Context: Over 2.5 billion people globally need assistive products, with individuals with disabilities among those most in need. In the Dominican Republic (DR), 12.3% of the population (1.2 million) live with disabilities, but access to assistive products is limited and data scarce. This study provides insights into assistive product use and need, unmet needs, and barriers to access, offering evidence to inform policy and improve availability.

Methods: Results were obtained through a secondary analysis of the DR’s rapid Assistive Technology Assessment (rATA), conducted by the Ministry of Public Health and PAHO in 2021 for the WHO and UNICEF Global Report on Assistive Technology. The rATA used a nationally representative cluster-sampling design, with data collected via telephone interviews. A total of 5,004 individuals were included.

Results: 34.7% (CI: 33.3%–36.0%) of participants needed a product, while 27.2% (CI: 25.9%–28.5%) used one. Vision and mobility products were the most needed. The top five were spectacles (32.3%, CI: 31.0%–33.6%), canes, sticks, tripods, or quadripods (2.9%, CI: 2.4%–3.4%), hearing aids (0.6%, CI: 0.4%–0.9%), wheelchairs (0.5%, CI: 0.3%–0.7%), and axillary or elbow crutches (0.5%, CI: 0.3%–0.7%). Need was higher among females (46.3%, CI: 44.4%–48.3%). Older adults (66.9%, CI: 62.8%–70.7%) had the highest need. Regional differences were notable, with greater need in Cibao Norte (40.1%, CI: 37.0%–43.3%) and Ozama (39.0%, CI: 36.8%–41.3%). Unmet need for products was 46.5% (CI: 44.1%–48.9%), with hearing products having the highest unmet need (86.7%, CI: 70.9%–94.6%). Overall, the main barriers to access were cost (59.1%, CI: 55.7%–62.5%) and lack of time (26.7%, CI: 23.7%–29.8%). Most products (72.1%, CI: 69.6%–74.4%) were obtained from private institutions, with 65.9% (CI: 63.8%–67.9%) paid out of pocket. Excluding spectacles, family and friends were the most common source (59.3%, CI: 51.0%–67.0%) and payer (65.3%, CI: 56.0%–73.5%).

Conclusion: The findings highlight an important unmet need for assistive products, particularly hearing aids, that deserves attention. Sex, age, and regional differences suggest the need for targeted interventions to ensure more equitable access, with further research to deepen understanding. Expanding public sector involvement could offer an opportunity to improve access and reduce financial burdens on individuals and families.

Universal Health Coverage (UHC) aims to ensure that all individuals and communities can access essential health services without financial hardship. While low to middle-income countries (LMICs), including Zimbabwe, have adopted policies to advance UHC, but challenges remain, particularly in health financing and human resources. In Zimbabwe, health access is inequitable across population groups, with a quality access rating of 31.7 against a target of 100 as of 2019 (Haakenstad et al., 2022). This scoping review evaluates Zimbabwe’s progress toward UHC and compares it with other low- and middle-income countries (LMICs) to identify lessons for improvement. Using a thematic context and political economy analysis framework, we analyzed peer-reviewed articles, policy documents, and reports from 2000 to 2024 and summarized Zimbabwe’s progress across the three UHC dimensions: population, services, and cost coverage. We drew policy recommendations for Zimbabwe based on lessons from the cross-country comparison of efforts made toward UHC. Our preliminary findings indicate that in Zimbabwe, the three dimensions of UHC have advanced at different rates. Despite Zimbabwe's UHC index improving from 30 in 2000 to 55 in 2019, challenges in health financing and human resources remain. Health policy in Zimbabwe promotes multi-sectoral collaboration and community participation in healthcare. However, a lack of political will and fiscal constraints negatively affect the mobilization of domestic funding for the health sector. We learned that to complement current policies that advance UHC, Zimbabwe needs to establish UHC indicator baselines and targets and define a core health services package. Scaling up innovative health financing mechanisms and decentralizing governance—particularly in human resources and service delivery—are crucial steps that will empower local authorities, improve responsiveness, and ensure that local health needs are effectively met.

As the world grapples with the growing burden of chronic diseases, aging populations, and economic disparities, universal healthcare (UHC) remains one of the most transformative yet contentious challenges of our time. While some nations have embraced UHC as a fundamental right, others have opted for their own unique approaches to healthcare accessibility. The impact of the different systems on healthcare disparities becomes more stark with an increasing demand for medical care- particularly in the face of financial constraints, workforce shortages, and systemic inefficiencies. This investigative review explores the distribution of UHC across high-, middle-, and low-income countries, emphasizing its profound impact on global health and healthcare outcomes, particularly in lower-income nations and regions with limited access to care.

