International Journal for Equity in Health最新文献

{"title":"Dollars and dilemmas: lenacapavir's pricing, patents, and the path to affordability.","authors":"Victor Abiola Adepoju, Abdulrakib Abdulrahim","doi":"10.1186/s12939-025-02610-3","DOIUrl":"10.1186/s12939-025-02610-3","url":null,"abstract":"<p><p>Lenacapavir (Yeztugo), the world's first twice-yearly human immunodeficiency virus (HIV) prevention injection, offers transformative potential but faces a critical challenge: affordability. While its production cost is estimated at just $25 per person annually, projections place its market price at over $25,000 in high-income settings, a 1000-fold markup that could restrict access in low- and middle-income countries (LMICs). Gilead's licensing agreements with six generic manufacturers, covering 120 low-income countries, mark a step forward. However, upper middle-income countries with significant HIV burdens remain excluded. Four of these excluded countries namely Argentina, Brazil, Mexico, and Peru that hosted the pivotal PURPOSE-2 trial, due to ongoing high HIV transmission among sexual and gender minorities (SGM) and their historical underrepresentation in HIV clinical trials. This raises serious concerns about post-trial access. Moreover, the licensing terms limit flexibility, restrict generic sales outside designated territories, and omit price caps. Without broader coverage or concrete affordability commitments, millions may be left behind. Patent filings and the absence of a Medicines Patent Pool (MPP) partnership also amplify structural barriers. To meet global HIV targets, lenacapavir's rollout must be guided by equity, not monopoly. The coming year will be decisive and will determine whether this breakthrough becomes a global game-changer or another symbol of structural health inequity.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"270"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292051","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 disease burden: the urgent need to address maternal health disparities among Indigenous populations in Latin America.","authors":"Edson Serván-Mori, Sergio Meneses-Navarro","doi":"10.1186/s12939-025-02600-5","DOIUrl":"10.1186/s12939-025-02600-5","url":null,"abstract":"<p><strong>Background: </strong>Despite significant advances in documenting health disparities among Indigenous populations in Latin America, maternal health inequities remain underexplored. Indigenous women in the region face disproportionately high maternal mortality rates, obstetric complications, and inadequate access to maternal health services, exacerbated by systemic barriers such as poverty, geographical isolation, and institutional racism.</p><p><strong>Methods: </strong>This commentary critically examines the recent review, which provides a comprehensive overview of health disparities affecting Indigenous populations but neglects maternal health. By synthesizing evidence from recent studies, the commentary underscores the urgent need to address maternal health disparities as a key area of health system reform.</p><p><strong>Findings: </strong>Emerging evidence highlights that maternal health disparities among Indigenous women are not only pervasive but also indicative of broader structural discrimination embedded in health systems. Discrimination related to ethnicity, gender, and socioeconomic status compounds maternal health inequities, leading to preventable maternal mortality and morbidity. These patterns persist despite the relatively low cost of essential maternal health services, such as antenatal care, skilled birth attendance, and emergency obstetric care.</p><p><strong>Conclusions: </strong>Addressing maternal health disparities among Indigenous populations in Latin America is crucial for advancing UHC. Integrating equity-oriented policies and targeted interventions that dismantle structural discrimination could substantially reduce preventable maternal deaths and morbidity. Future reviews and regional assessments must prioritize maternal health to provide a more comprehensive understanding of health inequities in the region, aligning with global health equity frameworks and UHC goals.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"276"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292042","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":"The impact of poverty on child malnutrition and health in Lebanon: the need for multisectoral interventions.","authors":"Nicolai Petry, Omar Obeid, James P Wirth, Carla El-Mallah, Mira El Mokdad, Joelle Najjar, Gloria Safadi, Nour El Houda Ezzeddine, Layal Jaafar, Yasmine Ibrahim, Valeria Galetti, Fabian Rohner, Diana Kobayter, Mirella Abi Zeid Daou, Farah Asfahani, Firass Abiad, Amirhossein Yarparvar","doi":"10.1186/s12939-025-02652-7","DOIUrl":"10.1186/s12939-025-02652-7","url":null,"abstract":"<p><strong>Background/objectives: </strong>Poverty and child malnutrition are deeply interconnected. Socioeconomic disparities limit access to adequate nutrition, healthcare, and education, and can lead to long-term developmental and economic consequences. This study examines the relationship between poverty and nutritional status, micronutrient deficiencies, and recent illnesses in children in Lebanon.