Lessons from Germany to help solve the U.S. medical debt crisis

The Boresha afya ya mama na mtoto (improve the health of mother and child) program works to reduce maternal and infant mortality rates by connecting mothers with community health volunteers. These volunteers provide important education on topics like antenatal care and also help to increase access to immunization services. When the group formed in 2018, 531 women died during childbirth or pregnancy, but as of 2023, that number has dropped to 344 thanks to the program’s initiatives.

Care Ring, in collaboration with other organizations like the University of North Carolina School of Nursing, launched The Bridge, a community-based healthcare initiative that aims to make preventive care easier to access. The Bridge features a mobile care unit that provides free health screenings, counseling support and connections to community resources. Since December 2022, The Bridge has provided care to more than 100 people, 39% of which didn’t have a regular doctor.

The state Ministry of Health in partnership with other local organizations is providing educational, medical outreach for pregnant women to discuss malaria, maternal mortality and the importance of having regular medical checkups, while providing necessary resources to increase their access to care.

The Atayese initiative makes healthcare services more affordable and accessible for underserved age groups including young children, pregnant women and elderly people. The initiative launched in 2013 and runs clinics and hospital services in several states and communities where they’ve provided treatment to hundreds — in some areas, thousands — of patients.

The RECOVERY Rehabilitation Center provides rehabilitation care for wounded soldiers. Providers at the center provide patients with specialized care and help to create individual action plans for when patients leave the center to ensure they have the means to adapt to their new way of life.

Emergency room visits cost money and are not the most comfortable places to be. The Massachusetts-based Medicare program called Independence at Home gives doctors incentives to visit frail patients at home and received a cut of the cost. The program also pairs patients with social workers and continues to save Medicare millions of dollars.

Since June 2024, Nigeria's National Health Insurance Authority (NHIA) has implemented a comprehensive fistula intervention program that fully covers transportation, surgery, feeding, post-operative care and follow-up services at no cost to patients. In Kano State alone, 2,157 women have received treatment through the intervention, with facilities handling 30-50 patients monthly, a significant increase from pre-program levels.

Nepal has built one of South Asia's most successful eye care systems through a community-driven model spearheaded by the Nepal Netra Jyoti Sangh (NNJS). Rather than relying on government funding, Nepal leveraged NGO partnerships, community donations, and deliberate human resource development to expand access to affordable eye care. In 2024 alone, over 3.2 million people received treatment at NNJS-affiliated hospitals.

Digital public infrastructure is helping African countries build more sustainable health systems by replacing fragmented, donor-funded projects with interoperable digital services. In Zambia, for example, the SmartCare Pro electronic health record system uses thumbprints to identify patients and track chronic diseases like TB and HIV, ensuring continuity of care, where it was historically missing.

Local organizations are working with the Department of Health and UNICEF to eradicate polio in Taraba state. By collaborating with community leaders, they’ve been able to spread positive information about polio vaccines, encouraging more families to vaccinate their children.