All World Health Organization (WHO) member countries were categorized by income level—high, upper-middle, lower-middle, and low—using the World Bank Atlas methods for the 2025 fiscal year. UHC status of the various countries was determined using the WHO Data Bank. Determinants and variables of health as reported by each country were obtained from the WHO data and world health statistics report 2024. Comparisons, statistical analysis, and figures were generated using GraphPad Prism 8.0. Significance was determined at p<0.5 with a confidence interval of 95%. Worldwide health determinants analyzed included population size, life expectancy, maternal, under-five and neonatal mortality, skilled health professional birth attendance, neglected tropical diseases, death probability from non-communicable diseases, HIV, tuberculosis, and malaria incidence, prevalence of markers for Hepatitis B, and household health expenditures. Overall, higher income levels were significantly associated with better health outcomes for both UHC and non-UHC groups. However, UHC groups consistently outperform non-UHC groups across almost all indicators, with the greatest disparities significantly observed in Low and Low-Middle income countries. This demonstrates the significant advantages of universal health coverage, particularly in reducing mortality and improving access to essential healthcare services. Highlighting these dynamic intersections of health economics and social determinants shifts the narrative from cost to investment and from intervention to prevention, designing a healthcare society which self-advocates for community health empowerment and a healthier society.

Health systems responsiveness (HSR) refers to health system’s ability to meet legitimate non-health expectations of the population. Traditionally, HSR has been conceptualized across eight domains: respect for dignity, autonomy, confidentiality, prompt attention to health needs, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. However, as the expectations of populations in high-income countries (HICs) and low- and middle-income countries (L&MICs) differ significantly due to diverse social and cultural contexts, the conceptualization of HSR also varies. To adapt the HSR framework for L&MICs, we conducted a systematic review of the literature to contextually modify its domains based on available evidence. The modified HSR framework was further refined and validated through a Delphi process involving 13 global health experts specializing in HSR. Our proposed framework for L&MICs is based on ten domains: (1) respect for dignity, (2) autonomy, (3) confidentiality of information, (4) quality of basic amenities, (5) access to social support networks, (6) choice of provider, (7) prompt access to care, (8) attention, clarity of communication and guidance, (9) consideration of financial protection, and (10) coordination and continuity of care; and 32 sub-domains. We translated this framework into qualitative and quantitative measurement tools to assess HSR in L&MICs from the perspectives of patients, community-leaders, service-providers, hospital managers, and policymakers, ensuring a comprehensive evaluation. The methodology and tools were pilot tested in District Rawalpindi, Pakistan. The overall HSR score for primary, secondary, and tertiary care hospitals in Rawalpindi was estimated at 4.0 on a 0 to 10 scale (10=perfect score). The health system performed well in respect for dignity, autonomy and confidentiality; was moderate for choice of provider, prompt access to care, attention, clarity of communication and access to social support networks; and performed poorly for quality of basic amenities, consideration of financial protection and continuity of care. The psychometric analysis of our tool demonstrated strong feasibility, reliability (Cronbach’s alpha = 0.69), and validity, confirming its suitability for use in L&MICs. We encourage researchers to apply our tools and methodology to assess HSR across L&MICs, with pilot testing in their specific contexts before broader implementation.

Introduction:Despite significant progress in expanding immunization access to low-income communities over the past two decades, recent WHO/UNICEF data reveals that 25 million children worldwide missed at least one doses of lifesaving vaccines in 2021. Among them, 18 million have never been vaccinated, contributing to high under-five mortality rates. These children, known as "Zero-Dose Children," are heavily concentrated in the Sahel and Horn-of-Africa regions, where more than 5.2 million reside across 11 countries, including Ethiopia.

Objective:To determine characteristics of mothers who has zero-dose children aged 12-23 months old in the CORE Group implementation Districts.

Methods:January-to-December 2024, CORE Group staff collected data on Zero-Dose Children using the ODK platform to assess the characteristics of mothers with Zero-Dose children. The identification of Zero-Dose Children was carried-out by CORE Group Community Volunteers(CVs) through house-to-house visits, while district project staff conducted mapping using standardized checklist loaded onto smartphones. The data analysis was done using SPSS software.