</p><p><strong>Methods: </strong>Data was collected as part of a national stratified cross-sectional household-based survey conducted in 2023. A total of 1,594 children aged 0-59 months were included in the analysis. Principal component analysis was used to create a household-level poverty index using indicators related to household-level ownership of durable goods, dwelling characteristics, food security status, and relevant livelihood coping strategies. Bivariate analyses were used to estimate the associations between poverty status and nutritional status indicators (i.e., stunting, underweight, wasting, anemia, iron deficiency, and vitamin A deficiency), multiple nutritional deficiencies, and recent illnesses indicators (i.e., diarrhea, fever, and lower-respiratory infection). Multivariable logistic regressions were used to estimate the association between poverty and nutrition and illness indicators and were further evaluated using Concentration Index Curves (CIC).</p><p><strong>Results: </strong>Multivariate analyses revealed significantly higher odds of stunting (OR: 5.27, 95% CI: 2.60, 10.66), underweight (OR: 5.46, 95% CI: 1.52, 19.56), vitamin A deficiency (OR: 2.65, 95% CI: 1.1, 6.33), diarrhea (OR: 1.99, 95% CI: 1.2, 3.3), fever (OR: 2.39, 95% CI: 1.52, 3.77) and lower respiratory infection (LRI, OR: 4.85, CI: 1.36, 17.26) for children from the poorest households compared to those from the wealthiest households. CIC showed that children from poor households were disproportionally affected by anemia, iron deficiency and wasting. Further, children with lower socioeconomic status were disproportionally affected by multiple deficiencies: 57.1% of children who suffered from 2 deficiencies were located in the lowest two poverty quintiles and 57.6% of those with three or more deficiencies were from the poorest households.</p><p><strong>Conclusion: </strong>Our findings underscore the profound impact of poverty on child malnutrition and infections. To effectively and sustainably address these challenges, a holistic, multisectoral approach is needed, combining targeted nutritional programs, social protection programs, WASH initiatives and educational interventions to break the cycle of poverty and malnutrition.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"267"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292047","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":"Assessing urban-rural inequality in the primary healthcare system readiness to provide postpartum care for mothers and newborns in Burkina Faso: a Gini index decomposition analysis.","authors":"Kadari Cisse, Danielle Yugbaré Belemsaga, Siaka Lougue, Adama Baguiya, Aristide Romaric Bado, Soumaila Traore, Henri Gautier Ouedraogo, Seni Kouanda","doi":"10.1186/s12939-025-02595-z","DOIUrl":"10.1186/s12939-025-02595-z","url":null,"abstract":"<p><strong>Background: </strong>Maternal and neonatal mortality have declined significantly in sub-Saharan Africa (SSA). Postpartum care is one of the most neglected components of healthcare. It still drives maternal and neonatal mortality in SSA. Studies have shown a gap between urban and rural areas in terms of maternal and newborn healthcare (MNHC) services, including postpartum care utilization. However, little is known about the gap in postpartum care provision. Our study aimed to assess urban‒rural inequalities in healthcare system preparedness to provide postpartum care for mothers and newborns in Burkina Faso.</p><p><strong>Methods: </strong>We analyzed data from the National Harmonized Health Facilities Assessment (HHFA) survey conducted in all health facilities (HFs) in 2020 in Burkina Faso. Only health facilities of primary level of healthcare were included. The availability of and readiness for postpartum care for mothers and newborns were analyzed using the World Health Organization (WHO) HHFA guidelines. The Gini index was used to assess urban-rural inequalities. It was decomposed in overall Gini index which measures the inequality based on the all the primary healthcare facilities and within-group Gini index which quantifies the inequality within each subgroup (urban and rural areas).</p><p><strong>Results: </strong>Out of 2115 HFs, 387 were in urban areas (18.3%). All postpartum services for mothers and newborns were available in 58.4% of the HFs in urban areas versus 83.9% in rural areas (p < 0.001). The overall readiness score was 58.4% (52.1% in urban areas compared with 59.8% in rural areas; p < 0.001). The urban‒rural differences in readiness were primary driven by difference in staff and guidelines domain (36.3% and 42.3%, p < 0.001) and the medicines and products domain (55.2% and 70.6%, p < 0.001). The differences were also significant for the first point of contact with the healthcare system (health centers: 52.9% and 59.8%, p < 0.001). The overall Gini index was 0.167 (95% CI: [0.161-0.172]), with a higher inequality index for private HFs and hospitals. The within-group Gini index was higher in urban areas (0.204 [95% CI: 0.190-0.219]) than rural areas (0.145 [95% CI: 0.139-0.150]).</p><p><strong>Conclusion: </strong>Our findings suggest an overall lower readiness score for the postpartum care, with a low overall and within urban and rural areas inequality. Even low, reducing these inequalities might help to provide high-quality postpartum care for all mothers and newborns regardless of their place of residence.