KIKWIT, Democratic Republic of the Congo — For years, women in Kwilu Province faced a frustrating reality: they would walk into a health clinic seeking family planning services and leave empty-handed. Not because contraceptives were unavailable on the shelves, but because health care providers lacked the confidence and skills to offer them. 

IUDs and implants sat unused in storage while women were quietly steered toward methods requiring less technical expertise. The reason was not patient preference—it was provider anxiety. 

“Before the PMNS-PF project (Projet Multisectoriel de Nutrition et de la Santé, or Multisectoral Nutrition and Health Project), I had never been trained in family planning,” said a nurse from Plateau I Health Center in Kikwit North. “Inserting an IUD—including hormonal IUDs—or placing and removing an implant gave me anxiety.” 

This scenario was all too common across Kwilu Province. The DRC’s National Strategic Plan for Family Planning (2021–2025) identified this gap clearly: health care providers needed practical, hands-on training—not just classroom theory, but real mentorship at the point of care. 

“Before the PMNS-PF project, I had never been trained in family planning. Inserting an IUD or implant was a source of anxiety for me. With training and clinical mentorship—observation, supervised practice, debriefing—everything changed. Today, I have mastered these procedures and I better support clients in making informed choices because they deserve better.” 
—Nurse, Plateau I Health Center, Kikwit North Health Zone 

A Turning Point: Mentorship at the Bedside

Enter clinical mentorship, an approach that brings expert guidance directly to health care facilities. Through the PMNS-PF project, implemented by SANRU and Pathfinder International with World Bank funding, 96 mentors were trained across 24 health zones in Kwilu Province. 

Unlike traditional training that ends when participants leave the classroom, clinical mentorship is ongoing and intimate. Mentors observe providers during actual patient consultations, offer real-time guidance, supervise practice, and debrief afterward. It is learning that happens where it matters most: at the bedside. 

At the Misay 1 Hospital Center in the Kikongo Health Zone, Irène Bule embodies this transformation. When her more experienced colleague was transferred to another facility, Irène was suddenly thrust into the role of family planning provider—with minimal training. 

“I like offering family planning services, but before, it was a more experienced colleague who handled it,” Irène recalls. “After her transfer, the head nurse designated me as a mentee.” 

Her mentor, Blaise Munkanga, a supervising nurse in Kikongo Health Zone, began regular visits. “With him,” says Irène, I went from almost zero to a competent provider. Today, I have mastered all the techniques. What I love most is following the technical checklist step by step. The more I use it, the more I have memorized it—my mastery strengthens with every review.” 

Blaise mentors providers across three health facilities and has witnessed countless similar transformations. “We often face staff instability—trained providers move or get transferred, leaving a gap in facilities. Now we mentor at least two providers per facility to ensure continuity even when someone leaves.” 

“In just three months of regular mentorship sessions, a provider reaches an impressive level of mastery. I have noticed that young women providers progress very quickly in rural areas.”

A Ripple Effect 

The impact extends far beyond individual health care workers. Nedine Ndeke, head of family planning services and a mentee in Mukula Nzadi, sees the broader picture: “In our health area, women finally have access—close to home—to family planning that is safe, respectful, and truly available.” 

Each of the 240 mentored providers supervises five community-based distributors in their health areas, exponentially expanding the reach of quality family planning services. 

Building a Sustainable System 

The 96 trained mentors are supported by Project Advisors who conduct monthly field visits alongside Central Office staff from Health Zones. Each advisor follows eight mentors—four per health zone—ensuring quality standards across the province. 

The mentorship relationship is defined as a reciprocal learning partnership: mentor and mentee work together toward mutually defined goals that develop the mentee’s skills, capacities, knowledge, and critical thinking. 
 
At the head of the program sits Dr. Patrick Kabeya, Senior Technical Advisor for Reproductive Health and Family Planning. Dr Kabeya provides strategic oversight for the program across both Kwilu and Kasai provinces—from priority-setting to quantifying contraceptive commodities to ensure consistent availability. 

“What I appreciate most,” says nurse Venance Gihalu Sembu, is being able to offer quality services, free of charge thanks to the project, and seeing the satisfaction of the women we serve. For us providers, it is motivating to feel our skills improving with each mentor visit.” 

Looking Ahead 

The success in Kwilu Province offers a roadmap for scaling quality family planning services across the DRC and beyond. By investing in health care providers through sustained, practical mentorship, the PMNS-PF project proves that technical skills—and confidence—can be built over time. 

For the 1,107,477 women who received modern family planning services in 2025, that gift translates into something profound: the power to make informed choices about their own bodies, their families, and their futures. 
 
“Our project turns policy into concrete change at health facilities in Kwilu,” says Dr. Jackson Kipulu, Reproductive Health & Family Planning Specialist. “Clinical mentorship visits at the workplace—observation, supervised practice, debriefing—national quality assurance guidelines to standardize every procedure and counseling step, and logistical support to reduce supply disruptions.”

Results in 2025 

• 96 mentors providing clinical mentorship
• 24 health zones covered in Kwilu Provincial Health Division 
• 720 mentorship visits conducted  
• 681 mentees trained. This includes 240 providers who were previously trained in family planning and 441 providers who were not previously trained. 
• 1,107,477 women using modern family planning methods.
• 99,763 women who received postpartum modern family planning services.  

In Uganda, we often speak about systems strengthening, localization, and sustainable change. But what does that look like in the lives of the people we serve? Through the EMPOWER Program, we are seeing what happens when health workers, communities, and local leaders are supported to lead change themselves: stronger health systems and communities sustaining positive change.  

Rebuilding trust and quality at heath facilities 

At Nakivale Health Centre III, which serves a large refugee community, midwife Doreen recalls a time when family planning services were limited, especially for women who had just given birth. 

“We used to have a very low uptake of family planning services, especially postpartum family planning,” she says. “Sometimes we would turn women away and ask them to return another day. It was heartbreaking to see some of them come back pregnant, reminding us that we had turned them away.” 

Working alongside Doreen and her colleagues, the EMPOWER Program focused on strengthening the skills and systems already in place. Health workers received mentorship, improved their counselling skills, and were supported to better manage commodities and documentation. Over time, the team began to see more women using family planning. 

