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IntroductionThe United Nations (UN) Sustainable Development Goal 6 seeks to ensure universal access to safe drinking water by 2030, but vast inequities in access exist, especially among vulnerable communities including limited resource, rural, disaster-affected areas. Flood disasters, exacerbated by the climate crisis, hinder the ability of individuals and families to meet essential drinking water needs and increase their susceptibility to waterborne illnesses. Point-of-use (POU) water treatment is an effective solution for water-insecure populations during and immediately following flood emergencies. However, an initial literature search identified knowledge gaps surrounding implementation of POU water systems. This scoping review aims to synthesise published evidence between January 2015 and July 2025 on barriers and facilitators to utilisation of POU water treatment systems during and immediately following flood-related disasters. The findings will inform efforts to promote resilience and agency among water insecure communities, specifically by equipping them with actionable knowledge on sustainable access to safe drinking water.Methods and analysisThis scoping review will be guided by the work of Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Search terms will be identified through an iterative process using the PICOT method and Boolean logic. Four databases—Scopus, PubMed, Web of Science and Google Scholar—with the addition of grey literature from UN agencies and non-governmental organisations focused on water-related issues will be searched. Two independent reviewers will apply a priori eligibility criteria to select studies. Conflicts will be resolved through discussion and a third independent reviewer absent agreement between the first two reviewers. Cohen’s kappa statistic will be calculated to assess inter-rater reliability. Data extraction will be guided by predefined data points, and the Consolidated Framework for Implementation Research will guide evidence synthesis through a solution-based approach.Ethics and disseminationInstitutional research ethics review is not required because no human subjects are involved. Findings will be disseminated through a peer-reviewed publication, a policy brief, conference presentations and infographics for use by organisations serving flood disaster impacted communities.

Cancer has been one of the leading causes of death in India in the past decade. The growing cancer burden has generated an unmet need to identify and address gaps in the healthcare system to enable access to affordable and quality cancer care for all in a manner that enhances the value of care. This paper provides an overview of the value-based care approach, identifies areas for enhancing the objectives of value-based care through multi-characteristic and multidimensional consideration of patient centricity and proposes health system strategies to improve comprehensive value-based care in India within the current context, focusing on implications for women's cancers. The core characteristics of patient centricity - heterogeneity and complexity - are detailed to complement and expand on previously defined aspects of value-based care. Comprehensive value-based cancer care can serve as a test case and proof of concept for the rest of the health system in India and focusing on women's cancers as a starting point can mandate attention to gender-responsive and transformative design and implementation.

ObjectivesOver 40 million people in low-income and middle-income countries (LMICs) experience serious health-related suffering (SHS) annually and require palliative care. Patient and caregiver experiences of SHS in LMICs are understudied despite their importance in guiding palliative care provision. Diabetes and cancer are the second-leading and third-leading causes of death in Mexico, causing a significant SHS burden on patients, families and health systems. This study examines SHS and palliative care from the point of view of patients with cancer and diabetes and their caregivers.DesignA qualitative descriptive study based on in-depth telephone interviews was conducted between August 2021 and February 2022. Data were analysed through inductive thematic analysis.ParticipantsOverall, 20 patients with end-stage cancer, 13 patients with diabetes and 35 family caregivers were interviewed individually.SettingParticipants were recruited from two family medicine clinics and a pain clinic in Mexico City.ResultsSeven themes emerged: (1) suffering as a multifaceted phenomenon, (2) diversity in perceptions of suffering, (3) different coping strategies, (4) need and perceived importance of relief from suffering, (5) barriers to accessing services to relieve suffering, (6) demand for the health sector’s active and humane role in addressing suffering and (7) preferences and need for comprehensive care for relief from suffering. The primary coping strategies included family companionship, protective buffering and faith-based support. Participants lacked knowledge of palliative care. They expressed the importance of relief from suffering, viewing it as the health sector’s responsibility and requesting more humane, personalised care and access to medicines and pain clinics.ConclusionsThe multifaceted nature of SHS highlights the health system’s responsibility to provide high-quality palliative care. Policies to enhance access to palliative care should integrate it into primary care, redesigning services towards patient and caregiver biopsychosocial and spiritual needs and ensuring access to medicines and competent health personnel.

