International Journal for Equity in Health最新文献

{"title":"Leading by example: a migrant health researcher's journey from participation to epistemic justice and migrant-centred governance in public health research.","authors":"Maria Gabriela Uribe Guajardo","doi":"10.1186/s12939-026-03055-y","DOIUrl":"10.1186/s12939-026-03055-y","url":null,"abstract":"<p><p>Participatory and co-produced approaches are increasingly promoted in migrant health research to improve equity and ensure research reflects community priorities. Despite growing guidance on conducting research with migrants, migrants remain underrepresented in research leadership, governance, agenda-setting, and knowledge production. Drawing on lived experience as both a migrant and public health researcher, this reflective paper examines the evolution of a program of research spanning health and social care integration, public health emergency preparedness, and international collaborations with migrant communities, frontline workers, and researchers. The paper traces a progression from a focus on service responsiveness and integration towards broader questions of participation, power-sharing, and knowledge justice. Findings highlight the importance of sustained relationships, and community partnerships in generating meaningful and actionable evidence. The work demonstrates how recognising migrants as legitimate knowledge holders through shared governance, remuneration, authorship, and leadership roles can strengthen both the quality and relevance of research. These experiences illustrate a shift from consultation and collaboration towards migrant-led approaches to knowledge generation. The next stage of migrant health research should move beyond participation and co-production towards epistemic justice and migrant-centred governance. This requires challenging traditional hierarchies of expertise and recognising migrants not only as research participants but as leaders, agenda-setters, and producers of knowledge. Such approaches offer a pathway towards more equitable, accountable, and responsive public health research, policy, and practice.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gendered forms of intergenerational solidarity in the COVID-19 pandemic: an intersectional perspective on the public renegotiation of a moral resource for future health crises in Germany.","authors":"Eva Katharina Boser, Lena Dörmann, Niklas Ellerich-Groppe","doi":"10.1186/s12939-026-03014-7","DOIUrl":"10.1186/s12939-026-03014-7","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, 'intergenerational solidarity' became a prominent buzzword in public debates. At the same time, a resurge of ageist stereotypes could be observed that proved to be a constant structuring element in the public renegotiation of intergenerational solidarity. Despite a growing body of research indicating that the COVID-19 pandemic also had a significant impact on inequalities related to other social categories, such as gender, the interplay between appeals for intergenerational solidarity and other social inequalities in public debates has received limited attention.</p><p><strong>Methods: </strong>To examine how appeals to intergenerational solidarity and gender-related aspects are intertwined in times of crisis, we provide an intersectional perspective on the public renegotiation of intergenerational solidarity during the COVID-19 pandemic, using the example of the German media debate. Based on a qualitative content analysis of articles from two major German weekly newspapers, Die Zeit and Welt am Sonntag, published between March 2020 and June 2022 (n = 351), we identified two paradigmatic cases for an intersectional in-depth-analysis, focusing primarily on the categorial intersection of age and gender within the material.</p><p><strong>Results: </strong>We can observe not only a resurge of ageism and age-related stereotypes in these media representations regarding various aspects of intergenerational solidarity, but also their entanglement with gender norms. Prevailing notions of intergenerational solidarity in the media continue to rely on gendered and age-based assumptions that shape how the moral actors, the basis, contributions, and normative goals of intergenerational solidarity are elucidated. We critically discuss these claims against the backdrop of broader intersectional feminist philosophy literature on structural social inequities and injustices.</p><p><strong>Conclusions: </strong>Our findings illustrate the significance of a gendered and heteronormative generational divide in appeals for intergenerational solidarity that include pertinent gender and age stereotypes. Intergenerational solidarity proves to be a moral resource in times of crisis, even though it often runs the risk of reiterating and perpetuating gendered ageism. However, approaches from intersectional feminist philosophy can help to conceptualize intergenerational solidarity as a diversity-sensitive moral resource in impending health crises in Germany and beyond.