Encouraged by this progress, the facility started a “Continuous Quality Improvement” project to strengthen immediate postpartum family planning. Early results show a steady increase in uptake of immediate postpartum family planning, with no women using it in September to 65 women using it by December 2025. 

For Doreen, the change is personal. 

“If we continue strengthening health education, more women will take up family planning, and we shall have empowered women deciding when and how many children to have.” 

Creating safe spaces for young mothers 

At Nawampiti Health Centre II, change is visible in the confidence of young mothers. 

With support from EMPOWER, the facility introduced Young Mothers’ Forums. These forums provide safe spaces where pregnant teenagers and young mothers can talk openly, receive counselling on family planning, learn about gender-based violence, and get guidance on antenatal care. 

Nalulondo Olivia, the maternity in charge, says the facility has realized a difference. 

“We never used to counsel clients properly,” she says. “Even now, some young people say, ‘Eh, these days you guys are teaching us?’ It is exciting to see them take interest in their reproductive health.” 

The facility also began offering long-acting reversible contraceptives, which were not previously available. In just three months, 78 young women under the age of 24 chose a long-acting family planning method. 

Barbara, a young mother, says this decision has given her peace of mind. 

“I’m happy I received Jadelle,” she says. “Now I can focus on my farming and take care of my one-year-old daughter without worrying about another pregnancy.” 

Working through trusted community voices 

Sustainable change does not happen in facilities alone. It also happens in communities, where beliefs and social norms shape decisions. Mutesasira Silver, a traditional healer, is one of the community gatekeepers trained through EMPOWER. 

“As a cultural leader, people listen to me,” says Silver. “Now I guide them not just spiritually, but toward healthier families.” 

Since his training, Silver has been referring clients to Bunyiro Health Centre III for family planning services. He is one of 509 trained community gatekeepers who are now helping families access information, encouraging open conversations, and supporting healthier choices. 

Restoring dignity through fistula repair camps 

In Mubende, the impact of this work can be seen in the life of Dorothy Namirembe. At 25, Dorothy had lived with obstetric fistula for six years. She stopped attending church, avoided social gatherings, and lost her partner. She lived in isolation and shame. 

Her turning point came when she heard a radio announcement about a fistula repair camp. She attended the camp and received surgery, giving her a fresh start 

“I had lost hope and even wished for death at some point,” she says. “But now I am fully recovered. I haven’t had to use pads since I left the hospital. Thank you for giving me life. I am looking forward to starting afresh.” 

Strengthening local systems 

These stories remind us that our role is not to replace local systems, but to strengthen them. When health workers are supported, they provide better care. When young mothers are given safe spaces, they gain agency to make informed decisions. When community leaders are engaged, they help shift norms. And when women receive quality care, they reclaim their dignity. 

Through EMPOWER, we are seeing country-led change in action. Health workers are leading improvements. Communities are shaping solutions. And together, we are building stronger, more responsive health systems that will continue serving families long into the future. 

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The Global Goal on Adaptation (GGA) now has a measuring stick. A decade after the Paris Agreement enshrined the GGA, countries finally agreed on a concrete measurement framework for tracking climate resilience at COP30 in Belém. After years of work, countries adopted adaptation indicators, including 10 focused on health.

1. Change in the rate of mortality associated with heat exposure
2. Change in the incidence of climate-sensitive infectious diseases
3. Change in the annual rate of reported heat-related occupational injuries and deaths
4. Extent of implementation of Mental Health and Psychosocial Support preparedness and response for climate change-sensitive events
5. Number of destroyed or damaged health facilities and number of disruptions to health services associated with climate-related events
6. Percentage of health facilities built or retrofitted to be climate resilient based on national, regional, or global guidance
7. Universal Health Coverage: Coverage of essential health services
8. Level of operationalization of climate-informed health early warning systems for climate change-related health risks accessible to vulnerable groups
9. Level of implementation of climate change, health vulnerability, and adaptation assessment
10. Proportion of the ministry in charge of health workforce that has received training on climate change and health in the last two years

These indicators give us a common language for monitoring everything from climate-sensitive infectious diseases to health facility resilience and, in a long-overdue move, the extent of mental health and psychosocial support for vulnerable populations.

But indicators alone don’t save lives. What matters is how governments translate these global metrics into national strategies, budgets, and services that reach communities on the frontlines.

The bridge between Belém and the clinic is built not with policy documents, but with political will, technical capacity, and sustained partnership. The key question is simple: will these indicators change what happens in hospitals, clinics, and communities when the next climate shock hits?

The COP30 Yardstick: A Political & Practical Win

Adopting these indicators represents a genuine breakthrough. For the first time, we have a universally agreed-upon standard to measure whether the world is adapting to climate change. The health indicators are particularly robust, calling for data on service continuity, health facility resilience, workforce capacity, and disease trends. However, as The Lancet rightly noted, this scientific success now faces the test of political will.

The adoption process was marked by last-minute maneuvering, with countries like Uruguay raising legitimate concerns about methodology and sovereignty. The critical question is whether the indicators can translate into real-world protection. The framework will live or die based on its ability to inform national plans, attract investment, and ultimately change outcomes for communities most exposed to climate risks. In other words, the framework must move from being a reporting exercise to becoming a decision-making tool.

From Global Metrics to Country Reality

This is where the global framework meets countries’ realities. The GGA indicators were never meant to be a prescriptive, one-size-fits-all reporting burden, but rather to “complement rather than replace existing monitoring systems.” The question is how to make that complementarity real.

The GGA’s call for tracking the “percentage of health facilities that are resilient” and the “coverage of essential health services supported by adaptation measures” is precisely the kind of system-strengthening Pathfinder excels at. For decades, Pathfinder International has worked alongside governments to strengthen health systems from the inside out. We don’t create parallel systems; we support ministries to integrate priorities into the policies and budgets they already own. This alignment is now more urgent than ever.

We support countries like Uganda and Ethiopia in developing Health National Adaptation Plans (HNAPs) through quantified  climate risk assessments that move beyond analysis to action—building operational roadmaps with costed priorities, adaptation planning, and clear indicators. We work closely with governments to answer the question the GGA now makes urgent: What does a “resilient health service” look like in our context, and how will we know we’re getting there?

