The study was a secondary analysis of data collected for the Africa Health Collaborative in Lusaka, Kafue, Kitwe and Ndola. It combined a digital questionnaire completed by 859 people with 64 key-informant interviews and five focus group discussions involving educators, employers, regulators, professional associations and health workers. Participants came from nine tertiary training institutions and four health facilities offering internships or early-career placements. Programmes represented medicine, nursing, public health, environmental health, pharmacy, clinical medicine, physiotherapy, midwifery and related primary health care disciplines.

Employment readiness was operationalised narrowly but transparently: respondents had to report that they felt prepared for the labour market and say that they had prepared a curriculum vitae. On that basis, 357 participants were classified as employment-ready and 502 were not. Readiness was reported by 27% of respondents aged 18–24, 53% of those aged 25–29, 75% of those aged 30–34 and 66% of respondents aged 35 or older. The descriptive pattern persisted in multivariable logistic regression, with adjusted odds ratios of 2.05 for ages 25–29, 4.31 for ages 30–34 and 3.28 for ages 35 or older, each compared with the youngest group.

Education and career status were also strongly associated with readiness. Respondents with undergraduate education or higher had nearly three times the odds of readiness compared with diploma holders, with an adjusted odds ratio of 2.91 and a 95% confidence interval of 1.89–4.48. Volunteers and early-career professionals had 17.55 times the odds of readiness compared with students, with a 95% confidence interval of 8.56–36.00, while interns had 2.97 times the odds, with a 95% confidence interval of 1.39–6.38. These are associations from a cross-sectional model and do not establish that internships or volunteering caused later employment or objectively improved competence.

District differences were observed, although the analysis cannot explain their causes. Compared with Kitwe, participants in Kafue had 3.22 times the adjusted odds of reporting readiness and those in Lusaka had 2.49 times the odds. The estimate for Ndola was also elevated, at 2.11, but did not meet the study’s threshold for statistical significance. The model reported a pseudo-R-squared of 0.2019, and a Hosmer–Lemeshow test did not indicate poor calibration, with a p-value of 0.9191. The survey also found that blended-learning participants were more likely to report readiness than those receiving exclusively in-person instruction, although only three respondents attended purely online programmes, making that category too small for a robust comparison.

Competency results exposed a gap between what participants knew and how confident they felt about applying their skills. Most respondents described themselves as very knowledgeable about their general training area, but their mean confidence across six technical domains was only 2.21 on a four-point scale. Communication scored highest at 2.42, followed by critical thinking at 2.26. Networking was lowest at 2.08, while technical skills scored 2.15 and leadership 2.19. The six-item scale had acceptable internal consistency, with Cronbach’s alpha of 0.78. These measures were self-reported, but interviews helped identify concerns that some training placed too much emphasis on theory and provided too little supervised practice with real patients.

Interviews and focus groups pointed to uneven training quality, weak regulation and insufficient clinical exposure as important barriers. Participants described concerns about training institutions prioritising enrolment and graduation over practical competence, alongside inadequate infrastructure and variable supervision. Some trainees reported short or poorly organised attachments and differences between classroom teaching and real workplace settings. Respondents also described anxiety about performing procedures, handling patients and entering an unfamiliar professional environment. These findings concern the sampled institutions and districts and cannot be assumed to describe every Zambian training programme or placement.

Employment was only one stage of the pathway examined: retention depended heavily on working conditions. Key informants cited staff shortages, heavy workloads, dilapidated facilities, limited equipment, low remuneration and a lack of incentives for difficult locations. Contract instability, including delays in absorbing volunteers and uncertainty over continued funding, added to the problem. Limited study leave, sponsorship and career progression restricted further education, while inadequate recognition and mentorship reduced morale. Participants described poor conditions and growth prospects as contributing to migration from public services; non-governmental organisations were viewed as offering more attractive support, including education opportunities and stronger work-life arrangements.

The study also found interest in employment beyond conventional clinical posts. Respondents most often preferred hospital facilities, selected by 80.7%, followed by non-governmental organisations at 66.5%, community settings at 40.5% and overseas work at 30.5%. They also identified opportunities in health education, community awareness, occupational health and safety, environmental management, entrepreneurship, private clinics, policy and sustainable development. The authors argue that primary health care should therefore be viewed as an employment ecosystem rather than a narrow set of clinical occupations, while stressing that career guidance, regulation, training quality and working conditions remain necessary for that ecosystem to support both services and workers.

Several limitations constrain what can be concluded. The cross-sectional design captures perceptions at one point and cannot establish causal relationships or track changes in readiness, job acquisition or retention over time. Employment readiness depends on self-reported confidence and possession of a curriculum vitae rather than standardized competency tests, employer evaluations or confirmed employment. Social-desirability and response biases may therefore influence the findings. The four districts were purposively selected because they host relevant training and employment institutions, the survey was concentrated in urban areas and the sample cannot fully represent remote rural health systems. The evidence supports closer attention to regulated training, supervised internships, mentorship, career progression and employment conditions, but longitudinal studies would be needed to show which pathways actually produce sustained jobs and better health services.

Subject of Research: Determinants of youth employment readiness in Zambia’s primary health care workforce

Article Title: Youth employment in the primary health care ecosystem in Zambia: barriers and opportunities

Article References: Mwila, G., Lakati, A., Sakanga, V., Bulanda, D., Mkandawire, L., Omogi, J., Banda, L., Gatumia, B., Abdi, O., Agukoh, A., Matiang’i, M., & Masibo, P. (2026). Youth employment in the primary health care ecosystem in Zambia: barriers and opportunities. Frontiers in Health Services, 6, Article 1869977. https://doi.org/10.3389/frhs.2026.1869977

Image Credits: AI Generated

DOI: 10.3389/frhs.2026.1869977

Keywords: Zambia, youth employment, primary health care, health workforce, employment readiness, internships, training quality, workforce retention, Youth, employment, primary, health

The researchers enrolled pregnant women at 36 weeks of gestation or later between March 21 and June 20, 2024. Two centers in Bahrain’s Southern Governorate delivered the intervention, while two in the Northern Governorate provided standard care. Of 193 women approached, 175 enrolled, comprising 81 in the intervention arm and 94 in controls. Each intervention package had three inseparable elements: a standardized session delivered by a trained mother-and-child health midwife during a routine antenatal visit, an early booking for a postnatal consultation between six weeks and six months after delivery, and QR-coded educational material. Control centers offered the national program’s usual verbal notification, with women expected to arrange their own postnatal visit after childbirth.

Within the intervention group, immediate changes were striking. Mean knowledge scores on a nine-item scale rose from 2.16 before the session to 8.48 afterward, a mean increase of 6.32 points (95% CI 5.62–7.03; p<0.001). Attitudes measured on an eight-item, 40-point scale increased from 25.79 to 35.89, a mean gain of 10.10 points (95% CI 8.77–11.43; p<0.001). The standardized effect sizes were large, with Cohen’s dz values of 1.98 for knowledge and 1.65 for attitude. Forty-eight percent of intervention participants scored at least 38 out of 40 after the session, and 31 reached the maximum. These measurements were taken minutes apart, however, and the control group was assessed only once. Without a concurrent second measurement, the increases could reflect immediate recall, repeated questionnaire exposure, social-desirability effects or the antenatal visit itself rather than the session alone.

Postnatal attendance was the outcome assessed identically in both arms, using electronic mother-and-child health records at each woman’s own center. A documented consultation with either a physician or a staff nurse counted as attendance. Six of the 175 participants could not be matched to a delivery record, leaving 169 outcomes; the result remained statistically significant under all four extreme assumptions about those missing observations. The observed difference was 31.4 percentage points (95% CI 17.3–45.6), corresponding to a risk ratio of 1.76 and a number needed to treat of about three women for one additional postnatal consultation. Both groups exceeded the 29% national attendance rate recorded in 2019, before face-to-face postnatal services were disrupted by the COVID-19 pandemic. The control proportion also exceeded the 27% found in a 2023 national survey, making it an imperfect estimate of attendance under untreated routine care.

Center-level results expose the study’s central weakness. Attendance was 69.7% and 75.0% in the two intervention centers, but 26.5% and 58.1% in the control centers. The 31.6-percentage-point gap between control centers was as large as the overall difference between study arms, and one control center performed almost as well as the intervention centers. The centers were selected by convenience, their division into study arms was not random, and the arms were geographically separated, making study group completely confounded with governorate. Historical service data were unavailable to establish baseline equivalence. An intraclass correlation coefficient of 0.091 for attendance produced a design effect of 4.73 and an effective sample of approximately 36 women rather than 169. When this clustering adjustment was applied, the confidence interval for the unadjusted odds ratio included the null value.