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"eHealthism in inclusion health: a qualitative longitudinal study with women experiencing homelessness.","authors":"Sophie Nadia Gaber, Elisabet Mattsson, Anna Klarare, Jenny Eriksson Lundström, Penny Rapaport","doi":"10.1186/s12939-026-03061-0","DOIUrl":"10.1186/s12939-026-03061-0","url":null,"abstract":"<p><strong>Background: </strong>While inclusion health approaches are increasingly recognised in research, policy, and practice as essential to addressing health inequities and social exclusion, there is limited understanding of how women experiencing homelessness engage with digital health. This represents a salient knowledge gap, given the growing interest in digital health to improve access, flexibility, and patient empowerment for marginalised populations. This study aimed to explore: (1) how women experiencing homelessness access and use digital technologies to support their health and wellbeing in everyday life; and (2) how their engagement with digital health is shaped by, and shapes, their interactions with health and social care systems, as well as with third-sector organisations.</p><p><strong>Methods: </strong>This qualitative longitudinal study gathered data through narrative interviews and participant observations with nine women experiencing homelessness in London, England. Data were analysed using a three-phase phenomenological-hermeneutic approach inspired by Ricoeur's narrative and interpretation theory. Women with lived experience of homelessness contributed to the study design and recruitment processes, co-produced study materials, supported the analysis and interpretation of findings, and co-produced recommendations.</p><p><strong>Results: </strong>Using eHealthism as an interpretive lens, our analysis identified three themes: (1) Taking care of my health on my own terms - with or without digital tools; (2) When digital tools are not enough - I still need support; and (3) Digital health can work - but it's not the same as seeing someone face-to-face.</p><p><strong>Conclusions: </strong>Based on the findings, we propose a three-layer conceptual framework of exclusion mechanisms in eHealthism, along with corresponding recommendations for inclusion health. Together the individual, relational, and contextual layers of exclusion mechanisms challenge assumptions of individual responsibility and universal digital empowerment, highlighting the need for meaningful choice in hybrid care and for ongoing, trauma‑informed relational support. Addressing these complexities is essential for developing inclusive digital health strategies that advance health equity for women experiencing homelessness and other groups at risk of social exclusion.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-led solutions to promote safe institutional deliveries in scattered tribal settlements of Madhya Pradesh, India.","authors":"Piyush Bhatt, Anviti Awasthi","doi":"10.1186/s12939-026-02849-4","DOIUrl":"10.1186/s12939-026-02849-4","url":null,"abstract":"<p><strong>Background: </strong>In Madhya Pradesh, India, the Department of Public Health and Medical Education has undertaken initiatives to promote institutional deliveries in aspirational districts through community engagement and the involvement of frontline health workers. However, in districts with scattered settlements, hilly terrain, and difficult-to-reach hamlets, geographic and infrastructural barriers continue to constrain maternal health outcomes. In the tribal district of Barwani, traditional beliefs and cultural preferences further reinforce the community's reliance on home-based deliveries, which increase the risk of preventable maternal and neonatal complications and deaths. To address these intersectional inequities in rural India, the Antara Foundation, a public health nonprofit, piloted a community-led Home Delivery Prevention Model in Pati block of Barwani district. The model aimed to quantify and address barriers contributing to home deliveries through the active involvement of the local community. Institutional delivery was used as a proxy indicator for access to institutional maternal care.</p><p><strong>Objective: </strong>This paper documents the implementation of the model that ensures institutional deliveries among pregnant women in 'hard-to-reach' hamlets (faliya) and explores how locally driven, community-led approaches can promote equitable access to public healthcare in remote, indigenous settings.</p><p><strong>Methodology: </strong>The model, designed in December 2023 with the help of community volunteers, was implemented from January to June 2024. A mixed-methods approach was used, with quantitative analysis of government data to identify pilot areas. Content analysis of the qualitative data, which was collected by the implementation team from pregnant women and their families through FGDs and interviews, informed the community action. A purposive sample of 127 pregnant women was selected across five sub-health centres (SHCs) with the highest number of home deliveries. Data collected was stored, handled and managed ethically throughout the pilot, guided by the Declaration of Helsinki 2024.</p><p><strong>Results: </strong>The intervention demonstrated preliminary improvements in family and local community support, resulting in institutional delivery for 83% of pregnant women who gave birth during the study period.