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Over the past 20 years, the Global Initiative for Asthma (GINA) has regularly published and annually updated a global strategy for asthma management and prevention that has formed the basis for many national guidelines. However, uptake of existing guidelines is poor. A major revision of the GINA
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report was published in 2014, and updated in 2015, reflecting an evolving understanding of heterogeneous airways disease, a broader evidence base, increasing interest in targeted treatment, and evidence about effective implementation approaches. During development of the report, the clinical utility of recommendations and strategies for their practical implementation were considered in parallel with the scientific evidence.
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Tuberculosis (TB) is among the top ten most common causes of death globally and as a single infectious disease it top among infectious diseases. Furthermore, it is noted as the top causes of death among people infected with the human immunodeficiency virus (HIV). Despite recent decreases in the numb
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er of notified cases, Namibia still has a high TB burden and is included among the top 30 high-burden TB countries by the World Health Organisation (WHO). In the 2018 Global TB Report, the estimated incidence rate of TB in Namibia was 423/100,000. The same report estimated that 60 people per 100,000 populations died of TB in Namibia, which is a concern, for a disease that is curable and preventable.
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The South African WHO Country Cooperation Strategy (CCS) 2023–2027 focuses on four key strategic priorities based on the country’s health needs and disease epidemiology, while also considering the need for building resilient health systems for UHC and health security in the post pandemic period.
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These include:
1. augment health systems strengthening reforms to accelerate progress towards universal health coverage.
2. address the quadruple burden of diseases and promote well-being across the life course in view of achieving global targets.
3. build health systems resilience and strengthen health emergency preparedness and response capacities.
4. enhance multisectoral collaboration and global partnerships for concerted action on health and its determinants.
In order to harness its expertise across its three levels, namely: the WHO Country Office (WCO), WHO Regional Office for Africa, and WHO headquarters, WHO will work closely and collaboratively with the Government of South Africa to implement the 2023–2027 strategic priorities.
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Nearly 800 women die every day from preventable maternal causes, and in 2022 alone, an estimated 2.3 million newborns died. For every maternal death, countless more women endure life-altering injuries, infections, and disabilities related to childbirth.
Maternal deaths are concentrated in the poo
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rest regions and conflict-affected areas. In 2020, sub-Saharan Africa accounted for nearly 70% of all maternal deaths, with just 22 countries responsible for 81% of the global total. Humanitarian crises and fragile health systems exacerbate these challenges, with maternal mortality rates in crisis-affected areas often double the global average. The barriers to progress are multifaceted, including inadequate funding, poor-quality healthcare, harmful gender and social norms, and critical gaps in data and accountability.
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Rwanda’s national health sector is focused on the equitable delivery of high-quality health services. The Government of Rwanda (GoR) recognizes that developing human resources in the health sector is a critical factor to the well-being of the population. Development of the health workforce has bee
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n guided by the Human Resources for Health (HRH) Programme (2012-2019) and its successor, the National Strategy for Health Professions Development (NSHPD) (2020-2030). Rwanda has made significant progress in enhancing its skilled health workforce, with notable improvements in the health professional-to-population ratio over the past decade, attaining 13.4 doctors, nurses, midwives, pharmacists, and dentists per 10 000 people in 2022. Despite such progress, health workforce levels remain below national and global recommendations.
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he National Department of Health (NDOH) presents this Malaria Elimination Strategic
Plan 2019-2023 for the Republic of South Africa. The strategy comes at an important time
as the Southern African Development Community (SADC) heads of state have recently
renewed the commitment to eliminate malari
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a in Botswana, Eswatini, Namibia and South
Africa by 2020 and in the whole SADC region by 2030, with the target of zero local malaria
cases and deaths. South Africa has made steady progress towards this elimination goal
through the implementation of evidence-based malaria policies aligned to the World Health
Organization’s (WHO) Global Technical Strategy.