Persistent data and capacity gaps impede effective adaptation planning and the prioritization of the people and places most at risk, despite recent efforts by finance institutions. Only 44% of countries have costed their health adaptation needs, and existing finance falls short by billions. This mismatch between ambition and financing is now one of the greatest risks to implementation.

The Gap Between Ambition and Implementation

The new mental health indicator provides a perfect case study. Global recognition that climate change affects mental health is vital. But translating that into services requires ministries to train providers, adjust essential service packages, and create referral pathways that function even when roads are washed out. It requires community health workers who can recognize distress and provide first-line support. This is the granular, systems-strengthening work Pathfinder supports every day, turning a global metric into on-the-ground action. It also demonstrates that resilience is not only about infrastructure, but also about people and systems continuing to function under stress.

How We Measure What Matters

The demand for better finance tracking leads directly to a second imperative: proving impact. To attract and justify increased investment, we need robust, multi-level data that shows what works. This is where Pathfinder’s approach to monitoring offers a model.

We measure impact across the entire spectrum of health systems. Our programming uses indicators at the household level (reaching individuals and creating model households with composite metrics on health, finance, and emergency preparedness); the community level (strengthening health worker networks); the facility level (ensuring infrastructure, services, and supplies can withstand climate shocks); and the systems level (supporting national budgeting, vulnerability assessments, and planning).

For the last five years (2020–2024), our climate-resilience contributions include:

• More than 2,200 health facilities strengthened and became resilient to provide essential services during climate shocks.
• 14,500 health professionals trained to identify, prepare for, and respond to climate shocks.
• 25,000 youth climate advocacy leaders and champions trained.
• Reached 1 million community members to create “climate-friendly model households.”
• Built the climate resilience skills of 350,700 community members through climate and health awareness events.

These figures matter because they demonstrate that adaptation is measurable, and that investments can produce visible, trackable results. This multi-layered approach is exactly the kind of robust monitoring the finance community demands. It’s not just about counting outputs; it’s about demonstrating outcomes. By showing how a trained health workforce or a resilient facility maintains essential services during a climate shock, we provide the evidence base needed to make the case for smarter, more targeted adaptation finance.

The Missing Link: Tracking Climate-Health Finance

We have the indicators. We know how to implement them. But the entire system is undermined by a lack of transparent, needs-based financing. At COP30, after two weeks of negotiations, countries agreed to at least triple adaptation finance to $120 billion per year by 2035. While an increase on paper, this builds on a missed target from COP26 to double adaptation finance by 2025. The gap between rhetoric and reality remains vast.

Global public adaptation finance flows were only about $26 billion in 2023, highlighting how far the world still has to go. A recent report by The Rockefeller Foundation and SEEK Development highlights a core problem: current climate finance reporting is based on self-reported data with no verification or standardization. We simply cannot track financial flows against actual health needs with any accuracy. The report confirms that only 0.5% of multilateral climate funding supports health initiatives, forcing low-income countries to take on debt just to protect their populations’ health.

We can’t manage what we don’t measure. Building on the COP28 Guiding Principles, we need a consistent nomenclature for reporting climate-health financing. Public, transparent reporting on investment volumes, grant vs. loan ratios, and geographic distribution is not a bureaucratic exercise; it is the only way to ensure that commitments represent new financing, not just the reclassification of existing projects. Without this transparency, adaptation indicators risk becoming aspirational rather than transformational.

The Path Forward

The Lancet’s honest accounting of the procedural concerns at COP30, the last-minute changes, and the truncated negotiations are not minor footnotes. They reflect legitimate anxieties among the most climate-vulnerable countries that global frameworks can become unfunded mandates, or worse, tools for conditionalities.

When ministries own the process of selecting and adapting indicators, when they have the technical support to cost their adaptation priorities, and when they can demonstrate results to financiers, the framework becomes a tool for empowerment, not imposition.

Real accountability is ultimately domestic. It’s citizens holding their governments responsible for protecting health in a changing climate. It’s ministers of health making the case to ministers of finance that adaptation investments today prevent catastrophic costs tomorrow.

The COP30 framework gives the world a common language for adaptation progress. Pathfinder remains committed to helping governments speak that language fluently, not as a compliance exercise, but to ensure the resilient, equitable health systems every community deserves.

The indicators are adopted. The finance target is set. Now the test is whether the world can turn measurement into protection, and promises into lives saved.

Employability is typically treated as a technical problem: a matter of skills gaps, training curricula, and labor market alignment. But in practice, it is far more complex. In contexts shaped by structural inequality, regional instability, climate pressure, and often restrictive gender norms, employability is not just about whether people are qualified for work—it is about whether systems are designed to include them.

In Jordan, Pathfinder International has observed how traditional approaches to workforce development have struggled to keep pace with the rapidly changing world of work. As new green and digital sectors emerge, the challenge is no longer simply preparing individuals for jobs, but rethinking what employability means in the first place.

A System Under Pressure

Jordan faces one of the highest youth unemployment rates in the region. For young people, particularly recent graduates, the transition from education to employment is becoming increasingly uncertain. Many leave university with qualifications but little exposure to real workplaces, professional networks, or labor market expectations. Many young people in Jordan are caught between their goals and a seemingly impenetrable job market.

For women, the barriers are even greater. Social norms, limited mobility, care responsibilities, and lack of access to finance and markets mean that many women—especially in rural areas—are excluded from economic participation altogether.

“The job market here is so weak, but the youth are very well educated. We often just lack these employability-specific skills in order to close that gap.”
—Participant in Livelihoods Program Youth Track

These challenges are compounded by a rapidly changing world of work. Climate pressures, economic instability, and the rise of green and digital sectors are reshaping labor markets faster than traditional systems can adapt. The result is a growing gap between people’s potential and the opportunities available to them.

“For us, as women in [Mafraq, North Jordan], finding work was nearly impossible. There are significant cultural barriers. It’s often hard for us to convince our family and our community to accept that we want to work and that we want to provide for our families.”
—Participant in Livelihoods Program Women’s Track

Where Climate Action Meets Economic Inclusion

In response, Pathfinder International launched a program called Improving Leadership and Underserved Populations in Jordan, with a strong focus on green and future-oriented sectors.