</p><p><strong>Conclusion: </strong>This pilot study provides evidence that community-led models, grounded in local participation and integration with public systems, can enhance the uptake of institutional care in regions with high geographic and social inequities.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healing our intergenerational wounds: a praxis of community healing envisioned by refugee young adults engaging in participatory avatar-based community circles.","authors":"Vivetha Thambinathan, Lloy Wylie, Deluxna Ganesh, Luxana Ramesh, Elizabeth Anne Kinsella","doi":"10.1186/s12939-026-02993-x","DOIUrl":"10.1186/s12939-026-02993-x","url":null,"abstract":"<p><p>Refugee communities across the world have long gathered to connect and support one another during times of crisis, and this has been well-documented. Despite the vast amount of literature pertaining to coping and resiliency among refugee communities, there is limited knowledge about refugee community healing. Approximately one in three refugees experiences depression, anxiety, or post-traumatic stress that can persist long after displacement. Dominant approaches within Western, Educated, Industrialized, Rich, Democratic (WEIRD) psychologies tend to conceptualize trauma through an individualistic lens, often overlooking social, historical, and collective dimensions of suffering. This can result in siloed findings with limited relevance to refugee communities. Addressing this gap, this paper reports on the third phase of a Decolonizing Participatory Action Research (PAR) study examining historical trauma and intergenerational healing among second-generation Tamil refugee young adults in Toronto. This community-driven study foregrounds a praxis of healing envisioned with, by, and for refugee communities. Two research questions guided the inquiry: (1) What elements are important for community healing among Tamil young adults? and (2) What do community healing practices and therapeutic interventions look like in this context? Using storytelling and participatory avatar-based community circles, alongside reflexive thematic analysis, seven key elements of community healing were identified: (1) agency and self-determination; (2) historical trauma-informed approaches; (3) cultural safety; (4) intergenerational connectedness and belonging; (5) destigmatized access and delivery; (6) holistic and authentic healing practices; and (7) truth-telling as justice. Findings highlight community healing as a dynamic, dialectical process, requiring both resistance to intersecting systems of oppression and the cultivation of radical hope for justice and liberation. Findings also emphasize the importance of culturally grounded, community-led interventions in promoting mental well-being. This study contributes innovative, participatory methodology and actionable insights for practitioners and policymakers, advancing a shift toward liberatory approaches to refugee health.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental illness stigma and treatment-seeking willingness in Japan: a national survey study.","authors":"Andrew M Subica, Shinichi Nagata","doi":"10.1186/s12939-026-03007-6","DOIUrl":"10.1186/s12939-026-03007-6","url":null,"abstract":"<p><strong>Background: </strong>Japanese adults report high mental illness stigma and low treatment use, yet the specific public stigma beliefs and attitudes associated with Japanese treatment seeking remain unclear. This study had three aims: (1) describe public stigma in a national Japanese sample and compare these patterns descriptively with U.S. public stigma, (2) examine which Japanese public stigma components independently predicted Japanese treatment-seeking willingness, and (3) examine the effects of the potential facilitators of mattering and prior treatment experience on Japanese treatment-seeking willingness.</p><p><strong>Methods: </strong>Data were collected from a geographically representative national online sample of 1,012 Japanese adults, assessing treatment-seeking willingness and vignette-based measures of public stigma involving perceived seriousness and treatability, causal attributions, desired social distance, and perceived dangerousness. Japanese participants were compared with U.S. adults from the 2018 U.S. General Social Survey. Linear regression examined public stigma predictors and potential facilitators (e.g., mattering) of Japanese treatment-seeking willingness.</p><p><strong>Results: </strong>Only 54% of Japanese participants reported treatment-seeking willingness, with low perceived treatment need. In descriptive cross-national comparisons, Japanese participants reported significantly lower rates of perceived mental disorder seriousness, lower beliefs in treatment effectiveness/recovery, and fewer neurobiological attributions, with higher desired social distance but lower perceived dangerousness than U.S. adults. Within the Japanese sample, believing treatment would improve mental disorders, greater mattering, and prior treatment experience independently predicted greater treatment-seeking willingness, while believing disorders would improve without treatment and greater desired social distance predicted lower willingness.