The adjusted logistic regression strengthened the reported association, with intervention-group status remaining the only significant predictor of attendance. Baseline knowledge and attitude did not independently predict attendance in the model or in exploratory comparisons. That absence of evidence does not establish that understanding and attitudes are unimportant, particularly because the study was not designed to prove an absence of effect. It instead suggests that the structural elements of care may have been more closely connected with attendance than individual scores measured after the session. The intervention cannot identify which component mattered because education, QR-coded material and advance booking were always delivered together. The design also did not measure session duration, training duration, delivery fidelity, staff workload or implementation cost.

The study population offers additional context. Participants were Bahraini women or non-Bahraini women married to Bahrainis, were at least 18 years old, attended antenatal care at 36 weeks or later, spoke Arabic or English, used smartphones and did not have diabetes, hypertension, sickle cell disease or difficulty understanding the educational material. Excluding women without smartphones improved comparability between arms but limited generalizability, since those women may face some of the greatest barriers to postnatal care. The intervention group was older and had a more favorable family-income distribution, while baseline knowledge was also higher and attitudes were less favorable. The study did not establish baseline equivalence between the four centers, and the sample fell short of its target of 100 women per group. Among exploratory medical comparisons, daily medication use was associated with lower attendance, 34.2% compared with 61.8% among women not taking medication, but the finding came from multiple uncorrected subgroup tests and requires dedicated study.

Awareness of the postnatal clinic largely depended on informal networks. Among respondents who knew the clinic existed, 20% cited friends and 18% cited family, making social connections the leading reported sources of information. Doctors during antenatal visits accounted for 17%, doctors after delivery for 16%, and formal health-education sessions for only 3%. These findings connect the intervention to a practical problem: accurate information was often available through relatives and peers, while structured channels were rarely used. The intervention also tested more than information alone. By securing an appointment before delivery, it attempted to remove an organizational step that women in the control arm had to complete independently after childbirth, a task that a prior national survey found many women did not know how to perform.

For practice, the findings support further testing of routine early booking and provider-led counseling as an integrated antenatal service, rather than treating education and appointment logistics as separate issues. Bahrain’s postnatal clinics provide a free consultation for a general maternal assessment, depression screening and counseling on breastfeeding and family planning. The package tested in this study was delivered within an existing antenatal appointment, but the research did not demonstrate its cost, sustainability or acceptability. Confirmation now requires a larger cluster-randomized trial or a stronger quasi-experimental design involving more centers, preferably one capable of separating midwife counseling from advance booking and QR-coded information. Until then, the scientifically supported conclusion is that the combined approach was associated with higher documented postnatal attendance in the participating centers, while knowledge and attitudes improved immediately within the intervention arm. The striking between-arm result warrants attention, but the equally striking center-to-center variation prevents a definitive claim that the package itself caused the increase.

Subject of Research: Antenatal counseling and early postnatal booking in Bahraini primary health care centers

Article Title: Antenatal health education with early postnatal booking and postnatal clinic attendance in primary health care centers in Bahrain: a quasi-experimental study

Article References: Alhaddad, M. E. E., Hubail, M. A. H., Rashed, M. M. A., Alnajjar, I. B. S., Husain, T. K. S., AlAali, F. A., Asoomi, H. A., Makarem, B., Chlif, S., Habbash, F., Almarabheh, A., Salah, A. B., & Shehata, M. H. (2026). Antenatal health education with early postnatal booking and postnatal clinic attendance in primary health care centers in Bahrain: a quasi-experimental study. Frontiers in Public Health, 14, Article 1938634. https://doi.org/10.3389/fpubh.2026.1938634

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1938634

Keywords: Bahrain, postnatal care, antenatal education, early booking, maternal health, primary health care, clinic attendance, quasi-experimental study, health services, Antenatal, health, education

Researchers assessed each facility against three service tiers: Tier 1 for minimum services, Tier 2 for intermediate services and Tier 3 for comprehensive essential primary health care. A facility was counted as providing a tier when it delivered at least 80% of the services in that tier. Of the 204 facilities, 65.2% provided at least 80% of Tier 1 services, 46.6% provided at least 80% of Tier 2 services and 35.8% provided at least 80% of Tier 3 services. The proportion meeting the 80% threshold across all three tiers was considerably lower, at 31.9%.

Readiness was evaluated across six domains, with five domains classified as poor, fair or good. The strongest good-readiness result was for management and finance, reported in 42.6% of facilities. Around 40.2% of facilities had good readiness for health management information system tools and registers, supply-chain tools and registers, and guidelines. Good readiness was less common for tracer equipment, at 34.8%; infrastructure and utilities, at 33.3%; and tracer drugs, at 29.9%. Management indicators were also uneven: 81.9% of facilities had a functional management committee and 81.9% had standard operating procedures, while 54.4% had an updated Basic Health Care Provision Fund annual quality-improvement plan. Staffing readiness showed a separate shortfall, with 16.2% of facilities meeting the World Health Organization standard of at least 2.3 health care workers per 1,000 population and none meeting the Minimum Service Package standard across all cadres.

Principal component analysis and multivariable logistic regression were used to examine the relationship between readiness and service provision, with statistical significance assessed at an alpha of 0.05. Tracer drugs and equipment availability were common predictors of providing at least 80% of services across the tiers. Compared with facilities with poor tracer-equipment readiness, facilities with fair readiness had higher adjusted odds of delivering all three tiers, with an adjusted odds ratio of 2.38 and a 95% confidence interval of 1.92–11.14. Facilities with good tracer-equipment readiness also had higher adjusted odds, with an adjusted odds ratio of 3.93 and a 95% confidence interval of 1.96–8.49. The reported results marked the fair-readiness comparison as statistically significant at p < 0.05. Because the assessment was cross-sectional, these estimates describe adjusted associations rather than causal effects or changes over time.

The study’s scope was limited to 204 Basic Health Care Provision Fund facilities in six prioritized states, so the results do not necessarily represent all public primary health care facilities in Nigeria. Within that sample, however, the analysis linked stronger readiness with more extensive service provision and identified tracer drugs and equipment as common predictors across the three service tiers. The authors concluded that investing in facility functionality and prioritizing funds for tracer drugs and equipment could improve service availability and delivery in Nigerian public primary health care facilities.

Subject of Research: Association between facility readiness and service availability in 204 Nigerian public primary health care facilities across six prioritized states

Article Title: Assessing primary health care facilities in six prioritized Nigerian states: Linking facility readiness with service availability

Article References: Fasawe, O., Abba, A., Yerima Mohammed, A., Kukoyi, C., Gulma, K. A., Abubakar, A. A., Shuaibu, A., Jamoh, B., Mahmoud, M. N., Shamsudeen, Y., Mustafa, I. A., Dangana, I. A., Yakubu, A., Sani, A., Peter, B., Oladapo, O., Mohammed, N., Umar, N., Anyanwu, L. N., & Ayo, A. S. (2026). Assessing primary health care facilities in six prioritized Nigerian states: Linking facility readiness with service availability. PLOS One, 21(10), e0360425. https://doi.org/10.1371/journal.pone.0360425

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360425

Keywords: Nigeria, primary health care, health facilities, service availability, tracer equipment, tracer drugs, facility readiness, Basic Health Care Provision Fund, Minimum Service Package, health workforce, Assessing, primary

The study, led by Mary Samantha and colleagues at Mbarara University of Science and Technology with collaborators including Stephen Bartels of Massachusetts General Hospital and Harvard Medical School, set out to map the multilevel determinants that shape whether frontline providers can put mhGAP-IG recommendations for alcohol use disorder into routine practice. Alcohol use disorder is a major public health concern in Uganda, but detection and management at the primary care level remain limited, meaning most people with the condition never receive an evidence-based intervention. The researchers interviewed eighteen participants, fifteen primary health care providers and three district health team members, in a district in southwestern Uganda, purposively selecting them to capture variation across professional cadres and health system roles.