Background Suffering generated by life-limiting or life-threatening conditions is a complex phenomenon inextricably linked with human experience. Most of this suffering can be ameliorated with adequate access to palliative care that is unavailable in much of the world, especially low-resource settings. Exploration of the definitional boundaries of and needs pertaining to suffering due to illness suggests that patients and families assign specific importance to the compassionate and supportive aspects of palliative care. However, the intrinsic and personal value of suffering alleviation has not been systematically studied in low- and middle-income countries, where it is direly needed. Methods SAVE ( S uffering A lleviation and the V alue of E xperiential knowledge) protocol is developed based on deliberation of a global expert group on limitations of quantitative measurement of suffering, literature reviews, and piloting in two countries – Barbados and Mexico – to support evidence generation that is anchored by lived experience. Results The SAVE study protocol presents a methodological blueprint for study design, implementation, and analysis to conduct research on the value assigned to alleviation of serious health-related suffering by multiple stakeholders, especially patients and non-professional caregivers. The protocol incorporates an instrument for data collection. It also provides guidance on qualitative approaches and their importance to understanding lived experience to strengthen health system performance assessment. Conclusions Exploration of suffering based on personal experience is primarily focused on high-income contexts and/or clinical care management. Evidence generated using the protocol, which focuses on responsiveness, can advance development of people-centered metrics and bolster the investment case to equitably expand access to palliative care worldwide. Importantly, it can shift priority-setting and practice towards high-value healthcare. Plain language summary Pain and other types of suffering are often not addressed when people face life-limiting or life-threatening conditions, especially in areas with limited healthcare access. This study aims to prioritize alleviation of health-related suffering and palliative care within health systems. It asks how personal experiences and stories on suffering due to illness from patients and families can better guide priority-setting, resource allocation, and implementation decisions by policymakers. The results provide new ways to gather qualitative information (non-numerical and commonly focused on knowledge, attitudes, and perspectives) and understand patient and caregiver journeys rather than solely using quantitative data (numerical) in policy and practice. Comprehensive evidence on lived realities can provide important details on what patients and their families value most, which can in turn be used to improve the responsiveness of healthcare. Bhadelia et al. present a protocol to examine the intrinsic and personal value of alleviating serious health-related suffering and of palliative care based on lived experience. It highlights opportunities to shift health system priority-setting alongside responding to the call for greater incorporation of qualitative approaches.

Noncommunicable diseases (NCD) -- primarily cancer, cardiovascular dis...ease, diabetes and chronic respiratory diseases -- represent a major health, social, and economic burden that affects women globally, yet their impact on women in low- and middle-income countries (LMIC) has not been fully recognized. NCDs cause premature death and disability among women of all socioeconomic strata worldwide. This burden is expected to increase substantially in the coming decades, especially in LMICs, because of a combination of factors, primarily the \"ageing\" of the population, improvements in maternal health in LMICs and a projected increase in smoking, obesity and other risk factors for NCDs among women. Given the links between NCDs, maternal conditions and infectious diseases in women, it is essential that women's health advocates and NCD experts unite in their commitment to promote women's right to health throughout the lifecourse as a central component of efforts to strengthen health systems and to protect women's health in a post-2015 environment.

Health systems in low- and middle-income countries were designed to provide episodic care for acute conditions. However, the burden of disease has shifted to be overwhelmingly dominated by chronic conditions and illnesses that require health systems to function in an integrated manner across a spectrum of disease stages from prevention to palliation. Low- and middle-income countries are also aiming to ensure health care access for all through universal health coverage. This article proposes a framework of effective universal health coverage intended to meet the challenge of chronic illnesses. It outlines strategies to strengthen health systems through a \"diagonal approach.\" We argue that the core challenge to health systems is chronicity of illness that requires ongoing and long-term health care. The example of breast cancer within the broader context of health system reform in Mexico is presented to illustrate effective universal health coverage along the chronic disease continuum and across health systems functions. The article concludes with recommendations to strengthen health systems in order to achieve effective universal health coverage.