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"274"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292102","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":"A scoping review of equity toolkits for international academic partnerships.","authors":"Chelsea E Modlin, Prakriti Shrestha, Larry W Chang, Joseph Ali, Nelson K Sewankambo, Chizoba Wonodi","doi":"10.1186/s12939-025-02632-x","DOIUrl":"10.1186/s12939-025-02632-x","url":null,"abstract":"<p><strong>Introduction: </strong>When there are frank asymmetries in power, resources, and capacity efforts to advance academic collaboration are essential for the conduct of ethical partnership-based health research, education, and policymaking. Numerous toolkits are available that provide structured templates for academic partnerships and other key stakeholders to systematically evaluate and reflect on how their practices enhance or inhibit equity. However, there is no comparative analysis available to examine similarities and differences between the multitude of toolkits available.</p><p><strong>Method: </strong>We conducted a comprehensive scoping review of international partnership equity toolkits across the domains of global health research, education, and practice in four academic databases (PubMed, Scopus, Web of Science, and WHO Regional Indexes) and grey literature. The search took place June through August 2023. A primary search used broad keyword combinations followed by a secondary search of toolkit titles identified during the primary search. PRISMA extension for scoping reviews was followed. Key themes, motivations, development processes, application practices, and uses of these toolkits were examined by a combination of (1) templated extraction of data and (2) applying an inductive and iterative coding approach by two independent reviewers.</p><p><strong>Results: </strong>Within the academic databases, 7580 abstracts were screened (7580 primary, 198 secondary), 120 documents underwent full-text review (112 primary, 8 secondary) and 27 articles (26 primary, 1 secondary) met inclusion criteria. Within the grey literature, 104 articles and webpages (40 primary, 64 secondary) met inclusion criteria. Seventeen toolkits were identified. The majority were geared toward evaluating research (n = 15) rather than education (n = 2) or practice (n = 0) partnerships. Toolkits covered a broad range of objectives, development methods, and target audiences. Twenty-three countries were represented in the creation of the toolkits; however, less than half (8/17, 47%) of toolkits had representation from low- or low/middle-income countries. We identified six broad categories within the toolkits - oversight, partnership dynamics, ethical foundation, contextual factors, partnership procedures and activities, and capacity. Under these, themes such as stakeholder engagement, communication, partnership outputs, clarification of roles and responsibilities, funding, and management of data or other products generated by the partnership were common.</p><p><strong>Conclusion: </strong>There was variability in the development, intended audience, and application methods of the toolkits, yet there was also substantial thematic content overlap. Limited information on the application or use of toolkits is available. To date, there is no data on whether these toolkits resulted in equity-oriented changes in partnership practices or policy.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"268"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292012","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":"Influence of a pilot urban primary healthcare model on the use of medically trained healthcare providers among the low-income slum populations in Bangladesh: findings from an implementation research study.","authors":"Md Golam Rabbani, Zakir Hossain, Khadija Islam Tisha, Kamrun Nahar, Zillur Rahman Sakin, Towhida Nasrin, Mohammad Wahid Ahmed, Md Zahid Hasan, Chandrasegarar Soloman, Margub Aref Jahangir, Maya Vandenent, Shehrin Shaila Mahmood","doi":"10.1186/s12939-025-02622-z","DOIUrl":"10.1186/s12939-025-02622-z","url":null,"abstract":"<p><strong>Background: </strong>Delivering quality primary healthcare to the urban population has been challenging in many developing countries including Bangladesh. With a fragmented and pluralistic urban health system, the country experiences major hurdles in the provision of primary healthcare to its urban dwellers. Since 2021, an urban primary healthcare model called 'Aalo Clinic' is being piloted to serve the low-income urban population in Bangladesh. With an aim to ensure universal health coverage for the urban population, the model delivers an essential package of health services. We aimed to assess the implementation effect of this pilot model on the utilization of healthcare from medically trained providers (MTPs) for the management of acute illness.</p><p><strong>Methods: </strong>Following a cross-sectional study design, an implementation research study was conducted between October 2021 and August 2023 in the Korail, Mirpur, Shyampur, Dhalpur, and Tongi-Ershadnagar slums. Cross-sectional household surveys were conducted at baseline and end-line, involving over 2000 households in each round. Descriptive analysis and Chi-squared test were performed to assess the changes in healthcare utilization from MTPs, and logistic regression models were applied to assess the effectiveness of the model on healthcare utilization from MTPs while controlling for other covariates.