Methodologically, the team conducted individual in-depth interviews using a semi-structured guide informed by the Consolidated Framework for Implementation Research, or CFIR, a widely used implementation science framework that organizes determinants into five domains: the characteristics of the intervention itself, the outer setting, the inner setting, the characteristics of the individuals involved, and the implementation process. Data were analyzed using a deductive-inductive thematic approach, meaning the researchers looked both for patterns matching the CFIR domains and for emergent themes that the framework did not anticipate. This design allowed the study to move beyond the common but narrow question of whether providers support a new program and instead ask what constellation of factors determines whether that support can translate into clinical action.

The findings paint a technically precise picture of partial readiness. Providers generally perceived the mhGAP-IG recommendations for alcohol use disorder as useful and feasible for non-specialist practice, a favorable perception of the intervention’s characteristics that the authors describe as an important foundation. Participants also expressed strong willingness to improve AUD care, reflecting positive individual-level motivation. However, this goodwill collided with two capability deficits: limited familiarity with the mhGAP-IG guide itself and gaps in clinical competencies for assessing and managing alcohol use disorder. In other words, providers wanted to act but often lacked the procedural knowledge and skills to do so confidently, a combination that implementation scientists recognize as a critical readiness bottleneck.

Organizational constraints inside the clinics compounded these individual gaps. Providers described high workloads that left little time for screening and counseling, limited availability of medicines needed for AUD management, and scarce educational materials to support patient education. Documentation and referral systems were weak, meaning even when a provider identified a patient with alcohol use disorder, there was no reliable mechanism to record the diagnosis or connect the patient to further care. Supervision was inconsistent, removing a key source of ongoing feedback and quality control. Each of these inner-setting weaknesses interacts with the others: heavy workloads undermine training retention, weak documentation prevents monitoring, and absent supervision allows skills to decay, creating a self-reinforcing cycle of constrained capacity.

The outer setting proved equally decisive. Participants emphasized that community normalization of alcohol use, in which heavy drinking is socially accepted or even expected, undermines clinical efforts before they begin. Stigma surrounding alcohol use disorder discourages patients from disclosing symptoms or seeking help, while geographical barriers make it difficult for rural patients to reach facilities or for providers to conduct outreach. Weak enforcement of alcohol policy at the local level and limited financing for mental health services further constrained what clinics could realistically achieve. These community and policy-level determinants sit largely outside the control of individual providers, which is precisely why the study’s authors argue that implementation readiness cannot be assessed or built at the provider level alone.

Perhaps the study’s most consequential technical insight is that readiness depends on alignment across all CFIR domains simultaneously. Readiness, in this framing, is an emergent property of the fit between intervention usability, provider capability, organizational capacity, and the broader community and health system context. A favorable perception of the guide plus strong willingness, the authors conclude, are insufficient to establish implementation readiness if familiarity, competency, workload, supplies, documentation, supervision, community attitudes, and financing are not addressed in parallel. This multilevel alignment perspective has direct implications for how scale-up efforts in Uganda and other low- and middle-income countries should be designed and evaluated, shifting the focus from single-component training workshops to coordinated system-level strategies.

Participants themselves offered a concrete prescription for what implementation would require. They emphasized that rolling out mhGAP-IG for alcohol use disorder would demand more than provider training, highlighting the need for practical decision-support tools that fit into real clinical moments, integration of AUD care into routine workflows and existing documentation systems, engagement of district leaders and community stakeholders, and ongoing monitoring paired with supportive supervision rather than one-off inspection. The study was conducted with ethical approval from the Mbarara University of Science and Technology Research Ethics Committee and registered with the Uganda National Council for Science and Technology, and it was supported by the Fogarty International Center of the National Institutes of Health under award number D43TW011964.

For a global health community increasingly focused on closing the treatment gap for mental, neurological, and substance use disorders, the study offers a technically rigorous template. It demonstrates that the CFIR framework can surface the interacting determinants that determine whether a WHO-endorsed protocol survives contact with a rural clinic’s daily reality, and it identifies the specific levers, competency-based training, practical tools, strengthened documentation and referral, workflow integration, stakeholder engagement, and supportive supervision, that implementation strategies should combine. The message for policymakers is clear: goodwill among providers is a real and valuable asset, but it is only the first link in a chain that must include organizational capacity, community context, and sustained system support if evidence-based alcohol use disorder care is to reach the rural populations who need it most.

Subject of Research: Primary health care providers’ readiness to implement the WHO mental health Gap Action Programme Intervention Guide (mhGAP-IG) for alcohol use disorder in rural Uganda: a qualitative study using CFIR

Article Title: Primary health care providers’ readiness to implement the WHO mental health Gap Action Programme Intervention Guide (mhGAP-IG) for alcohol use disorder in rural Uganda: a qualitative study using CFIR

Article References: Samantha, M., Mlahagwa, W., Maling, S., Bartels, S., Obua, C., & Wakida, E. K. (2026). Primary health care providers’ readiness to implement the WHO mental health Gap Action Programme Intervention Guide (mhGAP-IG) for alcohol use disorder in rural Uganda: a qualitative study using CFIR. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15643-3

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15643-3

Keywords: alcohol use disorder, mhGAP-IG, primary health care, implementation readiness, implementation science, CFIR, Uganda, qualitative research, WHO, global mental health, Primary, health

The research, conducted by a team from Mogadishu University, the Somali Ministry of Health and Human Services, SIMAD University, and the University of Leeds, combined a systematic review of national and international policy documents with in-depth interviews of 13 key informants drawn from across Somalia’s health landscape. Participants included federal policymakers, health-system technical advisers, regulators, dental academics, professional association leaders, and frontline service providers working in public hospitals and private dental clinics. The study was designed not merely to describe the availability of oral health services but to generate implementation-oriented evidence on how essential dental care could be embedded within Somalia’s ongoing primary health care and universal health coverage reforms.

Somalia’s health system has been shaped by decades of conflict, institutional fragmentation, recurrent humanitarian crises, population displacement, and limited public financing. Recent reform efforts, including the Health Sector Strategic Plan III 2022–2026, the Essential Package of Health Services 2020, and the Investment Case for the Somali Health Sector 2022–2027, have created genuine opportunities for health-system development. However, service availability remains deeply uneven, donor dependence is substantial, the private sector plays a dominant yet variably regulated role, and out-of-pocket spending continues to be the primary source of health financing. Within this context, oral health has received remarkably limited policy and programmatic attention, with dental care remaining largely reactive rather than preventive.

The study’s findings paint a picture of a system in which oral health is formally acknowledged within national policy frameworks but remains almost entirely absent from routine service delivery. Somalia’s Essential Package of Health Services 2020 does include selected oral-health-related interventions, such as oral health promotion, referral of dental conditions, dental extraction, drainage of dental abscesses, and management of dental emergencies. However, these provisions are narrowly focused on clinical care and are not supported by a comprehensive implementation framework defining service standards, workforce competencies, essential commodities, financing mechanisms, referral pathways, quality assurance processes, or routine monitoring indicators. As one senior technical advisor to the Ministry of Health explained, oral health has often been included in policy documents but not adequately funded or implemented.

This policy-implementation gap is compounded by a service-readiness crisis. Available evidence indicates a high burden of untreated caries among both children and adults, alongside significant levels of severe periodontal disease and oral cancer. Despite this burden, key oral health services—including oral health screening, urgent oral care and pain management, and basic restorative treatment—were unavailable in public primary health care facilities as of 2021, the most recent year for which nationally comparable service-readiness data are available. No subsequent national oral health survey or facility-readiness assessment has since been published for Somalia, leaving policymakers without the basic evidence needed to plan, budget, or advocate for resources.

The financing structure emerged as perhaps the most consequential barrier to equitable access. With oral health financing largely dependent on out-of-pocket expenditure and private-sector provision, the cost of consultations, treatment, transportation, and medications frequently discourages timely care-seeking, particularly among low-income families. Many individuals delay seeking treatment until symptoms become severe, often relying on self-medication, traditional remedies, or informal providers as more affordable alternatives. Conditions that could have been prevented or managed through early intervention commonly progress to pain, infection, tooth loss, and the need for more complex and costly treatment. As one service-delivery participant noted, public health facilities rarely receive state funding for dental equipment or staff, meaning that a family’s financial situation completely dictates their access to care.

The workforce dimension of this challenge is equally stark. Somalia has fewer than 100 practising dentists nationally, with an acute shortage of dental specialists and virtually no allied oral health personnel such as dental therapists, hygienists, or dental nurses capable of supporting preventive and primary-level services. The existing dental curriculum was described as hospital-centred and focused on specialized clinical procedures rather than preparing graduates for community-based or preventive practice. Workforce maldistribution compounds the problem, with rural, remote, and underserved communities facing persistent shortages of qualified providers. Participants widely viewed task-sharing—the strategic deployment of community health workers, nurses, midwives, and other primary care personnel to deliver selected oral health interventions—as a practical and necessary strategy, provided it is supported by competency frameworks, standardized training, supervision, and regulatory oversight.