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Insufficient funding is hindering the achievement of malaria elimination targets in Africa, despite the pressing need for increased investment in malaria control. While Western donors attribute their inaction to financial constraints, the global health community has limited knowledge of China’s ex
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panding role in malaria prevention. This knowledge gap arises from the fact that China does not consistently report its foreign development assistance activities to established aid transparency initiatives. Our work focuses on identifying Chinese-funded malaria control projects throughout Africa and linking them to official data on malaria prevalence. By doing so, we aim to shed light on China’s contributions to malaria control efforts, analysing their investments and assessing their impact. This would provide valuable insights into the development of effective financing mechanisms for future malaria control in Africa.
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This Guide is part of WHO’s overall programme of work on Political Economy of Health Financing Reform: Analysis and Strategy to Support UHC. The impetus for this work came from demands for more concrete evidence, recognition and integration of political economy issues within
health financing, and
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overall system, reform design and implementation processes. This Guide is complementary to WHO’s Health Financing Progress Matrix assessment, as well as Health Financing Strategy development guidance. In this way, it promotes an embedded political
economy analysis approach that can be used in conjunction with other health financing assessments and guidance. The political economy framework can also be extended and easily adapted to broader health policy reforms.
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Social and Behaviour Change Communication (SBCC) is essential for the effective control, prevention and elimination of malaria. The 2018–2030 Strategic Framework for Malaria SBCC guides countries and partners in strengthening capacities, refining strategies and sharing best practices, all of which
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are aligned with the WHO Global Technical Strategy for Malaria. Despite progress, malaria continues to threaten billions of people, and success hinges on access to interventions and behavioural change. This framework emphasises advocacy, technical guidance and tools to ensure that SBCC is prioritised and resourced as an essential element in the global fight against malaria.
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Malaria remains a significant public health concern, particularly in sub-Saharan Africa, where the majority of cases and fatalities occur, especially among children under five. Although there was a significant decline in global mortality and incidence between 2000 and 2015,
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progress has stalled since the late 2010s due to climate change, conflict, drug and insecticide resistance, and the ongoing effects of the pandemic. Economic modelling shows that achieving the Sustainable Development Goal target of reducing malaria incidence by 90% by 2030 could generate substantial economic benefits, including an increase in GDP of $142.7 billion in endemic countries and $80.7 billion in global trade gains. To save lives, strengthen health systems, and drive sustainable economic growth, renewed investments in malaria control and elimination programmes, vaccine deployment, and coordinated international support are essential.
Accessed on 25/08/2025.
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In an era of constrained resources and tightening budgets, strategic prioritization in tuberculosis (TB) programming is more critical than ever. Countries must make informed decisions to allocate limited resources effectively - maximizing impact, preventing avoidable deaths, and sustaining
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progress towards ending TB.
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The guide presents a structured framework covering assessment and planning, service delivery models, integration with broader health and social services, monitoring, and sustainability. It emphasizes community leadership, human rights, equitable access and adaptation to local contexts, including clo
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sed settings. Practical tools are included to support implementation and accelerate progress towards global targets for controlling HIV and eliminating viral hepatitis epidemics.
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In 2015, the United Nations set important targets to reduce premature
cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately
bears the brunt of CVD burden and has one of the highest risks of dying
from non-communicable diseases (NCDs) worldwide. There is currently
an epide
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miological transition on the continent, where NCDs is projected
to outpace communicable diseases within the current decade. Unchecked
increases in CVD risk factors have contributed to the growing burden of three
major CVDs—hypertension, cardiomyopathies, and atherosclerotic diseasesleading to devastating rates of stroke and heart failure. The highest age
standardized disability-adjusted life years (DALYs) due to hypertensive heart
disease (HHD) were recorded in Africa. The contributory causes of heart failure
are changing—whilst HHD and cardiomyopathies still dominate, ischemic
heart disease is rapidly becoming a significant contributor, whilst rheumatic
heart disease (RHD) has shown a gradual decline. In a continent where health
systems are traditionally geared toward addressing communicable diseases,
several gaps exist to adequately meet the growing demand imposed by CVDs.