</p><p><strong>Results: </strong>The utilization of healthcare from MTPs was significantly higher in the end-line (9.81% from Aalo Clinic and 18.6% from non-Aalo Clinic MTPs) compared to the baseline (0.64% from Aalo Clinic and 17.68% from non-Aalo Clinic MTPs). Healthcare utilization from local drug stores declined from 80.56% at baseline to 67.19% at end-line. Multivariate logistic regression showed respondents were 12.43 times more likely (95% CI: 7.49-20.63) to use Aalo Clinic services at end-line, indicating increased uptake of medically trained providers following the model's implementation.</p><p><strong>Conclusions: </strong>The Aalo Clinic Model was effective in influencing healthcare-seeking pattern of the slum populations and enhancing the utilization of qualified care from MTPs. The study supports replicating the model within existing healthcare structures and scaling it nationwide to advance universal health coverage in urban Bangladesh, contingent on sustained government funding for its operations.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"273"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292040","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":"Ethnic inequalities and contraception in Latin America and the Caribbean: a scoping review.","authors":"Paulina Ríos-Quituizaca, Jesus Endara-Mina, Sergio Ramos-Avasola, Alisson Yánez, Nancy Armenta-Paulino","doi":"10.1186/s12939-025-02501-7","DOIUrl":"10.1186/s12939-025-02501-7","url":null,"abstract":"<p><strong>Background: </strong>One of the Sustainable Development Goals (SDGs) is SDG 3.7. Ensuring universal access to sexual and reproductive health. The COVID-19 pandemic exacerbated pre-existing inequalities, disproportionately impacting ethnic groups in Latin America and the Caribbean (LAC). This review examines 23 years of evidence on contraceptive inequalities among these populations.</p><p><strong>Methods: </strong>A comprehensive literature review was conducted covering the period from 2000 to 2023 across seven databases. A combination of natural language and MESH/DECS terms was used, focusing on ethnicity and contraception in LAC countries. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR), 856 studies were identified. After title and abstract screening, 92 full texts were reviewed, and 33 studies were included that analyzed or compared contraceptive coverage based on ethnicity.</p><p><strong>Results: </strong>The countries with the highest output on this topic are Guatemala, Mexico, and Ecuador. More than half (22) relied on national representative surveys, with most focusing on women of reproductive age, while only five included adolescents. Eight studies analyzed Afro-descendant populations, and 27 studies included indigenous populations. Although some studies reported increases in contraceptive coverage over time, 85% identified lower usage rates or probabilities among ethnic minorities, with persistent gaps.</p><p><strong>Conclusion: </strong>This review highlights contraceptive coverage gaps related to ethnicity in LAC, revealing enduring inequalities. As post-pandemic efforts aim to reduce disparities, countries with significant indigenous populations must prioritize evidence generation. Further research is needed in countries showing progress and among subgroups, such as adolescents or intra-country ethnic groups, to understand underlying causes and enhance contraceptive Access.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"272"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292105","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":"Association of insurance status among cancer patients and survival outcomes: a systematic review and meta-analysis.","authors":"Jiashuai Tian, Jiayang Kong, Na Zhou, Liliang Zhang, Xinyu Cai, Dai Su, Guangying Gao","doi":"10.1186/s12939-025-02629-6","DOIUrl":"10.1186/s12939-025-02629-6","url":null,"abstract":"<p><strong>Introduction: </strong>Health insurance coverage is a critical determinant of cancer care access. However, the association of different insurance statuses affecting survival outcomes remains understudied worldwide. This meta-analysis provides global evidence on the association between insurance status and survival and highlights structural health inequities across national health insurance systems.</p><p><strong>Methods: </strong>We searched five databases for cohort studies published between 1 January 2000 and 15 July 2025. Random-effect multilevel and traditional meta-analyses were employed to address heterogeneity. The Newcastle-Ottawa Scale (NOS) and the ROBINS-I method assessed all studies for quality.