Our aim was to create real pathways into work and income generation. For youth, this meant soft skills training, career coaching, mentorship, and exposure to cleantech and green economy sectors. For women, it meant building a sustainable agribusiness model around cucumber farming and pickling, linking production directly to markets.

The idea was simple: employability should not exist in isolation. It must be connected to real demand, real infrastructure, and real economic opportunity.

Behind Every Statistic is a Story

Across the project, the most powerful insights came not from reports or indicators, but from the participants themselves.

One young woman told us, “I’ve been using my new skills since day one of the workshops—I’d be crazy not to be putting everything I’ve learned into practice! Firstly, my CV and LinkedIn profile are now developed to a very high standard. Secondly, I now understand what HR departments look for when they are hiring and what can make me stand out as an applicant. Thirdly, I know my rights now as a freelancer and how to negotiate contracts to make sure they are fair for me as an employee. These are all amazing benefits for me.”

Another participant shared, “After the training, the biggest change I’ve noticed is my ability to present myself and my skills in a more professional and persuasive way […] I had a chance to present my project to a panel of donors and—thanks to my new skills—we got the funding we wanted.”

Among the women in the pickling line, the reflections were equally as striking. One participant said, “Once I turned 40, nobody wanted to hire me. This project gave me a way out.” Another explained, “People used to tell me women like me couldn’t work. Now I’m proving them wrong.”

One Syrian participant shared her story with us, “In a few words, this project is my life. When I came from Syria with my family, there was no escape from our situation and very few social outlets or opportunities. This project has been a breath of new life and comfort for me. I came here, I met new people, I learned new things… it’s been beneficial in ways I can’t describe.”

These were not just talents being acquired, they were identities being reshaped.

Every Skill is a Step Forward

Now, 16 months into the program, the changes are visible. Participants have demonstrated stronger communication skills, greater confidence, and clearer career direction. Many have developed business ideas, improved their job readiness, and expanded their professional networks.

But perhaps the most important shift has been psychological. People have begun to see themselves differently—not as passive job seekers, but as proactive agents capable of navigating the labor market, making informed decisions about their futures, and carving out a place for themselves in the Jordanian job market.

Through the program, 150 women have found employment. As a result, these women have increased their income and improved their skills, which has led to greater decision-making power at home, stronger social connections, and renewed self-esteem.

“This project has been a new chapter for me: new challenges, new friends, new skills, and a renewed sense of hope.”
—Participant in Livelihoods Program Women’s Track

Investing in People, Not Just Projects

In a world shaped by climate change, technological disruption, and economic uncertainty, traditional employment models are no longer enough to catalyze sustainable outcomes. Training programs that operate in isolation, disconnected from markets and real opportunities, risk producing skills without futures.

“I have taken part in similar workshops in the past where I wasn’t able to gain as much knowledge because the materials hadn’t been well thought out and were far too basic.”
—Participant in Livelihoods Program Youth Track

What this program demonstrates is a different approach: one that links people to real economic systems, integrates private sector actors, and prioritizes sustainability over short-term outcomes. It moves from training to employability, and from employability to meaningful economic participation.

“The networking opportunity that is included as part of the project scope and prospect of employment at project end were really appealing to me. To be able to gain so much knowledge and then be given a chance to use it is really exciting.”
—Participant in Livelihoods Program Youth Track

Redefining employability is not just a technical challenge—it is a moral one. It requires us to see people not as beneficiaries, but as contributors; not as problems to solve, but as potential to unlock. Employability is no longer just about getting a job. It is about building resilience, agency, and the capacity to thrive in a changing world.

In Kourfey, Niger, a problem was weighing heavily on Moussa Tahirou. As a teacher, he noticed that many of the young girls enrolled in primary school would suddenly disappear from the education system. The reason was almost always the same: early marriage.

“I realized that girls’ education was seriously threatened in my community, and that this was jeopardizing not only their future, but also that of the entire community,” said Moussa.

In the department of Filingué, where Kourfey is located, child marriage has not yet been eradicated. According to Mohamed Jimraou Sani, Departmental Director of Women’s Empowerment and Child Protection in Filingué: “Early marriage does exist here in Kourfey, but the majority of cases are not reported. We are only informed when serious problems arise: health complications, school dropouts, or rejection of the marriage by the girl herself.”

One former student had a particularly profound impact on Moussa: Aminata, a bright girl with dreams of one day working in health care. At 14, she was taken out of school and forcibly married to a 55-year-old man.

Shortly afterwards, Aminata became pregnant. When she suffered a serious complication, she was not taken to a health center. As a result, she lost her baby and developed an obstetric fistula, a condition that will have lifelong consequences for her health.

Moussa could not stay silent any longer.

In 2021, he mobilized young people around him and formed the Association of Young People for Sustainable Development in Kourfey (AJEDDUK) to drive community action in favor of health, education, and sustainable development. In 2024, through Moussa’s commitment, AJEDDUK was selected to join Pathfinder’s J-Matassa project. The project seeks to reduce early marriage, unwanted pregnancies, and maternal mortality; provide opportunities for personal and professional development; and strengthen women and young people’s financial autonomy so they can choose their own paths forward.

“It was a great opportunity for me to change things, transform mindsets, and give hope back to hundreds of young girls,” said Moussa.

J-Matassa, led by Pathfinder in consortium with Marie Stopes International and the Association of Young Girls for Reproductive Health, organized quarterly awareness-raising caravans and community dialogues. Between January and September 2025, these activities reached 51,718 people in 340 villages across seven health districts, building community awareness about issues related to reproductive health and the overall wellbeing of local communities.

Through J-Matassa, Moussa received training in advocacy, project management, gender-based violence response, organizational capacity strengthening, and technical support. “The support of the J-Matassa project helped me be better structure my activities, document them, and above all, achieve concrete objectives in the field,” said Moussa.

“Young men are also at the heart of the strategy,” he added. “Young men are often the ones to marry underage girls. When they are informed [about the issue], they, themselves, can become change agents and influence their families.”