Among these, high-quality research to inform interventions, underfunded
health systems with high out-of-pocket costs, limited accessibility and
affordability of essential medicines, CVD preventive services, and skill
shortages. Overall, the African continent progress toward a third reduction
in premature mortality come 2030 is lagging behind. More can be done in
the arena of effective policy implementation for risk factor reduction and
CVD prevention, increasing health financing and focusing on strengthening
primary health care services for prevention and treatment of CVDs, whilst
ensuring availability and affordability of quality medicines. Further, investing
in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on
interventions. This review summarizes the current CVD burden, important
gaps in cardiovascular medicine in Africa, and further highlights priority
areas where efforts could be intensified in the next decade with potential
to improve the current rate of progress toward achieving a 33% reduction
in CVD mortality.
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Measures to strengthen primary health-care systems in low- and middle-income countries
Etienne V Langlois, Andrew Mc Kenzie, Helen Schneider & Jeffrey W Mecaskey
World Health Organization
(2020)
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Primary health care offers a cost–effective route to achieving universal health coverage (UHC). However, primary health-care systems are weak in many low- and middle-income countries and often fail to provide comprehensive, people-centred, integrated care. We analysed the primar
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y health-care systems in 20 low- and middle-income countries using a semi-grounded approach. Options for strengthening primary health-care systems were identified by thematic content analysis. We found that: (i)despite the growing burden of noncommunicable disease, many low- and middle-income countries lacked funds for preventive services; (ii)community health workers were often under-resourced, poorly supported and lacked training; (iii)out-of-pocket expenditure exceeded 40% of total health expenditure in half the countries studied, which affected equity; and (iv)health insurance schemes were hampered by the fragmentation of public and private systems, underfunding, corruption and poor engagement of informal workers. In 14 countries, the private sector was largely unregulated. Moreover, community engagement in primary health care was weak in countries where services were largely privatized. In some countries, decentralization led to the fragmentation of primary health care. Performance improved when financial incentives were linked to regulation and quality improvement, and community involvement was strong. Policy-making should be supported by adequate resources for primary health-care implementation and government spending on primary health care should be increased by at least 1% of gross domestic product. Devising equity-enhancing financing schemes and improving the accountability of primary health-care management is also needed. Support from primary health-care systems is critical for progress towards UHC in the decade to 2030.
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The chapter Dementia in Latin America and the Caribbean: Prevalence, Incidence, Impact, and Trends over Time, is part of the publication series titled “Decade of Healthy Aging: situation and challenges”. This document aims to provide an outline of the current situation in Latin America and the C
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aribbean in respect of the prevalence and incidence of dementia and its impact on the health status of older people. As dementia is a significant global health problem which also has social and economic impacts this document highlights the importance of monitoring dementia in the region. The document evidences that dementia is one of the main contributors to dependence and disability in older people in Latin America and the Caribbean and, although its prevalence and incidence increase exponentially with age, it is not part of normal aging. Alzheimer’s disease is the most common dementia, and there is no cure for this condition, but with timely diagnosis is possible to ameliorate symptoms. It is important to assess what are the needs of people leaving with dementia and their families and to integrate dementia risk reduction strategies in pre-existing strategies for other non-communicable diseases. As shown in the report, despite the huge burden dementia is still underdiagnosed, and it is fundamental to better monitor its prevalence, incidence and the different societal impact that dementia can have. For that, it is crucial to promote the use of harmonized methodologies to address this information in a broader number of studies and countries in the region. This can contribute to the generation of direct actions to decrease dementia risk and lead to healthier lives for people with dementia and their families.
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Background
Asthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced a
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sthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention.
Methods
We conducted six focus group discussions, including 15 children and 28 carers, and individual interviews with four lay-educators and a senior nurse. Translated transcripts were coded independently by three researchers and key themes identified.