</p><p><strong>Results: </strong>We included 37 studies between 2000 and 2025, contributing 219 effect sizes. In the United States (US), patients insured in Medicare (HR: 1.29, 95% CI: 1.17-1.42, P < 0.001; τ²₍₂₎ = 0.046, I²₍₂₎ = 67.28%; τ²₍₃₎ = 0.022, I²₍₃₎ = 31.89%), Medicaid (HR: 1.39; 95% CI: 1.28-1.51, P < 0.001; τ²₍₂₎ = 0.049, I²₍₂₎ = 74.07%; τ²₍₃₎ = 0.016, I²₍₃₎ = 24.60%), or without insurance (HR: 1.42, 95% CI: 1.31-1.53, P = 0.001; τ²₍₂₎ = 0.032, I²₍₂₎ = 65.99%; τ²₍₃₎ = 0.015, I²₍₃₎ = 30.77%) had worse overall survival (OS) than private insurers. Cancer stage, cancer type, and the adjustment variables are moderators of effect size heterogeneity in the US. The association between insurance status and survival was stronger in early-stage (I-II) cancers and among patients with breast and prostate cancer, whereas survival disparity across insurance statuses was smaller or not statistically significant for advanced (III-IV) stages and patients diagnosed with lung, liver, and colorectal cancer. In China, patients without Urban Employee Basic Medical Insurance (non-UEBMI) showed worse OS (HR: 1.39; 95% CI: 1.22-1.59; I² = 60.0%; τ² = 0.012) than UEBMI patients. Qualitative evidence from Germany, South Korea, Thailand, and Brazil did not identify statistically significant associations between insurance status and cancer survival outcomes. Uninsured individuals were experiencing poorer OS than those with any other form of insurance status globally.</p><p><strong>Conclusions: </strong>The association between insurance status and cancer survival differs across national health insurance systems. Insurance policies should prioritize early-stage cancer care, cancer types with a favorable prognosis, and uninsured groups. Future research should use prospective international cohorts to explore how insurance structures and covariate interactions affect survival and to achieve equity in global cancer care.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"265"},"PeriodicalIF":4.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274472","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":"Strengthening primary health care resilience through community innovation: a qualitative case study from Quito's response to COVID-19.","authors":"Betzabé Tello, Iván Dueñas-Espín, Laura Di Giorgio","doi":"10.1186/s12939-025-02620-1","DOIUrl":"10.1186/s12939-025-02620-1","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to analyse and document how Quito, the capital city of Ecuador, transformed its Primary Health Care (PHC) model following the COVID-19 pandemic. The reform involved a shift from a reactive, hospital-centred response to a community-based model focused on prevention, social determinants of health, and local engagement.</p><p><strong>Methods: </strong>This study used a qualitative case study design with a comparative and deductive approach, featuring 11 semi-structured interviews with health professionals, decision-makers, and administrative staff, alongside a review of secondary sources, including national and municipal legal framework (such as the Organic Code and the municipal Organic Statute), ordinances, the Municipal Code, and governance documents and accountability reports from three mayoral administrations. Thematic analysis identified key enabling factors and compared Quito's experience with other cities in Ecuador and Latin America.</p><p><strong>Results: </strong>The central innovation was the creation of multidisciplinary Community Health Teams (Equipos de Salud Comunitaria, ESC) assigned to each of Quito's 65 parishes. These teams focused on health promotion, disease prevention, and intersectoral coordination. Their implementation was supported by continuous training, integration of digital tools, community-based communication strategies, and protocols for operating in high-risk environments. A major driver of the reform was the political negotiation to sustain the increased health budget beyond the pandemic, enabling the long-term operation of ESCs. Ensuring the physical safety of health personnel also became a core component of the model, supported by risk mapping, emergency communication systems, and coordination with local security actors. The model was institutionalized through legal frameworks and aligned with national initiatives such as the Healthy Municipalities Programme and Comprehensive Family, Community and Intercultural Health Care Model (MAIS-FCI). The model demonstrated improved territorial access, community trust, and responsiveness amid rising urban violence, but faces limitations in technological infrastructure, monitoring indicators, and long-term sustainability.</p><p><strong>Conclusions: </strong>Quito's experience highlights the potential of decentralised municipal governance to lead PHC reform through integrated, preventive, and community-based strategies. The findings provide valuable lessons for other cities in low- and middle-income countries seeking to enhance PHC resilience in fragile contexts. Strengthening digital capacity and ensuring institutional protection and funding for ESC will be key to sustaining progress.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"266"},"PeriodicalIF":4.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274476","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":"Malaria in their words: thematic analysis of online narratives from Sub-Saharan Africa.","authors":"Sirey H Zhang, Ogechi Nwankwoala, Chioniso S Jakazi, Anjali J D'Amiano, Jean-Bertin Kabuya, Kelvin Kapungu, Miriam Laker, Matthew M Ippolito","doi":"10.1186/s12939-025-02570-8","DOIUrl":"10.1186/s12939-025-02570-8","url":null,"abstract":"","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"264"},"PeriodicalIF":4.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258115","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}