Today, in the Filingué region, Moussa has many more allies in the fight against early marriage. Through relationships built through J-Matassa, he has support from religious and traditional leaders as well as technical divisions of local government. Despite initial resistance linked to tradition and cultural norms, the community dialogue approach is bearing fruit.

According to Moussa: “The changes are palpable: parents are publicly testifying that they have abandoned early marriage, some girls have been able to stay in school thanks to awareness-raising efforts, the community is expressing collective pride in actions taken, and even older people are asking to join or support the association.”

Additionally, with support from J-Matassa and in alignment with a recent presidential decree, the departmental directorate and local organizations have set up Village Child Protection Committees (CVPE). J-Matassa established a total of 85 CVPEs, with 12 members per committee. These CVPE play a critical role: early identification of child marriage, ongoing local awareness-raising, family mediation, and acting as a link between communities and government services.

“These committees are made up of influential people: village chiefs, religious leaders, health workers, school principals, young people, and women’s groups. These are actors to whom the communities will listen,” said Moussa.

Despite substantial progress, obstacles persist: insufficient legal enforcement, lack of birth certificates for many girls, and the falsification of documents to circumvent the legal age. Still, with commitment from community leaders like Moussa and young people across Filingué, we know that change is possible—and it is happening now.

“When the community thanks me, I feel useful. I know that my commitment has had a real impact,” said Moussa.

De la prise de conscience à l’action : le combat d’un enseignant pour maintenir les filles à l’école

À Kourfey, au Niger, un problème pesait lourdement sur Moussa Tahirou. En tant qu’enseignant, il avait remarqué que de nombreuses jeunes filles inscrites à l’école primaire disparaissaient soudainement du système éducatif. La raison était presque toujours la même : le mariage précoce.

« J’ai réalisé que l’éducation des filles était sérieusement menacée dans ma communauté et que cela compromettait non seulement leur avenir, mais aussi celui de toute la communauté », explique Moussa.

Dans le département de Filingué, où se trouve Kourfey, le mariage des enfants n’a pas encore été éradiqué. Selon Mohamed Jimraou Sani, directeur départemental de l’autonomisation des femmes et de la protection de l’enfance à Filingué : « Les mariages précoces existent ici à Kourfey, mais la majorité des cas ne sont pas signalés. Nous ne sommes informés que lorsque des problèmes graves surviennent : complications de santé, abandon scolaire ou rejet du mariage par la jeune fille elle-même. »

Une ancienne élève  a profondément marqué Moussa : Aminata, une jeune fille brillante qui rêvait de travailler un jour dans le domaine de la santé. À 14 ans, elle a été retirée de l’école et mariée de force à un homme de 55 ans.

Peu après, Aminata est tombée enceinte. Lorsqu’elle a souffert d’une complication grave, elle n’a pas été emmenée dans un centre de santé. Elle a donc perdu son bébé et développé une fistule obstétricale, une affection qui aura des répercussions sur sa santé pour le reste de sa vie.

Moussa ne pouvait plus rester silencieux.

En 2021, il a mobilisé les jeunes de son entourage et a créé l’Association des jeunes pour le développement durable à Kourfey (AJEDDUK) afin de mener des actions communautaires en faveur de la santé, de l’éducation et du développement durable. En 2024, grâce à l’engagement de Moussa, l’AJEDDUK a été sélectionnée pour participer au projet J-Matassa de Pathfinder. Ce projet vise à réduire les mariages précoces, les grossesses non désirées et la mortalité maternelle, à offrir des opportunités de développement personnel et professionnel, et à renforcer l’autonomie financière des femmes et des jeunes afin de leur permettre de choisir leur propre voie.

« C’était une formidable opportunité pour moi de changer les choses, de transformer les mentalités et de redonner espoir à des centaines de jeunes filles », a déclaré Moussa.

 J-Matassa, mené par Pathfinder International en consortium avec Marie Stopes International au Niger et l’Association des jeunes filles pour la santé reproductive, a organisé des caravanes de sensibilisation et des dialogues communautaires trimestriels. Entre janvier et septembre 2025, ces activités ont touché 51 718 personnes dans 340 villages répartis dans sept districts sanitaires, renforçant ainsi la sensibilisation aux sujets liés à la santé reproductive et au bien-être des communautés locales.

Grâce à J-Matassa, Moussa a reçu une formation en matière de plaidoyer, de gestion de projet, la prise en charge des cas de violence basées sur le genre , de renforcement des capacités organisationnelles et de soutien technique. « Le soutien du projet J-Matassa m’a permis de mieux structurer mes actions, de les documenter et, surtout, d’atteindre des objectifs concrets sur le terrain », a déclaré Moussa.

« Les jeunes sont également au cœur de la stratégie », a-t-il ajouté. « Ce sont souvent les jeunes qui épousent des filles mineures. Lorsqu’ils sont informés [du problème], ils peuvent eux-mêmes devenir des acteurs de la prévention et influencer leurs familles. »

Aujourd’hui, dans la région de Filingué, Moussa bénéficie de nombreux alliés dans la lutte contre les mariages précoces. Grâce aux relations qu’il a nouées avec J-Matassa, il bénéficie du soutien des chefs religieux et traditionnels ainsi que des services techniques gouvernementaux. Malgré une résistance initiale liée aux traditions et aux normes culturelles, l’approche fondée sur le dialogue communautaire porte ses fruits.

Selon Moussa : « Les changements sont palpables : les parents témoignent publiquement qu’ils ont abandonné le mariage précoce, certaines filles ont pu rester à l’école grâce aux efforts de sensibilisation, la communauté exprime sa fierté collective face aux mesures prises, et même les personnes âgées demandent à rejoindre ou à soutenir l’association. »

De plus, avec le soutien de J-Matassa et conformément à un récent décret présidentiel, la direction départementale et les organisations locales ont mis en place des comités villageois de protection de l’enfance (CVPE). J-Matassa a crée un total de 85 CVPE, composés chacun de 12 membres. Ces CVPE jouent un rôle essentiel : identification précoce des cas de mariage d’enfants, sensibilisation locale continue, médiation familiale et liaison entre les communautés et les services gouvernementaux.

« Ces comités sont composés de personnes influentes : chefs de village, chefs religieux, agents de santé, directeurs d’école, jeunes et groupes de femmes. Ce sont des acteurs auxquels les communautés prêtent attention », explique Moussa.