Result:Over the course of one year, data was collected from 686 mothers with Zero-Dose children. The majority(67.3%) were between 20 and 30 years old, and 60.2% were unable to read/write. Most(93.9%) mothers were married. Regarding access to vaccination sites, 44% reported average travel-time of 15–30 minutes, while 43.1% travel more than 30 minutes to reach the nearest vaccination facility. Minimal gender difference was observed among Zero-Dose children, with 52.3% being male and 47.7% female. The main reasons cited for children not receiving any vaccinations included lack of awareness about importance of immunization 30%, absence of health facility in the area 23.5%, and unavailability of health workers to administer vaccines in the village 10.6%.

Conclusion: In the study settings, a significant number of Zero-Dose children were identified by CVs and subsequently vaccinated. Illiteracy and young maternal age were key predictors. Therefore, promoting girls' education and increasing community awareness are recommended to prevent early-marriage. Furthermore, the main reasons for children not receiving vaccinations were lack of awareness about immunization, and unavailability of health facilities and healthcare workers in the area. Implementing community awareness on importance of immunization, strategies: like outreach and mobile immunization services, is crucial to addressing these challenges.

Background

Mycetoma is a chronic, disabling, Neglected Tropical Disease (NTD) endemic to Latin America, Asia, and Africa, primarily affecting low-income rural laborers. Despite being recognised as an NTD by WHO, mycetoma remains under-reported, underfunded, and overlooked from national health agendas. Effective control requires multisectoral coordination; however, fragmented policies persist. Systems thinking offers a critical lens to address complex interactions and identify solutions that mitigate mycetoma burden.

Objective

To evaluate national readiness for mycetoma prevention and management in Ethiopia, Mexico, and India through a traffic light classification and systems thinking analysis.

Methods

We conducted comparative policy analysis using qualitative methods across five domains: surveillance, financing, workforce, community engagement, and case management. A systematic search across languages was conducted to review national NTD strategies, WHO reports, and local research studies to identify the explicit integration of mycetoma-specific actions into national health activities. Domains were classified as Green (well-developed), Yellow (limited or in progress), or Red (critical gaps). A Complex Adaptive Systems (CAS) map, visualizing interconnected relationships between domains, identified leverage points for sustainable and equitable mycetoma control.

Results

Ethiopia showed low readiness except for surveillance (Yellow). Mexico demonstrated strong community engagement (Green), partial progress in workforce and management (Yellow), and significant gaps in financing (Red). India had strengths in workforce and case management (Yellow) but lacked surveillance and public awareness (Red). No country allocated dedicated funding, perpetuating mycetoma’s neglected status.

Systems mapping revealed reinforcing feedback loops. Limited financing compromises management, workforce capacity, and access to diagnostics and treatment. Weak surveillance and low community awareness contribute to under-detection and deprioritization. Mexico’s long-standing community dermatology model demonstrated how strong grassroots engagement can enhance surveillance and early case detection.

Conclusion

All three countries had critical gaps in readiness across surveillance, financing, and community engagement. The traffic light framework highlighted the fragmented response to mycetoma, while CAS revealed how weaknesses in one domain amplify others. Prioritizing mycetoma-related policies can improve early detection, reduce disability, and promote equity. These tools provide a practical roadmap for designing cross-sectoral interventions to strengthen national and global mycetoma control efforts.

Background: The scope of pharmacy practice in Canada is expanding, and so are the responsibilities of hospital pharmacy managers. However, the knowledge of their existing training and learning needs is lacking. Objective: To identify skill gaps, explore leadership pathways, assess the efficacy of existing training, and describe learning needs among Canadian hospital pharmacy leaders. Methods: A mixed-method study comprising of an electronic survey with questions related to leadership competencies and focus groups delving deeper into qualitative aspects of the needs of the training was conducted. Descriptive statistics, one-way ANOVA, and linear regression analysis assessed the association between self-reported skill gap and sociodemographic and employment-related factors for the quantitative data. Results: The respondents were predominantly midlife managers working in academic hospitals with 10 years or less of experience, many of whom had prior clinical leadership training. Many respondents reported competency gaps in Finance and Budgeting, Human Resource Management, and Leadership domains. Every average one-point increase in the competency difference was associated with a two-point decrease in job satisfaction score (95% CI: -3.2 to -0.85, p-value <0.001). Those who received both clinical and leadership training reported less average difference by 11 points compared to those who received only clinical training (95% CI: -22 to -0.05, p-value <0.05). Conclusions: The skill gap for leaders mostly exists in managerial competencies. We recommend upgrading current pharmacy residency training and offering other smaller training opportunities for skill upgradation.