</p><p><strong>Conclusions: </strong>Findings revealed a pattern of Japanese public stigma marked by high social distancing and treatment/recovery pessimism that may contribute to low treatment-seeking willingness and unmet mental health need. Positively, mattering emerged as a possible treatment-seeking facilitator. Public stigma and mattering may therefore represent potentially modifiable treatment-seeking barriers and facilitators, respectively, with implications for supporting mental health equity in Japan and addressing Japan's treatment gap.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moving beyond the average: a method to measure health related-inequalities within randomised trials.","authors":"Zachary D V Abel, Sophie Cole, Guido Erreygers, Laurence S J Roope, Philip M Clarke","doi":"10.1186/s12939-026-02977-x","DOIUrl":"10.1186/s12939-026-02977-x","url":null,"abstract":"<p><strong>Background: </strong>Randomised trials seldom investigate the impacts interventions have on socioeconomic inequality in health, focusing instead on their average treatment effects.</p><p><strong>Methods: </strong>We illustrate how standard measures of inequality such as the corrected concentration index can be reported in randomised experiments to quantify the interventions' socio-economic distribution effect alongside more traditional average treatment effects. We illustrate this with a proof-of-concept example using a study on the impact of information and financial incentives on verified COVID-19 vaccination uptake in rural Ghana (n = 2,271). We estimate the distributional treatment effects of informational public health messaging, low- and high-cash financial incentives relative to a placebo group and present this information on an achievement plane.</p><p><strong>Results: </strong>Health messaging had a pro-rich socioeconomic inequality impact of -0.132 [95% CI: -0.28-0.02] relative to the placebo group, while the low and high cash incentives had impacts of -0.108 [95% CI: -0.29-0.07] and - 0.081 [95% CI: -0.26-0.11] respectively, providing no significant evidence for changes in inequality relative to the placebo group. A low-cash incentive was the only intervention that was shown to increase vaccination uptake.</p><p><strong>Conclusions: </strong>A socioeconomic inequality of health distributional indicator could routinely be calculated in experimental results and presented alongside average treatment effects. This would enable the identification of whether there are equality-efficiency trade-offs. The methods presented in this paper can be used to support policy decision making with representative datasets provided there is appropriate statistical power.</p><p><strong>Trial registration: </strong>The RCT investigated in this paper was registered with the American Economic Association on January 10, 2022, RCT ID: AEARCTR-0008775.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health support for people on the move: a qualitative exploration of civil society organizations' roles and obstacles along the Balkan route.","authors":"Fabian Link, Zeliha Öcek, Apostolos Veizis, Michaela Coenen","doi":"10.1186/s12939-026-03048-x","DOIUrl":"10.1186/s12939-026-03048-x","url":null,"abstract":"<p><strong>Background: </strong>People on the move (POTM) are individuals in ongoing migration processes, often facing significant health risks and structural barriers to equitable access to essential services despite international frameworks recognizing healthcare rights. Civil society organizations (CSOs) play a key role in addressing these gaps. This study examines CSOs' health support for POTM from the perspective of CSO workers, using the Balkan Route as a case study.</p><p><strong>Methods: </strong>This qualitative study included CSO staff providing health-related support to POTM along the Balkan Route. Participants were recruited through purposive and snowball sampling across 11 countries. Data were collected between March and May 2024 through semi-structured, in-depth interviews addressing healthcare access, service gaps, CSO roles, challenges, and institutional relations. Interviews were analyzed using qualitative content analysis.</p><p><strong>Results: </strong>Fifteen CSO workers from 11 countries participated, representing local, national, and international CSOs. Analysis identified four main categories: (1) Structural and Sociopolitical Context (2), POTM (3), National Healthcare Systems (4), CSOs. Participants described fragmented migration governance, limited health system capacities, discrimination, and legal barriers as key determinants of healthcare access. POTM experienced cumulative health risks and multiple structural, administrative, and communication barriers. Although states were viewed as primarily responsible for healthcare provision, participants consistently reported that CSOs filled critical gaps by delivering health-related services, facilitating access through mediation, and advocating for more equitable healthcare. However, these roles were constrained by unstable funding, workforce shortages, political pressures, and ethical tensions regarding the substitution of state responsibilities. Trust and collaboration between CSOs, healthcare providers, public authorities, local communities, and POTM emerged as essential for effective healthcare support.