Malgré des progrès substantiels, plusieurs obstacles persistent : l’application insuffisante du cadre juridique, l’absence d’actes de naissance pour de nombreuses filles et la falsification de documents pour contourner l’âge légal. Néanmoins, grâce à l’engagement de leaders communautaires comme Moussa et des jeunes de Filingué, nous savons que le changement est possible et qu’il est en train de se produire.

« Lorsque la communauté me remercie, je me sens utile. Je sais que mon engagement a eu un impact réel. »

In this Q&A, we hear from Dr. Amina Dorayi, based in Abuja and serving as Pathfinder’s Regional Portfolio Director, West and Central Africa. 

What does “country-led” mean to you and Pathfinder’s work? 

Simply put, it means ensuring strategies are born and led in the countries where they live. We work with local partners to align Pathfinder’s support with national priorities and community needs, then identify a network of local champions to lead the work and advocate for its long-term future. 

How has Pathfinder’s country-led strategy ensured country-led approaches and solutions? 

We’ve equipped our country teams with the technical and operational authority to make independent decisions on finances, implementation, and partnerships. As a global organization, our leaders can draw on ‘South-to-South’ learning and global resources to fuel their local strategies. This allows us to reshape systems through advanced expertise and trusted, home-grown networks that bring the right decision-makers to the table. 

Can you give a specific example of how Pathfinder’s country-led approach is put into action? 

Nigeria has a recently revised community health worker strategy. We are taking that strategy and seeing how we can support certain states with implementing it. In practice, we sit together with state governments, partners, and donors to co-create, using data to inform us about health worker capacities and renumeration, health needs, and then we cost those strategies. Our aim is to reduce maternal and child deaths. We know that significant impact only happens when we use data to find out what works, what doesn’t, and exactly where system gaps are costing lives. 

What role does Pathfinder play in advancing country-led solutions? 

In addition to being a convener and government partner, we work with local community-based and civil society organizations to strengthen their own systems and policies, preparing them for growth, increased impact, and the ability to lead sustainable programs. Additionally, because our country and regional leaders at Pathfinder are part of our executive leadership, we share our expertise with a global audience, demonstrating the role that country-led solutions can play.   

How are the country-led approaches we support holding governments accountable for progress?  

We strengthen the capacity of advocates to hold governments accountable. For instance, we support journalists and bloggers who keep these issues in the public eye. We also convene civil society networks that use data to show where progress is stalling and where investment is vital. Most importantly, we listen to women. They are not just beneficiaries; they are active participants in design, monitoring, and advocacy. 

What makes our country-led approach sustainable? 

All of our programs are led by country nationals. By design, our support is grounded by lived experience. We have trusted leaders and strong country-based relationships. Sustainability requires we are part of the systems, reviewing policies and plans, engaging in design and review, monitoring and analyzing results. We are sought out by our country-based partners to do all of this.  

How does Women&Co—Pathfinder’s new strategy and innovation platform—build on our country-led approach to fuel women-led innovation? 

For Women&Co, our country-led approach is the foundation. In Nigeria, we identified women already driving change in their communities and provided a new platform to scale their solutions for health and climate resilience. We are giving young women, in particular, the space to network and lead. Every solution is designed and driven by the women who live there. 

If you had three words of wisdom about how successful country-led solutions are run, what would they be? 

Trust country teams: They know who to convene and ignite real systems change. 

Design with user: Country-led means the ingenuity of the people we serve drives the solution. 

Amplify women’s voices: Women know what works. They just need the platform to lead and be heard.   

Keep up with our country-led journey by subscribing to our Country-Led in Action newsletter on LinkedIn.

This critical challenge was evident when Pathfinder began supporting the Nasarawa state government to reach girls with the HPV vaccine: Although Nasarawa had made significant strides in vaccinating over 160,000 eligible girls, the official record told a different story.

When examining the data earlier this year, crucial vaccination records were missing from the first three months of the vaccination campaign in the national data system, DHIS2. The core issue was a quiet systemic struggle: Local Government Area (LGA) Monitoring and Evaluation Officers were not entering call-in data into DHIS2. This created a massive backlog.

When the official DHIS2 data entry windows for those first three months (Oct-Dec 2023) closed, thousands of vaccinated girls became numerically invisible. It was a profound irony: the state’s Ministry of Health and Primary Healthcare Development Agency had done the work, but lacked the evidence needed for informed decision-making about where to reach girls with the vaccine and remain accountable.

Supporting government with a system-led success

In response, the state Ministry of Health designed a practical, context-specific strategy to resolve capacity gaps hindering reporting, leveraging their partnership with the Federal Ministry of Health’s Department of Health Planning, Research, and Statistics, the custodians of DHIS2.

Pathfinder served as the technical assistance provider to the state government in executing the state’s strategy, which involved three critical phases:

• Working with the Federal Ministry of Health to temporarily reopen DHIS2’s data entry windows for all the backlog months.
• Organizing an intensive, hands-on two-day capacity-strengthening session. through the Federal Ministry of Health’s Health Information System Program to re-train all LGA Monitoring and Evaluation Officers.
• Ensuring the Monitoring and Evaluation Officers engaged directly with the DHIS2 platform, resolved specific data entry challenges using real-world examples, and learned simple visualization tools.

By following these steps, the backlog of campaign data that had been locked out for up to two years brought the state’s coverage figures to life for the first time.

Evidence-based decisions and accountability

Thanks to the state government’s decisive action and collaborative approach, long-missing vaccination figures from Nasarawa started appearing on DHIS2. The numbers stabilized, finally validating the efforts of health workers and completing the historical record of the vaccination campaign. The state could now confidently answer the guiding question of the campaign: “Yes, now we know where the girls are.”

With complete and current HPV vaccination data, the state can now easily see where there is low uptake and instantly identify performance gaps. Future outreach and corrective interventions will be fully evidence-based, not based on guesswork. The state can quickly respond to trends and detect girls who have not yet received the life-saving vaccine.

In Nasarawa state today, fewer girls are left to chance.

By strengthening local capacity and ensuring that data tells the truth, the state Ministry of Health made the system more agile and accountable, ensuring the right dose reaches the right girl at the right time, and securing her safer future.