Perhaps the most striking finding relates to the invisibility of oral health within Somalia’s health information systems. Currently, only a single indicator—dental consultations—is reported through the District Health Information System 2, the country’s primary health data platform. Private providers, who deliver the vast majority of dental care, do not routinely report to government systems, and local electronic records remain disconnected from national monitoring infrastructure. This absence of reliable data creates a self-reinforcing cycle in which oral health remains inadequately measured, therefore largely invisible within health planning and budgeting processes, which in turn reduces investment in surveillance and research, perpetuating the scarcity of evidence needed to support evidence-based decision-making.

Despite these formidable barriers, the study identified genuine opportunities for phased integration that build on existing health system platforms rather than requiring the immediate establishment of separate, resource-intensive dental infrastructure in every district. Participants converged around a pragmatic model that would embed oral health services within established primary health care, maternal and child health, school health, community health, nutrition, and noncommunicable disease platforms. Antenatal care visits, immunization clinics, nutrition programs, and school health initiatives were repeatedly identified as strategic entry points for oral health promotion, screening, risk assessment, and referral. The researchers drew on comparative evidence from Brazil, where oral health teams have been embedded within the Family Health Strategy since 2004, demonstrating that PHC-embedded integration is achievable at scale when accompanied by durable financing commitments and a workforce structure designed from the outset to include oral health personnel.

The study’s authors propose a phased implementation roadmap that moves from foundational governance, minimum service packages, and data systems in the short term, through workforce and financing reform in the medium term, to full curative-service expansion and universal health coverage integration in the long term. Short-term priorities include establishing a national oral health policy roadmap, defining a minimum package of preventive and promotive interventions deliverable at primary care level, incorporating oral health indicators into DHIS2, and beginning competency-based training of community health workers. Medium-term priorities focus on sustained workforce investment, financing reforms, and strategic purchasing arrangements to leverage private-sector capacity. Long-term goals centre on progressive incorporation of oral health into universal health coverage benefit packages. The findings suggest that oral health integration in Somalia is fundamentally a health-systems implementation challenge rather than solely a dental-service issue, and that the most sustainable pathway forward lies not in establishing a separate vertical dental programme but in embedding oral health within existing primary health care and universal health coverage structures—offering transferable lessons for other fragile and resource-constrained settings grappling with similarly neglected areas of care.

Subject of Research: Integration of oral health services into Somalia's primary health care system and universal health coverage reforms

Article Title: Integration of oral health into primary health care in Somalia: opportunities, barriers, and system-level implications for universal health coverage

Article References: Gedi, S., Ossoble, S. A., Dahir, M. M., Abdulsamad Mohamud, N., Ahmed, A., Hassan, J., & Omar, M. A. (2026). Integration of oral health into primary health care in Somalia: opportunities, barriers, and system-level implications for universal health coverage. Frontiers in Oral Health, 7, Article 1930618. https://doi.org/10.3389/froh.2026.1930618

Image Credits: AI Generated

DOI: 10.3389/froh.2026.1930618

Keywords: oral health, Somalia, primary health care, universal health coverage, health systems, health policy, dental caries, health workforce, task-sharing, health financing, DHIS2, fragile states

The evolution of the package across its 2010, 2017, and 2020 revisions also tells a story about how the global NCD agenda itself has matured. The expansion from cardiovascular-focused protocols to include asthma, chronic obstructive pulmonary disease, early cancer diagnosis, palliative care, and self-care guidance reflects growing recognition that noncommunicable diseases are not a single clinical category but a heterogeneous group of conditions whose management shares common infrastructure: trained staff, reliable medicines, functioning diagnostic equipment, and organized follow-up. For readers unfamiliar with the terminology, noncommunicable diseases—chiefly cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes—are responsible for the large majority of deaths worldwide, and their burden falls disproportionately on low- and middle-income countries, where roughly three quarters of NCD deaths occur. These conditions share modifiable risk factors such as tobacco use, harmful alcohol consumption, unhealthy diets, physical inactivity, and air pollution, which is why a package approach that bundles prevention, screening, and management has such broad potential reach.

The overview’s finding that workforce capacity is a persistent bottleneck deserves particular attention, because it connects to a well-documented global phenomenon. Many low- and middle-income countries face acute shortages of physicians, and those physicians who are available are often concentrated in urban tertiary hospitals rather than in the rural primary care facilities where most of the population seeks care. Against this backdrop, the evidence supporting task-shifting—delegating specific clinical tasks to non-physician health workers such as nurses, clinical officers, and community health workers—takes on strategic significance. Reviews of task-shifting in hypertension and diabetes care have generally found that, when accompanied by structured training, clear protocols, and supervision, non-physician workers can achieve clinical outcomes comparable to those of physicians for routine NCD management. This does not mean that task-shifting is a panacea; it requires investment in training curricula, regulatory authorization, and ongoing quality assurance, and the overview’s emphasis on strengthening the organization and resourcing of healthcare teams across system levels is a reminder that delegated tasks only function within a coherent team structure.

The finding on high-risk population screening similarly benefits from context. Population-wide screening for hypertension and diabetes is often proposed as a straightforward entry point for NCD care, but the evidence reviewed here suggests that targeting individuals at elevated cardiovascular risk can be a more efficient use of limited diagnostic capacity. The WHO PEN approach embeds this logic through its risk-based protocols, which recommend intensive treatment for people above defined risk thresholds while offering lifestyle advice to those at lower risk. The practical implication for program managers is that screening efforts should be designed with clear referral pathways and treatment availability in mind; identifying patients without the capacity to treat them erodes community trust and wastes scarce resources.

The inclusion of integrated HIV-NCD services among the effective delivery strategies reflects one of the most encouraging developments in global health over the past decade. Antiretroviral therapy programs, heavily supported by international financing, have built remarkably robust platforms in many high-burden countries: reliable supply chains, trained lay and professional workers, electronic patient records, and routine follow-up systems that achieve retention rates far exceeding those of typical NCD clinics. Evidence from reviews indicates that NCD services can be grafted onto these platforms—screening hypertensive patients at HIV clinic visits, managing diabetes alongside antiretroviral refills—with benefits flowing in both directions. The integration is not trivial, since HIV programs and NCD programs often sit in separate ministry departments with separate funding streams, and vertical financing structures can create perverse incentives against sharing resources. But the direction of travel is clear, and the overview’s endorsement of integrated services aligns with a broader movement toward people-centered, horizontally financed primary health care.

The role of community pharmacies is another strategy whose evidence base has grown substantially. In many countries, private pharmacies are the first and often the only point of contact with the health system, particularly in peri-urban and rural areas where public facilities are sparse. Reviews have found that trained pharmacy staff can contribute to blood pressure measurement, medication counseling, adherence support, and in some settings even initiation and titration of antihypertensive therapy under defined protocols. Harnessing this existing infrastructure requires regulatory clarity and quality oversight, but it represents a comparatively low-cost avenue for expanding access without constructing new facilities.

The overview’s attention to district hospitals may seem counterintuitive in a discussion of primary care, but it addresses a real structural weakness. Primary health facilities cannot safely manage NCDs if patients with complications, or requiring specialist input, have nowhere to be referred. District hospitals serve as the anchor of the referral chain, providing the diagnostic capacity, specialist expertise, and inpatient care that give primary care its credibility. Strengthening district hospitals—through training in NCD complications, reliable supply of essential medicines, and functional referral and counter-referral systems—therefore reinforces the entire service delivery pyramid rather than competing with primary care for resources.

The critique of hospital-centric systems deserves elaboration. Many health systems in low- and middle-income countries inherited hospital-focused models from earlier eras, in which prestige, staffing, and budgets concentrate at the top of the pyramid while primary facilities are starved. NCDs, which require decades of continuous management rather than episodic cure, expose the weaknesses of this model particularly starkly. A patient with hypertension needs regular monitoring, affordable medication refills, and lifestyle counseling over a lifetime—services that hospitals are poorly configured to provide at scale. The overview’s call for more patient-centered and prevention-oriented models is thus not merely rhetorical; it implies reorienting financing, training, and performance measurement toward continuity of care and risk factor control rather than episodic treatment.

