros Adhanom Ghebreyesus told the launch that he lived with hypertension, which is controlled by medication: “And that is the great paradox of hypertension. It can be controlled by relatively inexpensive medication.”

However, access to affordable medicine and blood pressure devices were the biggest barrier to controlling high blood pressure, added Tedros.

The report, which draws on data from 194 countries, also shows that only 28% of low-income countries had all five WHO-recommended hypertension medicines readily available in their clinics.

“Barriers span the pharmaceutical value chain, from regulatory systems and medicine selection, to pricing, procurement, prescribing, and dispensing,” according to the report.

Major gaps

Other major gaps in addressing hypertension include weak communication about risks – such as the consumption of alcohol, tobacco, salt and transfat, and physical inactivity.

Some countries had limited access to blood pressure devices, a lack of trained primary care teams, unreliable supply chains and costly medicines.

“Every hour, over 1,000 lives are lost to strokes and heart attacks from high blood pressure, and most of these deaths are preventable,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. 

“Countries have the tools to change this narrative. With political will, ongoing investment, and reforms to embed hypertension control in health services, we can save millions and ensure universal health coverage for all.”

Dr Kelly Henning, head of Bloomberg Philanthropies Public Health Program.

Dr Kelly Henning, who leads the Bloomberg Philanthropies Public Health Program, told the report’s launch that countries that “integrate hypertension care into universal health coverage (UHC) and primary care are making real progress, but too many low- and middle-income countries are still left behind.” 

Dr Tom Frieden, CEO of Resolve to Save Lives, said that the lives of 50 million people can be saved if the global control of high blood pressure was increased from the current 20% to 50%. He also highlighted that uncontrolled high blood pressure is the cause of one-in-six patients’ dementia.

“It only costs $5 a year to treat a patient with the best medications in the world,” said Frieden. “Twenty-five years ago, South Korea’s hypertension control was 15%. They have increased this to 62% this year … and seen a decline of over 80% in cardiovascular deaths.”

Resolve to Save Lives CEO Dr Tom Frieden.

The report also gives credit to Bangladesh and the Philippines for making significant progress – largely by “integrating hypertension care into UHC, investing in primary care, and engaging communities”.

Low-cost anti-hypertensive medication and limited patient fees in South Korea have enabled the country to improve blood pressure control nationally.

Between 2019 and 2025, Bangladesh increased hypertension control from 15% to 56% in some regions by embedding hypertension treatment services in its essential health service package and strengthening screening and follow-up care.

The Philippines has effectively incorporated the WHO’s HEARTS technical package into community-level services nationwide.

The draft declaration commits countries to scaling up “early screening, monitoring and diagnosis, affordable and effective treatment, and regular follow-up for people at risk of cardiovascular disease or living with high blood pressure”.

Impact of mental health

Social isolation is a risk factor for mental illness and Alzheimer’s.

Meanwhile, over one billion people across the world are living with mental health disorders, according to two WHO reports, ‘World Mental Health Today’ and ‘Mental Health Atlas 2024’, released earlier this month.

In low-income countries, fewer than 10% of affected individuals receive care, compared to over 50% in higher-income nations.

“Transforming mental health services is one of the most pressing public health challenges,” said Dr Tedros. “Investing in mental health means investing in people, communities, and economies — an investment no country can afford to neglect. Every government and every leader has a responsibility to act with urgency and to ensure that mental health care is treated not as a privilege, but as a basic right for all.”

The draft declaration commits to several measures to address mental health, including scaling up “psychosocial and psychological support, and pharmacological treatment for depression, anxiety and psychosis”, particularly at the primary health care level and within general health care services.

It also commits to addressing the stigma associated with mental illness, and the “health risks related to digital technology, including social media, such as excessive screen time, exposure to harmful content, social disconnection, social isolation, and loneliness.”

Weakened declaration

While NCD advocates have welcomed the three “150 million” targets, they have lamented the weakening of language on taxing unhealthy products since the zero draft in May.

As previously reported by Health Policy Watch, the text no longer refers to taxing sugar-sweetened beverages, and describes higher taxes on tobacco and alcohol as “considerations… in line with national circumstances” rather than concrete proposals.

