The quality of healthcare is generally low, but improving. In 2010, 91 children died before their fifth birthday for every 1000 live births, often from diarrhea, malaria or pneumonia. However, this figure is improving steadily; in 1990 there were 163 under five deaths for every 1000 live births. There is a shortage of qualified medical professionals in the country, and some medicines are in short supply or unavailable. 87% have access to healthcare but there are only two doctors and two paramedics per 100,000 people. The government is seeking to improve the situation as part of the Vision 2020 development programme. In 2008, the government spent 9.7% of national expenditure on healthcare, compared with 3.2% in 1996. It also set up training institutes including the Kigali Health Institute (KHI). Health insurance became mandatory for all individuals in 2008; in 2010 over 90% of the population was covered. Prevalence of some diseases is declining, including the elimination of maternal and neonatal tetanus and a sharp reduction in malaria morbidity, mortality rate, and specific lethality, but Rwanda’s health profile remains dominated by communicable diseases. HIV/AIDS seroprevalence in the country is classified by the World Health Organization as a generalized epidemic; an estimated 7.3% of urban dwellers and 2.2% of rural dwellers, aged between 15 and 49, are HIV positive.