Quality of care, flagged in the overview as a promising area for improvement, is often the missing dimension in discussions of NCD service expansion. Expanding coverage without ensuring quality can produce the illusion of progress: patients are diagnosed but not controlled, prescribed but not adherent, enrolled but not retained. Evidence from implementation research suggests that simple quality improvement tools—clinical audits, standardized protocols, supportive supervision, and patient registries that flag those lost to follow-up—can meaningfully improve hypertension and diabetes control even in low-resource settings. The WHO PEN protocols themselves function as quality tools by standardizing care, but they require complementary systems to monitor whether the protocols are actually followed.

The methodological character of this overview also merits a note for readers assessing the strength of its conclusions. As a narrative overview of reviews rather than a meta-analysis, it synthesizes heterogeneous evidence without pooling effect estimates, which is appropriate given the diversity of interventions and settings but means that its findings should be read as directional guidance rather than precise effect sizes. The inclusion of twelve reviews and one preprint, drawn from searches spanning 2010 to 2025, reflects a field that is still maturing; the authors’ call for longer-term evaluations acknowledges that most implementation studies measure short-term outputs such as screening numbers or prescription rates, while the outcomes that matter most—sustained blood pressure and glycemic control, reductions in cardiovascular events, and equity of access—require follow-up periods and study designs that are more demanding and less commonly funded.

Finally, the emphasis on context-specific adaptation is a recurring lesson from implementation science. Interventions that succeed in one country frequently falter when transplanted elsewhere without modification, because health system structures, workforce compositions, financing arrangements, and community expectations differ. The stepwise implementation approach recommended for WHO PEN—beginning with advocacy, stakeholder engagement, and facility capacity assessment before scaling—embodies this principle, allowing countries to identify local bottlenecks in medicines, diagnostics, or staffing before committing resources. The more than forty countries that have begun implementing the package represent a substantial natural experiment, and the lessons distilled in this overview suggest that success will depend less on the elegance of the protocols than on the unglamorous work of financing, supply chains, workforce planning, and team organization that turns a package of recommendations into a functioning service.

Subject of Research: Implementation of the World Health Organization’s Package of Essential Noncommunicable Disease Interventions: an overview of reviews

Article Title: Implementation of the World Health Organization’s Package of Essential Noncommunicable Disease Interventions: an overview of reviews

Article References: Xu, H., Hu, Y., Li, M., Yang, J., Breda, J. J., Wu, J., & Cieza, A. (2026). Implementation of the World Health Organization’s Package of Essential Noncommunicable Disease Interventions: an overview of reviews. Public Health Reviews, 47, Article 1609607. https://doi.org/10.3389/phrs.2026.1609607

Image Credits: AI Generated

DOI: 10.3389/phrs.2026.1609607

Keywords: WHO PEN, noncommunicable diseases, primary health care, low- and middle-income countries, task-shifting, hypertension, diabetes, health systems, screening, essential medicines, integrated care, community pharmacies

The research, published in the journal Heliyon, focused on a distinctive group within Iran’s primary health-care infrastructure: Women Health Volunteers, community members who collaborate with primary health-care centers on a voluntary, unpaid basis. These volunteers undergo basic health training and assist health professionals in delivering health promotion and prevention initiatives within their neighborhoods. Their responsibilities typically include educating families on healthy lifestyles, improving maternal and child health outcomes, encouraging chronic disease self-management, and bridging the gap between community members and primary care services. As these activities are unpaid and community-oriented, health volunteers represent an essential pillar of organized volunteerism within the Iranian primary health system.

To understand what motivates these volunteers, the research team drew on the Functional Approach to Volunteerism proposed by Clary and Snyder, a framework that holds individuals engage in volunteer activities because volunteering serves different psychological functions. These include the expression of values, social interaction, understanding, career development, enhancement, and protective motives. From this perspective, religiosity and spiritual health may be particularly relevant to the values function, as both constructs are associated with altruistic beliefs, meaning in life, and concern for the welfare of others. The framework is also consistent with Self-Determination Theory, which suggests individuals are more likely to engage in sustained prosocial behaviors when those behaviors satisfy intrinsic needs for meaning, relatedness, and personal fulfillment.

The study was designed as an analytical cross-sectional, non-experimental investigation conducted in 2025 in Saveh city. The final sample size was determined to be 345 participants initially enrolled, calculated using G*Power software based on a linear multiple regression model. Assuming a small-to-moderate effect size, a significance level of 0.05, a statistical power of 90 percent, and six predictors—religiosity, spiritual health, age, gender, education level, and marital status—the minimum required sample size was estimated at 181 participants. To account for potential incomplete questionnaires and improve statistical precision, a larger sample was recruited. Of the 345 health volunteers initially enrolled, 324 respondents with complete data were included in the final analysis.

Simple random sampling was employed after obtaining approval from the relevant ethics committee. A list of all registered health volunteers in Saveh was collected in collaboration with Saveh University of Medical Sciences, health centers, health bases, and pre-hospital emergency services. After assigning a unique numerical code to each individual on this list, a random number table was utilized to ensure random selection and minimize bias. Each number extracted from the table was matched with the assigned numerical code of the volunteers, and if a match occurred, that individual was selected as a final participant. Questionnaires were administered in two formats: online, completed by 165 respondents, and paper-based in person, initially distributed to 180 respondents, of which 21 incomplete questionnaires were excluded, yielding a final paper-based total of 159. Respondents were not randomly assigned to the two modes of data collection; rather, the mode of completion was determined by participants’ accessibility and personal preference. The researchers compared the main study variables across the two formats using the Mann–Whitney U test and found no statistically significant differences.

Three validated instruments were used to collect data. The Volunteer Functions Inventory, developed by Clary and colleagues, assesses the motivations underlying volunteering across six subscales: Protective, Values, Career, Social, Understanding, and Enhancement. The validated Persian version used in this study contained 29 items, with the total possible score ranging from 29 to 203. The Religiosity Questionnaire, based on the work of Glock and Stark, gauges individuals’ religious beliefs and attitudes across four dimensions—belief, emotional, consequential, and ritual—yielding a total score range of 0 to 104. The Spiritual Well-Being Scale developed by Paloutzian and Ellison is a 20-item self-report instrument assessing two dimensions of spiritual health: religious well-being and existential well-being, with a total score range of 20 to 120. In the present study, Cronbach’s alpha coefficients indicated acceptable reliability for all three instruments, with the Volunteer Functions Inventory reaching 0.98, the Religiosity Questionnaire 0.93, and the Spiritual Well-Being Scale 0.88.

The results revealed a significant positive correlation between the total score of volunteer functions and both spiritual health and religiosity. The correlation between volunteer functions and spiritual health was 0.26, while the correlation with religiosity was notably stronger at 0.40. Respondents with higher spiritual health and religiosity exhibited higher levels of volunteer functions. Furthermore, a significant positive correlation was observed between spiritual health and religiosity themselves, at 0.48. The majority of respondents demonstrated moderate levels of spiritual health and religiosity: 67.9 percent fell into the moderate category for spiritual health, and 70.1 percent for religiosity. The mean age of respondents was 29.87 years, with 63.9 percent female, 53.1 percent married, and 52.2 percent holding a bachelor’s degree.

Multiple linear regression analysis showed that, after controlling for socio-demographic variables including age, gender, education level, and marital status, both spiritual health and religiosity independently and significantly predicted the total volunteering function score. Spiritual health was positively and significantly associated with volunteering functions, with an unstandardized coefficient of 0.402 and a p-value of 0.021. Religiosity emerged as an even stronger positive predictor, with an unstandardized coefficient of 0.801 and a p-value below 0.001. Among the socio-demographic variables, only education level showed a significant negative effect, such that higher educational levels were associated with significantly lower volunteering function scores. In contrast, age, gender, and marital status were not significantly related to volunteering functions. The final regression model accounted for approximately 21 percent of the variance in volunteering function scores, and the overall model was statistically significant.

The demographic analysis revealed additional patterns. A weak but significant association was found between age and religiosity, suggesting that religiosity increases with age—a trend consistent with some studies observing an increase in religiosity in later life stages, which may be linked to accumulated life experiences and a heightened search for meaning during these periods. Women exhibited significantly higher levels of religiosity and spiritual health compared to men, and married respondents showed significantly higher levels of religiosity than single respondents. These differences may be influenced by gender-related socialization patterns, gender roles, and participation in religious social networks, while marital status may enhance engagement with religious and spiritual values through increased family responsibilities and social integration. However, the researchers noted that although these differences were statistically significant, the magnitude of associations was relatively small to moderate rather than strong.