The zero draft target of “at least 80% of countries” implementing excise taxes on tobacco, alcohol, and sugar-sweetened beverages to levels recommended by the WHO by 2030 is completely absent from the final draft.

The declaration has also removed virtually all references to WHO recommendations. This is apparently at the insistence of the United States, which withdrew from the WHO when Donald Trump became president in January, sources close to the talks told Health Policy Watch.

Image Credits: Bruno Martins/ Unsplash.

Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections.

Two Indian manufacturers will be able to mass-produce cheap generic versions of the HIV ‘miracle’ drug, lenacapavir, which almost eliminates HIV transmission via an injection given twice a year – thanks to support from donors.

The Gates Foundation will support Hetero Labs, while Unitaid, the Clinton Health Access Initiative (CHAI), and Wits RHI will support Dr Reddy’s Laboratories. This will reduce the annual price per patient for the two injections to $40, according to simultaneous announcements in New York on Wednesday.

Gates is offering Hetero “upfront funding and volume guarantees”, and Unitaid-CHAI-Wits RHI will provide Dr Reddy’s with “financial, technical, and regulatory support to deliver affordable, quality-assured generic versions of lenacapavir to low- and middle-income countries (LMICs) by 2027, following regulatory approval.”

In clinical trials, lenacapvir eliminated 99% of HIV transmission, making it the closest product to an HIV vaccine.

One study shows that scaling up access to lenacapavir to just 4% of the population in high-burden countries could prevent up to 20% of new infections, according to the Gates Foundation.

It has made more than $80 million available in “catalytic investments” to accelerate market readiness, scale delivery, and shorten the timeline for generic entry of lenacapavir.

End HIV

“Scientific advances like lenacapavir can help us end the HIV epidemic—if they are made accessible to people who can benefit from them the most,” said Trevor Mundel, president of global health at the Gates Foundation. “We are committed to ensuring that those at highest risk, who can least afford it, aren’t left behind.”

“Securing a US$40 price for the twice-yearly lenacapavir injection for PrEP is a historic breakthrough that proves the most advanced tools can be made affordable from the very start,” said Unitaid’s executive director, Dr Philippe Duneton.

In 2024, Gilead Sciences granted royalty-free licenses for lenacapavir production to six generic manufacturers for 120 low- and middle-income countries. Following regulatory approvals, generic lenacapavir will flow through national HIV programs and public procurement channels such as the Global Fund.

On 4 September, the US government announced that lenacapavir’s US manufacturer, Gilead, had made the drug available to the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund at cost.

PEPFAR plans a “market-shaping initiative” to get the drug to some two million people in countries with high burdens of HIV, according to the US announcement.

PEPFAR will focus on using lenacapavir to prevent mother-to-child HIV transmission.

Still ‘far away’

“The deals announced today on generics are a major step forward in ending the HIV epidemic,” said Kate Hampton, CEO of the Children’s Investment Fund Foundation (CIFF), which is also supporting the rollout of lenacapavir via the Global Fund. 

“They build on full value-chain investments by CIFF and others to foster a competitive market so that access to lenacapavir is affordable and reliable for all those who need it.”

“This is a watershed moment. A price of $40 per person per year is a leap forward that will help to unlock the revolutionary potential of long-acting HIV medicines,” said Winnie Byanyima, executive director of UNAIDS.

Describing lenacapavir as “revolutionary”, UNAIDS pointed out that its current annual price in the US is $28,000 per person.

UNAIDS estimates that 1.3 million people were infected with HIV in last year.

Beatriz Grinsztejn, president of the International AIDS Society, welcomed lenacapavir generics being made affordable, but said “availability in 2027 still feels far away.”

“With the HIV response in a funding crisis, countries are already making difficult trade-offs. To realize the full potential of this innovation, [pre-exposure prophylaxis] options like lenacapavir must reach the most vulnerable people, which requires urgent, additional investment to avoid delays or denied access.”

Meanwhile, a global HIV activist coalition noted that the $40 price will be “restricted to the 115 LMICs and five territories covered by Gilead’s voluntary license” announced  earlier this year.

They called for global access tongenerics, particularly as “over a quarter of new HIV acquisitions occur in the 26 countries and territories that are excluded by Gilead from its license, including Argentina, Brazil, Mexico”.

Image Credits: Gilead, Gilead.