Results
Prior to the intervention, participants reported challenges in asthma care including the busy and sometimes hostile clinical environment, lack of access to information and the erratic supply of medication. The education sessions were well received: participants reported greater understanding of asthma and their treatment and confidence to manage symptoms. The lay-educators appreciated pre-intervention training, written guidelines, and access to clinical support. Low education levels among carers presented challenges, requiring an open, non-critical and individualised approach.
Discussion
Asthma education can be successfully delivered by lay-educators with adequate training, supervision and support, with benefits to the patients, their families and the community. Wider implementation could help address human resource shortages and support progress towards Universal Health Coverage.
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Africa’s health sector is facing an unprecedented financing crisis, driven by a sharp decline of 70% in Official Development Assistance (ODA) from 2021 to 2025 and deep-rooted structural vulnerabilities. This collapse is placing immense pressure on Africa’s already fragile health systems as ODA
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is seen as the backbone of critical health programs: pandemic preparedness, maternal and child health services, disease control programs are all at
risk, threatening Sustainable Development Goal 3 and Universal Health Coverage. Compounding this is Africa’s spiraling debt, with countries expected to service USD 81 billion by 2025—surpassing anticipated external financing inflows—further eroding fiscal space for health investments. Level of domestic resources is low. TThe Abuja Declaration of 2001, a pivotal commitment made by African Union (AU) member states, aimed to reverse this trend by pledging to allocate at least 15% of national budgets to the health sector. However, more than two decades later, only three countries—Rwanda, Botswana, and Cabo Verde—have
consistently met or exceeded this target (WHO, 2023). In contrast, over 30 AU member states remain well below the 10% benchmark, with some allocating as little as 5–7% of their national budgets to health.
In addition, only 16 (29%) of African countries currently have updated versions of National Health Development Plan (NHDP) supported by a National Health Financing Plan (NHFP). These two documents play a critical role in driving internal resource mobilisation. At the same time, public health emergencies are surging, rising 41%—from 152 in 2022 to
213 in 2024—exposing severe under-resourcing of health infrastructure and workforce. Recurring outbreaks (Mpox, Ebola, cholera, measles, Marburg…) alongside effects of climate change and humanitarian crises in Eastern DRC, the Sahel, and Sudan, are overwhelming systems stretched by chronic underfunding. The situation is worsened by Africa’s heavy dependency with over 90% of vaccines, medicines, and diagnostics being externally sourced—leaving countries vulnerable to global supply chain shocks. Health worker shortages persist, with only 2.3 professionals
per 1,000 people (below the WHO’s recommended 4.45), and fewer than 30% of systems are digitized, undermining disease surveillance and early warning. Without decisive action, Africa CDC projects the continent could reverse two decades of health progress, face 2 to 4 million additional preventable deaths annually, and a heightened risk of a pandemic emerging from within. Furthermore, 39 million more
Africans could be pushed into poverty by 2030 due to intertwined health and economic shocks. This is not just a sectoral crisis—it is an existential threat to Africa’s political, social, and economic resilience, and global stability. In response, African leaders, under Africa CDC’s stewardship, are advancing a comprehensive three-pillar strategy centered on domestic resource mobilization, innovative financing, and blended finance.
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Access to safe, effective and quality-assured health products and technologies is crucial for achieving universal health coverage and primary health care goals. The continued growth of the aging population; increasing burden of noncommunicable diseases; growing burden of mental health issues; climat
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e change; shifting patterns of vector borne diseases, fungal disease and waterborne diseases; antimicrobial resistance; and new infectious hazards create an ongoing need for equitable access to safe, effective and quality-assured health products and technologies, and renewed investments in research and development for innovative health products and technologies.
The coronavirus pandemic exposed the inequalities in access to health products, highlighting the need for longer-term strategies to strengthen access to health products and technologies outside of and in emergency situations. While technological and scientific advances present an opportunity to increase access to health products and technologies, the risk of increasing inequality due to higher prices for new health products and technologies; the persisting problem of substandard and falsified medical products; a lack of skilled workforce in many low- and middle-income countries; and a lack of data for decisionmaking and for measuring progress present significant challenges.
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