The finding that higher education levels were associated with lower levels of spiritual well-being, religiosity, and volunteer functions warrants careful interpretation. The researchers suggested this pattern may reflect differences in how individuals with varying educational backgrounds engage with religion and spirituality. Secularization theory has often been used to explain this association, suggesting that higher education and modernization may expose individuals to broader worldviews and critical thinking perspectives, which can be accompanied by a gradual decline in traditional religious involvement. However, this relationship is not universal and appears to be context-dependent, influenced by cultural setting, measurement approaches, and individual differences. The correlation coefficients ranged from approximately negative 0.11 to negative 0.19, indicating weak but consistent trends that warrant further investigation rather than strong causal or deterministic interpretations.

The researchers acknowledged that spiritual health and religiosity overlap conceptually, and that this overlap might influence the observed relationships. While related, these two concepts are distinct: spiritual health generally refers to a broad sense of meaning, connection, and existential well-being, whereas religiosity is more about how closely someone follows religious beliefs, rituals, and practices. Previous research has shown that although these areas are correlated, they are generally considered distinct constructs capturing different aspects of people’s inner lives and behaviors. The instruments utilized in this study are grounded in established theory and have been validated as measuring distinct constructs, which mitigates the risk of confounding. The magnitude of the observed associations is consistent with prior empirical reports, suggesting the results do not arise solely from conceptual overlap. Nonetheless, some shared variance is inevitable when studying closely related psychosocial concepts, and future research could benefit from using more precise or multidimensional measures to more clearly differentiate between spiritual health and religiosity.

Several limitations constrain the interpretation of these findings. Owing to the cross-sectional design, causal inferences cannot be drawn; as data were collected at a single point in time, only associations—not causal relationships—between religiosity or spiritual health and volunteering can be inferred. Social desirability bias remains a potential concern, as respondents may overreport religious devotion owing to its socially valued status, though anonymity mitigated this risk. Additionally, socioeconomic status and prior volunteer experience were not assessed and therefore could not be included as covariates in the regression models. These variables are known to be associated with both religiosity and volunteering behavior, and their omission could potentially confound the observed associations. Several secondary bivariate analyses were also conducted without formal adjustment for multiple comparisons, meaning the possibility of Type I error inflation cannot be completely excluded.

The cultural context of these findings deserves particular attention. In individualistic countries like the United States, Canada, and Australia, volunteering is often driven by personal goals such as learning new skills, self-development, and career growth. In contrast, in collectivist societies like India, Japan, and China, motivation tends to come from ethical and social values, such as supporting the community, sharing responsibility, and following religious norms. The researchers cautioned that care is warranted when generalizing these findings to culturally different populations. Within the specific context of a religiously oriented society like Iran, however, the results suggest that religious beliefs, practices, and broader dimensions of spiritual well-being may contribute meaningfully to volunteer functions. Prior research has also emphasized that combining religion with active spiritual practices—like prayer, meditation, gratitude, and quiet reflection—has a stronger effect on volunteering than simply following religious doctrines, and that the social side of religiosity, such as joining collective rituals and being part of religious communities, is especially powerful in motivating volunteer behavior.

Looking forward, the researchers recommend longitudinal and prospective studies to clarify the direction and mechanisms of the relationships between spiritual and religious dimensions and volunteering behavior. Future research should also incorporate comprehensive measures of socioeconomic background and volunteer history to better isolate the unique contributions of religiosity and spiritual health to volunteer functions. The results indicate that demographic factors, particularly educational level, may be associated with differences in volunteer functions and should be considered in future research and program development. For health systems in Iran and similar contexts that depend heavily on volunteer networks to deliver community health services, understanding these motivational foundations could prove essential for sustaining the volunteer workforce upon which primary care delivery increasingly relies.

Subject of Research: Associations between religiosity, spiritual health, and volunteer functions among community health volunteers in Iran

Article Title: Religiosity, spiritual health, and volunteer functions among health volunteers in Saveh, Iran: A cross-sectional study

Article References: Arab, F., Khademi, S., & Saeedi, M. (2026). Religiosity, spiritual health, and volunteer functions among health volunteers in Saveh, Iran: A cross-sectional study. Heliyon, 12(16), Article e45585. https://doi.org/10.1016/j.heliyon.2026.e45585

Image Credits: AI Generated

DOI: 10.1016/j.heliyon.2026.e45585

Keywords: religiosity, spiritual health, volunteer functions, health volunteers, Iran, cross-sectional study, volunteer motivation, primary health care, Women Health Volunteers, community health, psychology of religion, Heliyon

Before the uprising in March 2011, Syria was one of the more advanced middle-income settings for cancer care in the Eastern Mediterranean Region. Oncology services were, however, heavily centralized in Damascus, Aleppo, and Latakia. As the conflict escalated between 2011 and 2014, and then internationalized following Russia’s military intervention in 2015, waves of attacks on health infrastructure and shifting lines of territorial control carved the system apart. By the relatively frozen phase between 2020 and 2024, three main configurations had consolidated: a northwest serving roughly five to six million people, a northeast serving around three to four million, and the former government-controlled areas containing about two-thirds of the population and every major city. The northwest and northeast lacked comprehensive cancer services almost entirely, forcing the most severe cases to be referred abroad, particularly to Türkiye, while even the major cities operated under strained conditions with outdated protocols and reliance on unbranded medicines from Iran and India that had not undergone quality control.

The scale of need is substantial and growing. According to Global Cancer Observatory data for 2022, Syria recorded an estimated 22,000 new cancer cases and nearly 14,000 deaths, though these are modelled figures rather than in-country counts, because no functioning national cancer registry existed during the conflict. The authors caution that the true burden is likely higher, given diagnostic gaps, access barriers, and patients who simply never present to care. Around 20 specialized oncology centers operate across several governorates, but the designation is misleading: few facilities offer the full range of surgical, systemic, and radiation treatment within one institution, so patients must piece together their care across multiple sites, often traveling enormous distances at considerable personal cost.

The technical shortfalls described in the article are severe. Only six linear accelerators are available countrywide for radiotherapy, four at Al-Bairuni, of which three are functioning, and two in Lattakia, one of which is out of service. Waiting times of three to six months for radiotherapy are reportedly affecting an estimated 40 percent of urgent cases. CT-PET imaging, essential for accurate diagnosis and staging, is unavailable in the public sector; it exists only in Damascus’s private clinics at prices prohibitive for most patients. There are no operational bone marrow transplantation centers in the country, chemotherapy supply chains are frequently interrupted, and pathology and molecular diagnostic capacity varies widely between facilities. These figures, drawn from ministry-level information, operational reports, and rapid service mapping, are indicative rather than definitive, but they consistently point to a system unable to deliver continuous, multimodal cancer care.

The authors’ central argument is counterintuitive in an emergency: rather than rushing to reopen facilities and expand services, Syria’s early recovery should prioritize governance, referral structure, and financial protection first. They define institutional coherence as the alignment of governance, regulatory, financing, and service delivery structures under a unified national framework, and consolidation as the strategic coordination of services while capacity is rebuilt. Experience from other post-conflict settings supports this sequencing. In Bosnia and Herzegovina, strengthening primary care governance and institutional accountability preceded tertiary expansion and helped restore system coherence. In Liberia, adopting a nationally defined essential health service package aligned implementing partners under shared priorities and reduced fragmentation. Expanding specialized services without stabilizing the institutional architecture, the authors warn, risks reinforcing systemic disorganization and inequity rather than repairing it.

Referral pathways emerge as a critical fault line in the cancer care continuum, the chain running from prevention and early detection through diagnosis, treatment, follow-up, and supportive care. In principle, primary health care should serve as the entry point, applying standardized early detection protocols and distinguishing urgent from routine referrals. In practice, Syria’s primary care system has lost its gatekeeping function. Patients bypass it and self-refer directly to overwhelmed tertiary centers, contributing to diagnostic delays. Many people instead obtain care from pharmacies, community practitioners, and informal providers outside official health system standards, a pattern driven by destroyed facilities, the killing and migration of health workers, and economic hardship.