Violence against women and girls is one of the most pervasive—and preventable—human rights violations in the world. This crisis is exacerbated by another: climate change.

Climate change and climate-induced emergencies—and their downstream effects on income, nutrition, water, and access to health services and products—are linked to increased rates of gender-based violence, child marriages, and poor sexual and reproductive health outcomes. Because climate change poses a disproportionate threat to the health and livelihood of women and girls, shifting harmful gender norms and practices among climate-vulnerable communities is critical.

That’s why, in honor of this #16Days of Activism Against Gender-Based Violence, we’re highlighting our new Toolkit for Applying a Gender-Transformative Approach to Women-Led Climate Resilience. This toolkit provides practical guidance for promoting women’s leadership and agency in improving community resilience to climate change and expanding access to quality health care.

Why are women and girls more affected by climate change?

Today, nearly 48 million more women than men face food insecurity and hunger. By 2050, climate change could drive 158 million more women and girls into poverty—16 million more than the anticipated number of men and boys. Some driving factors:

• Women are often responsible for gathering food, water, and fuel. As resources become scarce, women must work harder and travel farther to access them, hindering their economic pursuits and forcing girls to leave school.
• Climate change disrupts access to health care as women’s health threats proliferate. For example, rising temperatures are linked to stillbirths and transmission of vector-borne diseases.
• Climate-induced stress fuels rising rates of gender-based violence, including femicide, intimate partner violence, and child marriage.

How does the toolkit help?

While climate change programs often acknowledge the role of gender in differential outcomes for women and men, little guidance exists on how to develop programs that explicitly target these disparities while also promoting the leadership of women and girls. This toolkit provides practical resources, tools, and insights to fill this gap, based on Pathfinder’s experience implementing a women-led climate resilience program in Bangladesh and Pakistan.

What does the toolkit look like in action?

Our gender-transformative approach to women-led climate resilience is rooted in collaborative design and co-implementation. Through working closely with members of the community, local organizations, and institutional partners, we developed a five-pronged approach for improving gender equity across the individual, household, community, and institutional levels:

1. Examine how harmful gender norms and social expectations lead to disparities in power and access to resources
2. Work with communities to promote more equitable gender norms
3. Elevate the position of women, girls, and marginalized groups
4. Target the social structures and policies that perpetuate gender inequality
5. Engage boys and men as allies for achieving gender equality

This approach resonated—and sparked tangible, lasting change among climate-vulnerable communities in Bangladesh and Pakistan. This change was driven by community volunteers called Climate Champions.

Chandi and Mohin

Climate Champions Chandi and Mohin, a married couple, live in Umerkot, Sindh, Pakistan—an area experiencing increasingly frequent droughts and floods.

After participating in a workshop that brought together women, girls, men, and boys to discuss and challenge harmful gender norms, they were inspired to volunteer for Pathfinder’s Surmi Ke Sur, a community theatre initiative where men and women performed together, raising awareness about the impact of climate change on women and girls, speaking out against child marriage, and changing the way the community viewed traditional gender roles.

Today, Chandi is a community leader, and Mohin’s models and encourages men’s and boys’ allyship. Together, they have performed in over 50 community theater events, facilitating important conversations and catalyzing real change in attitudes and behaviors around gender equity.

read our toolkit for more on our CLIMATE CHAMPIONS’ impact

This toolkit will walk you through the three phases of our GTA approach: (1) Collaborative Design, (2) Co-implementation, and (3) Monitoring, Evaluation, and Learning. For each phase, you will find practical guidance, links to relevant tools and templates, and real-life examples of these concepts in action.

See more of our women-led climate resilience work in Pakistan

The cost to mothers and children is especially devastating: 1,049 women die of pregnancy-related complications for every 100,000 live births and 103 infants die among every 1,000 who are born. The need to deliver quality care, particularly for maternal and newborn health, is urgent.  

To better redistribute essential health service delivery tasks among available health worker cadres, Kano state adopted a Task-Shifting Task-Sharing (TSTS) policy.

Addressing a critical health workforce gap  

Pathfinder International and Impact Catalysts, in collaboration with government partners, took this policy from paper to practice through the TSTS Project in Kano. The program equipped 145 health care workers across 26 Local Government Areas (LGAs) with hands-on training in core primary health care competencies, from maternal and newborn health to family planning, immunization, and data use.  

Mentorship played a central role. Clinical mentors and LGA Monitoring and Evaluation Officers provide on-the-job guidance, helping providers apply their skills with confidence and use data to improve service quality. 

“Before this training, newborn resuscitation used to scare me. After the mentorship, I feel confident and ready. Just last month, I successfully resuscitated a newborn, and that moment reminded me why these skills matter.”
—CHEW, Kano State

The initial results from this practical, supportive model are promising. Facilities that were once inactive or underperforming began to improve. 

Data from participating primary health centers also showed measurable service improvements between August and September: 

These gains reflect not just new knowledge, but renewed confidence and stronger teamwork across the health system. 

Rahama primary health center leads the way 

On November 4, 2025, Rahama Primary Health Center in Bebeji LGA experienced one of its busiest days with nine women in labor, one expecting twins. Without mentorship, such a day might have overwhelmed the team. Thanks to the mentorship-led guidance of Hafsat Yusuf, a TSTS mentor, all nine deliveries, including the twin birth, were successfully managed without complications, postpartum hemorrhage, or neonatal deaths. The team demonstrated remarkable skills in labor monitoring, safe delivery, and immediate newborn care. Babies were immunized promptly, and mothers received essential postnatal attention within hours of delivery.

“I was struggling with partograph filling, but my mentor’s guidance improved my skills. I can now track labor progress accurately and make informed decisions.” 
—CHEW, Bebeji LGA

Learning and impact 

The Rahama experience illustrates the power of mentorship as a catalyst for transformation. It demonstrates that when healthcare workers are supported to learn, apply, and lead, the outcomes are immediate and lasting. 