</p><p><strong>Conclusions: </strong>CSOs are central to healthcare in supporting healthcare access for POTM, particularly through their mediating role between migrants, healthcare systems, and public authorities. Strengthening trust-based collaboration while preserving CSO independence and maintaining state accountability may contribute to more equitable healthcare access in migration contexts.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"More work means less pay\": a qualitative understanding of physicians' patient selection decision-making under DRG reform in Nanjing, China.","authors":"Xiaoying Zhu, Daniel Ll Strachan, Shenglan Tang, Tiara Marthias, Ajay Mahal, Barbara McPake","doi":"10.1186/s12939-026-03044-1","DOIUrl":"10.1186/s12939-026-03044-1","url":null,"abstract":"<p><strong>Background: </strong>Patient selection, also known as 'cream-skimming', can lead to the systematic exclusion of high-cost, clinically complex patients from necessary care. It has been identified as an opportunistic response under Diagnosis-Related Groups (DRGs) payment systems globally. As China advances the rollout of DRG reform alongside commitments to promoting healthcare equity, understanding the ecology of physicians' cream-skimming behaviour and how to mitigate it is imperative.</p><p><strong>Methods: </strong>We purposively sampled 21 physicians from two hospitals with different incentive structures in 2024 and conducted semi-structured face-to-face interviews on their experiences with and responses to DRG reform. Data were analysed using an inductive thematic approach followed by deductive framework analysis.</p><p><strong>Results: </strong>We found that, in this study setting, physicians often assessed whether the expected reimbursement would cover the anticipated treatment costs when making admission decisions, with patient selection emerging as an adaptive response to DRG payment incentives. Their decisions were shaped by interacting factors related to capability, opportunity, and motivation. Capability captured physicians' confidence in managing financially risky cases; opportunity encompassed the physical and social conditions that enabled them to balance financial risk with quality of care; and motivation concerned the value they placed on different outcomes. Physicians were more likely to admit financially risky patients when three dimensions aligned: they believed that these patients could be effectively managed under DRG payment, expected their decisions to produce meaningful and recognised outcomes, and valued those outcomes, including patient welfare and the fulfilment of professional obligations.</p><p><strong>Conclusions: </strong>The findings suggest that physicians' responses to DRG payment are driven not only by formal payment rules but also by how financial risks are perceived and mediated within hospitals and the broader health system. Improving equitable access requires realigning performance metrics with clinical needs, strengthening referral and post-acute care pathways, and reducing reliance on individual risk-based decision-making through team-based support.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond physical access: disability-inclusive primary health care as a test of health equity in Sub-Saharan Africa.","authors":"Mohamed Daud Mohamed, Yakub Burhan Abdullahi, Abdikadir Ahmed Hassan, Iqro Omar Ibrahim, Liban Abdullahi Sudi, Nuradin Abdullahi Sheikh Rashid","doi":"10.1186/s12939-026-03000-z","DOIUrl":"10.1186/s12939-026-03000-z","url":null,"abstract":"<p><p>Disability inclusion in primary health care is not a peripheral issue but a fundamental test of whether health systems in sub-Saharan Africa are advancing health equity and universal health coverage. Persons with disabilities experience persistent and overlapping barriers across the care pathway, including physical inaccessibility, unaffordable services, inaccessible information, poor provider communication, stigma, weak referral systems, and limited access to rehabilitation and assistive technology. These barriers are intensified by poverty, gender inequality, rural residence, and under-resourced health systems, producing avoidable inequities in access, quality, continuity, and financial protection. This commentary argues that disability-inclusive primary health care should be reframed from a narrow focus on physical access to a broader agenda of health-system accountability. Drawing on recent evidence from sub-Saharan Africa, it highlights how exclusion is embedded in routine system design, financing, workforce capacity, data systems, and governance. The paper further argues that meaningful inclusion requires disability-disaggregated monitoring, accessible communication, reasonable accommodation, provider training, strengthened referral pathways, financing for rehabilitation and assistive products, and formal participation of persons with disabilities and their representative organizations in planning and oversight. Disability-inclusive primary health care is therefore not a specialist add-on, but a core measure of whether universal health coverage reforms are genuinely equitable, people-centered, and resilient. Embedding disability inclusion into routine primary health care performance systems offers a practical pathway to stronger accountability and more inclusive health systems across sub-Saharan Africa.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}