That dysfunction has deep historical roots, and the article is unusually direct about them. The former regime used health services to reward political loyalty and punish dissent. Before 2011, Latakia and Tartus, areas loyal to the government, had one hospital bed for every 573 and 672 people respectively, compared with 2,113 per bed in Idlib and 1,379 in Al-Raqqa. Workforce data from UNHCR and the World Bank show that doctor density rose in Tartus and Damascus during the war while falling most sharply in Dera’a, Homs, Sweida, rural Damascus, Quneitra, and Deir-ez-Zor. Restoring public confidence in primary care as the gateway to oncology services, the authors argue, therefore requires confronting this inherited inequity head-on, not merely drafting new referral protocols.

Lessons from Liberia and Rwanda suggest that referrals work when they rest on practical mechanisms rather than paperwork alone. In Liberia’s early recovery, compliance improved when district hospitals designated focal persons and communication between referring clinics and receiving facilities was structured rather than informal. Rwanda strengthened referral continuity through clear lines of responsibility between health centers and district hospitals, combined with supervisory follow-up. For Syria, the authors recommend building on the tacit, unwritten knowledge that accumulated across the conflict years: designated referral focal points within oncology centers, streamlined inter-facility communication, and simple confirmation that referred patients actually arrived. Monitoring, they suggest, should start with high-yield indicators such as confirmation of arrival and time to service receipt, before expanding into integrated data platforms. Distance and transport costs compound the problem, as evidence from post-conflict West Africa and from Ukraine, where patients cross regions and borders for unavailable oncology services, both demonstrate.

Financial protection is the third pillar of the proposed strategy, and the authors treat it as a governance instrument rather than a budgetary afterthought. Given Syria’s severe fiscal constraints, universal coverage of oncology benefits is not immediately feasible. Instead, they propose defining a phased essential cancer service package centered on first-line chemotherapy regimens matched to national disease burden and expected survival benefit, in line with the Disease Control Priorities framework, which prioritizes cost-effective, high-impact interventions. Targeted protection for pediatric cancers and curative-intent multimodal care would deliver the greatest mortality reduction while preserving fiscal discipline. Centralizing procurement of essential oncology medicines would reduce stock-outs, price variability, and geographic inequity, while standardized national treatment protocols adapted to available medicines would curb unwarranted variation in prescribing. As fiscal space grows, coverage could broaden progressively.

Perhaps the article’s most important message is that in fragile systems, sequencing is not a retreat from equity but a strategy to protect it. Concentrating complex services temporarily can preserve quality and specialist capacity while the system is rebuilt, provided consolidation is explicitly transitional and paired with a phased decentralization plan as workforce, infrastructure, and financing improve in governorate hospitals. The alternative, rapid expansion on top of fragmented governance, would lock in the very disparities that the war created, leaving patients in peripheral regions traveling vast distances and paying catastrophic costs for incomplete care. Syria’s cancer patients, the authors conclude, need continuity restored across the entire care continuum before capacity can credibly grow, and that continuity depends on aligning governance, service delivery, and financing into a single, accountable national framework.

Subject of Research: Post-conflict reconstruction of cancer care services and health system governance in Syria

Article Title: Rebuilding cancer care in post-conflict Syria: restoring continuity across the cancer care continuum

Article References: Shalabi, S., Abbara, A., Aljerk, W., Debel, J., Safadi, S., Khoshnood, K., Sullivan, R., Ferrouh, Y., & Alkhalil, M. (2026). Rebuilding cancer care in post-conflict Syria: restoring continuity across the cancer care continuum. Frontiers in Cancer Control and Society, 4, Article 1843120. https://doi.org/10.3389/fcacs.2026.1843120

Image Credits: AI Generated

DOI: 10.3389/fcacs.2026.1843120

Keywords: Syria, cancer care, oncology, health system fragmentation, post-conflict recovery, referral pathways, radiotherapy, health financing, cancer registry, health governance, primary health care, financial protection

Health advocacy, as defined by the widely used CanMEDS framework of medical competencies, involves far more than treating the patient in front of you. It requires physicians to recognize health needs that patients themselves may never voice, to mobilize resources on their behalf, and to promote changes that advance health equity in collaboration with individuals and communities. In a country like Brazil, where the constitutionally guaranteed Unified Health System (SUS) was built on the principle of universal, comprehensive care, this competency carries particular weight. The country’s National Curriculum Guidelines for medical education explicitly emphasize comprehensive care across all levels of the health system, and they call for the development of ethical, critical, and socially engaged professionals. Still, the study’s authors note that translating these aspirations into actual teaching practice remains a persistent challenge for medical educators everywhere.

To understand how advocacy is actually taught — or not taught — the research team, led by Mariana Eri Sato of FMUSP’s Primary Health Care Supervision unit together with Márcia Oliveira Mayo Soares and Milton Arruda Martins, turned to a qualitative, hermeneutic approach. Rather than surveying a large sample with fixed questions, the researchers convened a focus group with eleven professors drawn from six different specialties: Gynecology and Obstetrics, Pediatrics, Psychiatry, Preventive Medicine, Internal Medicine, and Family and Community Medicine. Crucially, every participant was actively engaged in teaching primary health care to undergraduates, meaning the discussion captured the perspectives of the very faculty members tasked with delivering this content. The session was audio-recorded, fully transcribed, and then analyzed through comprehensive interpretive reading, a technique in which researchers immerse themselves in the material to identify recurring analytical categories. Those categories were subsequently interpreted in light of established theoretical frameworks in medical education, and the study received ethics approval from the Research Ethics Committee of FMUSP’s Hospital das Clínicas, with informed consent obtained from all participants.

The single most consistent theme to emerge from the discussion was the difficulty of teaching students to identify health needs that go beyond the explicit demands patients bring into the consultation room. A patient may present with back pain, for example, while the underlying issue is unsafe housing, unemployment, food insecurity, or untreated depression that the patient never mentions. Learning to see these hidden dimensions — and to connect the care of one individual patient to the collective health of the community they belong to — is, in the professors’ view, the central educational challenge of advocacy. It demands a fundamental shift in clinical reasoning, from the classic biomedical model that asks ‘what disease explains this symptom?’ to a broader question: ‘what social and structural forces are shaping this person’s health, and what can I do about them?’

For all these difficulties, the participants were remarkably unified on one point: primary health care is a privileged setting for learning advocacy. Unlike a hospital ward, where patients appear as isolated cases stripped of context, primary care embeds future doctors in communities over time. Students working in primary care settings witness firsthand how social determinants of health — income, education, sanitation, access to transport — translate into disease and suffering. They see families across generations, follow patients through the consequences of policy decisions, and encounter the gap between what the health system promises and what it delivers. In the Brazilian context, where SUS organizes care around territorial responsibility and community engagement, primary care offers an almost laboratory-like environment for observing the interplay between medicine and society.

Yet the professors also identified a sobering institutional reality: the contribution of primary health care to the curriculum is often undervalued. Within the culture of academic medicine, where high-technology hospital specialties traditionally command prestige, the intellectual and social richness of community-based teaching can be dismissed as secondary. This devaluation is not merely symbolic. It shapes how resources are allocated, how teaching time is protected, and how seriously students take their primary care rotations. When the institutional signal suggests that advocacy and community health are peripheral concerns, students absorb that message regardless of what the official curriculum says.

Indeed, the study’s most consequential finding concerns the nature of the obstacles themselves. The professors did not point primarily to pedagogical problems — a lack of teaching techniques, materials, or know-how. Instead, the barriers they identified were institutional: curricular fragmentation that slices learning into disconnected blocks, assessment systems that fail to measure advocacy competencies at all, and the hidden curriculum, the unwritten norms and values that students absorb by watching what is rewarded and what is ignored. Curricular fragmentation is particularly corrosive for advocacy, because advocacy is inherently integrative; it requires students to bridge clinical care, public health, ethics, and social analysis, precisely the connections that fragmented curricula tend to sever. And assessment gaps matter enormously in competency-based education, because what is not tested is, in practice, not taught. If students are never evaluated on their ability to recognize unvoiced health needs or mobilize community resources, they quickly learn that these skills are optional.

The hidden curriculum deserves particular attention because it operates beneath the level of formal instruction. Students learn from what their teachers model, from the jokes told in the corridor, from which rotations are described as ‘real medicine’ and which are treated as boxes to tick. If hospital-based, procedure-oriented faculty implicitly convey that advocacy is soft or political work unworthy of a serious physician, no amount of lecture content on social determinants will counteract that message. Conversely, the study suggests, the same mechanism can work in favor of advocacy when it is made deliberate: faculty who visibly advocate for their patients, who name the social forces behind a clinical problem, and who treat community engagement as core medical work transmit a powerful counter-message.