“The mentorship has empowered me to take charge of my facility. I can now provide quality ANC, delivery, and postnatal care to my patients.”
—CHEW, Shanono LGA

The Kano TSTS model’s success can be traced to three core principles: 

1. Mentorship matters. Continuous, hands-on guidance bridges the gap between training and real-world practice. 
2. Data drives improvement. Facilities that track performance are more responsive to community needs. 
3. Confidence saves lives. Empowered providers deliver safer, more compassionate care. 

“The TSTS training has been a game-changer for our healthcare system. We have seen a significant improvement in the quality of services provided by our healthcare workers, and our M&E officers are now better equipped to track progress and identify areas for improvement.”
—Zonal Monitoring & Evaluation Officer

Looking ahead 

Kano’s health leadership is now taking the mentorship model forward, scaling it, owning it, and anchoring it in the primary healthcare system. For Pathfinder and partners, the work is shifting from direct support to ensuring the state can carry the transformation long after the project ends. 

Because each safe delivery in a small, rural health center is evidence that the system is learning, adapting, and becoming stronger from within. 

READ OUR PROGRESS BRIEF

Learn more about how Pathfinder is strengthening the foundation for task-shifting and task-sharing in Kano and Kaduna states.

This World AIDS Day arrives with a powerful symbol of scientific progress: lenacapavir, the long-acting injectable PrEP that can prevent HIV infection with just two doses a year, is now becoming available across several countries, including Eswatini and Zambia in Africa. For the first time, millions of people, especially adolescent girls and young women at highest risk, may soon have access to a discreet, highly effective prevention option that could reshape the global HIV response.

But history has taught us a hard truth: scientific breakthroughs do not transform epidemics on their own. We have seen it with antiretroviral therapy, early PrEP, and self-testing innovations. Tools only save lives when people feel safe and supported enough to use them. If stigma and discrimination persist, even the most promising technologies will remain out of reach for the very people they are meant to protect.

As we reflect on the 2025 World AIDS Day theme: Overcoming Disruption. Transforming the AIDS Response, one disruption remains stubbornly unchanged: HIV-related stigma.

Despite decades of progress, stigma continues to undermine prevention, testing, adherence, and retention in care. Recent global surveys show that more than 37% of people living with HIV (PLHIV) experience internalized stigma, nearly one in four report discrimination when seeking non-HIV health services, and just last year, 13% of PLHIV experienced discrimination when accessing HIV services. Furthermore, discriminatory attitudes persist, with 47% of respondents across 42 countries expressing negative views toward PLHIV (UNAIDS, 2024).

The persistence of stigma

HIV stigma is driven by cultural norms, social values, and entrenched misconceptions. Misinformation and fear fuel judgment and rejection in families, communities, schools, workplaces, and healthcare facilities. For many PLHIV, stigma is not only an external threat but also an internal burden, forcing them to  live with the constant expectation of rejection, further undermining their health and well-being.

Stigma often intersects with other forms of discrimination based on gender, sexuality, poverty, race, or social status, amplifying vulnerabilities for marginalized populations. For example, 49% of transgender people, 40% of people who inject drugs, 26% of sex workers, and 16% of gay men and other men who have sex with men reported recent experiences with discrimination. Structural barriers, such as inadequate access to health services, poverty, and social exclusion, make the problem even more complex, leaving PLHIV neglected and at the margins of society.

Stigma is both structural and deeply personal. It is rooted in longstanding cultural norms, gender inequalities, and misinformation. For many, the fear of being judged by a nurse, shunned by family, or ridiculed by peers is more frightening than the virus itself. When stigma intersects with other forms of discrimination, against transgender people, sex workers, people who inject drugs, and LGBTQ+ communities, the impact is magnified, pushing those most at risk further from services.

Communities at the heart of the solution

But communities are proving to be powerful agents of change. Community-driven initiatives like Operation Triple Zero (OTZ), a psychosocial support group in Kano state, Nigeria, where Pathfinder International had been working to strengthen HIV services, challenge stigma from within, shifting harmful attitudes and creating safe spaces where PLHIV can live openly and with dignity.

“Attending the OTZ meetings has boosted my morale. I’m so glad to meet other HIV-positive peers and make friends. I have learned that I can live and excel just like anyone else,” said a participant in the support groups. 

Local leaders, faith-based organizations, youth networks, and peer groups all play a central role in reshaping narratives about HIV by sharing accurate information and confronting myths. Storytelling and dialogue are particularly effective tools. When PLHIV share their journeys, they put a human face to the epidemic, replacing fear with empathy and connection. Such conversations dismantle stereotypes and encourage acceptance, transforming communities into environments where people feel supported rather than shamed.

“People living with HIV have the right to live free from discrimination. Dignity is not optional – it’s essential.” UNAIDS, 2025

Advocacy and policy change

Beyond personal interactions, grassroots campaigns have challenged discriminatory laws, promoted legal protections, and influenced national policies to safeguard the rights of PLHIV. By centering the voices of those most affected, advocacy not only influences public perception but ensures that reforms reflect lived realities. Social media campaigns, mobile health applications, and online support networks now complement in-person efforts, reaching wider audiences, amplifying stories, and rallying collective action against stigma and discrimination.

Building inclusive futures

Ultimately, addressing HIV-related stigma and discrimination is not simply about correcting misinformation, it is about transforming social norms and building inclusive societies. Community health workers and peer educators remain vital in this process, bridging the gap between health systems and households while normalizing HIV testing and treatment. Rights-based initiatives, such as support groups and anti-stigma campaigns, also help reduce prejudice in schools, workplaces, and healthcare settings.

When communities take ownership of the fight against stigma, they create environments where PLHIV can thrive without fear, helping move the world closer to the goal of ending HIV as a public health threat.

As lenacapavir and other innovations reach Africa, investing in communities is not optional—it is essential. Community health workers, case managers, and peer mentors bridge the gap between households and healthcare systems. Support groups and rights-based programming ensure that new technologies translate into real uptake, real adherence, and real impact.

Ending AIDS as a public health threat requires more than scientific innovation. It requires communities empowered to transform social norms, dismantle discrimination, and create the conditions where people can safely seek services, whether that is a twice-yearly injection, a viral load test, or lifelong treatment.

This World AIDS Day, let us celebrate the promise of lenacapavir and other emerging innovations, but let us also remember that science will not end AIDS. People will. Communities will.