That is precisely where the study’s conclusions offer grounds for optimism. The participants identified a set of strategies already embedded in primary health care teaching at FMUSP that could serve as underrecognized vehicles for developing advocacy: role modeling by engaged faculty, the Person Centered Clinical Method (PCCM), small-group learning, and reflective portfolios. Each of these tools, the researchers argue, already pushes students beyond the biomedical gaze. The Person Centered Clinical Method explicitly trains students to explore the patient’s illness experience, context, and goals, creating natural openings for identifying unvoiced needs. Small-group learning allows students to discuss difficult cases collectively and to practice articulating the collective dimensions of health. Reflective portfolios ask students to make their values and observations explicit, turning tacit experience into conscious learning. The problem is not that these methods fail to teach advocacy; it is that nobody has named them as advocacy teaching, and so their contribution goes unrecognized, unsupported, and unassessed.

The study’s practical implication is therefore deceptively simple: make the invisible visible. By explicitly framing existing primary care teaching practices as health advocacy education, aligning assessment systems with that framing, and securing institutional support for community-based teaching, medical schools could embed advocacy across the curriculum without inventing new courses from scratch. For a world grappling with widening health inequities, aging populations, and the mounting burden of diseases rooted in social conditions, the stakes extend well beyond one Brazilian institution. The FMUSP professors’ experience suggests that the future of advocacy in medicine may depend less on adding content than on recognizing, rewarding, and protecting the teaching that is already happening — often in the least glamorous corners of the medical school, where students first learn what it truly means to stand up for a patient.

Subject of Research: Teaching health advocacy competency in primary health care medical education

Article Title: Teaching health advocacy in primary health care: a qualitative study with professors from the University of São Paulo medical school

Article References: Sato, M. E., Soares, M. O. M., & Martins, M. A. (2026). Teaching health advocacy in primary health care: a qualitative study with professors from the University of São Paulo medical school. BMC Medical Education. https://doi.org/10.1186/s12909-026-10587-y

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10587-y

Keywords: medical education, health advocacy, primary health care, qualitative research, social determinants of health, competency-based education, CanMEDS framework, hidden curriculum, Brazilian Unified Health System, University of São Paulo, curriculum reform, faculty perspectives

A new study published in BMC Health Services Research offers one of the clearest pictures yet of what drives rural women of reproductive age to embrace or reject digital maternal care. Researchers Deborah Anjolajesu Elegbeleye and Motunrayo Florence Olanrewaju, both of the Department of Public Health at Babcock University in Ogun State, surveyed 336 women aged 15 to 49 who were attending nine rural primary health centres spread across three Local Government Areas in the Ibadan zone of Oyo State: Ido, Oluyole, and Ona Ara. Using multistage probability sampling, a technique that randomly selects clusters at successive levels to produce a representative sample, the team captured a snapshot of women who rely on exactly the kind of under-resourced facilities that telehealth is supposed to strengthen.

The instrument at the heart of the study was the Rural Telehealth Adoption Assessment Questionnaire, or R-TAAQ, a validated bilingual tool designed specifically for rural populations. Its architecture draws on three of the most influential frameworks in health behaviour and technology research: the Technology Acceptance Model, which emphasises perceived usefulness and ease of use; the Health Belief Model, which focuses on how people weigh susceptibility, severity, and benefit; and the Unified Theory of Acceptance and Use of Technology, which incorporates social influence and facilitating conditions. By grounding the questionnaire in these models, the researchers could measure not just whether women knew about telehealth, but whether they believed it would help them and whether they intended to use it.

The headline finding is genuinely encouraging. Nearly two-thirds of the women, 62.8 percent, demonstrated high knowledge of telehealth, scoring an average of 5.80 out of a possible 8 points on the knowledge scale. Even more striking, 82.4 percent held positive perceptions of its benefits, with a mean benefit score of 25.6 out of 30. And willingness to adopt was high across the board: 83.9 percent of respondents said they were willing to embrace telehealth for their maternal and reproductive health needs, averaging 11.1 out of 15 on the willingness scale. The response rate of 93.6 percent suggests these figures reflect genuine engagement rather than the skewed views of a small, self-selected minority.

But the statistical core of the study lies in what predicted that willingness, and here the results take an unexpected turn. Using chi-square tests, Pearson correlations, and binary logistic regression, the researchers tested whether knowledge, perceived benefits, facilitating conditions such as infrastructure and support, and a full range of socio-demographic characteristics shaped adoption intention. Perceived benefits emerged as the only variable significantly associated with willingness to adopt, with a chi-square statistic of 46.774 and a p-value below 0.001. Knowledge of telehealth, by contrast, showed no significant association at all, with a p-value of 0.428, and facilitating conditions produced a correlation coefficient of just 0.037, statistically indistinguishable from zero.

The logistic regression sharpened the picture further. Women who perceived strong benefits from telehealth were more than eleven times as likely to be willing to adopt it, with an adjusted odds ratio of 11.274 and a 95 percent confidence interval running from 5.427 to 23.422. The model explained a meaningful share of the outcome, with a Nagelkerke R-squared of 0.254, and correctly classified 84.5 percent of cases. In plain terms, believing that telehealth would genuinely improve one’s care was the dominant force behind the decision to embrace it. Neither age, education, income, nor any other demographic factor reached significance, with the single exception of parity: women with three or four children were dramatically less willing to adopt, with an adjusted odds ratio of 0.073 and a p-value of 0.027.

That parity finding deserves careful attention. Women who have already borne several children may feel they have managed pregnancy and childbirth successfully without digital tools, or they may face time constraints and caregiving burdens that make new technologies feel like one demand too many. Whatever the mechanism, the result signals that telehealth programmes cannot treat rural women as a uniform bloc. Mothers of larger families may need tailored outreach, different service designs, or different channels of communication altogether if they are not to be left behind by a digital transition that benefits their neighbours.

The deeper lesson, however, is the one about benefits versus knowledge. For years, digital health advocates in low- and middle-income countries have assumed that the path to adoption runs through education: teach people what telehealth is, and uptake will follow. This study suggests that assumption is backwards, at least for this population. Women in these rural Ibadan communities already knew a great deal about telehealth, and that knowledge did not move the needle on their intentions. What moved the needle, overwhelmingly, was whether they believed the technology would deliver real, tangible improvements to their maternal care. The practical implication is that benefit-focused communication, messages that demonstrate concretely how a virtual consultation saves a dangerous journey or connects a pregnant woman to a skilled provider, will do far more work than awareness campaigns alone.

The authors are careful to note that willingness is not the same as sustained use. Intention is a necessary starting point, but structural barriers, unreliable electricity, patchy mobile networks, the cost of data, and the availability of devices, can still derail adoption after the initial enthusiasm. The study’s finding that facilitating conditions did not predict willingness does not mean infrastructure is irrelevant; it means that infrastructure alone will not create demand. The researchers conclude that telehealth promotion in rural primary health care settings should prioritise benefit-focused messaging while simultaneously addressing those structural obstacles to enable sustained engagement, a two-track strategy that treats perception and provision as equally essential.

For a country where rural women bear a disproportionate share of nearly one-third of the world’s maternal deaths, the stakes of getting this right could hardly be higher. What this study offers is a demand-side evidence base that has been missing from the conversation: rural Nigerian women are not waiting to be convinced that telehealth exists, and they are not blocked by ignorance or indifference. They are, by and large, ready. What they need is to be shown, convincingly and repeatedly, that the technology will make a real difference to their health and the health of their babies, and to be given the infrastructure that lets that promise hold. The digital bridge to safer motherhood, it turns out, is built first in the mind.

Subject of Research: Telehealth adoption readiness among rural women of reproductive age in Nigeria

Article Title: Knowledge, perceived benefits and willingness to adopt telehealth among women of reproductive age attending selected rural primary health care centres in Ibadan, Oyo State, Nigeria

Article References: Elegbeleye, D. A., & Olanrewaju, M. F. (2026). Knowledge, perceived benefits and willingness to adopt telehealth among women of reproductive age attending selected rural primary health care centres in Ibadan, Oyo State, Nigeria. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15815-1

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15815-1

Keywords: telehealth, maternal health, Nigeria, rural health, primary health care, technology acceptance, perceived benefits, women's health, health services research, digital health, reproductive health, Oyo State