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In the Irbid Governorate, Jordan, equitable healthcare facility distribution is vital to ensuring healthcare accessibility and improving public health outcomes. This study investigated the spatial distribution, accessibility, and conformity of healthcare facilities to the Ministry of Health standards to identify areas requiring improvement. Using geographic information systems (GIS), three spatial analyses were conducted: nearest neighbor analysis, buffer analysis, and service area analysis. These analyses comprehensively assessed the healthcare landscape, revealing a random spatial distribution pattern of healthcare facilities; and indicating an absence of structured organization. The buffer analysis revealed concentrations in specific regions, while others were underserved. The Service Area Analysis revealed significant healthcare access challenges, especially in remote areas. The healthcare resource distribution of the Irbid governorate fell short of national and international standards, emphasizing the need for improvements. To address these disparities, policymakers and healthcare authorities should focus on equitably redistributing resources, tailoring allocation to local needs, improving remote area infrastructure, and refining government policies. Continuous monitoring and evaluation are imperative to ensure alignment with international standards and achieve healthcare equity. The insights from this case study provide valuable guidance for regions facing similar healthcare distribution challenges.

Background Lower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019. Methods The study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time. Results From 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region. Conclusion The study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region.

Objectives In recent years, countries in the Middle East and North Africa (MENA) region have seen a rise in immigration, driven by global conflicts, leading to increased prevalence of physical and mental health issues among refugees. This places significant demands on both refugees and healthcare professionals encountering them in various situations. The analysis considers the social and psychological implications of relying on specialized trainers versus the refugees themselves to determine the most effective and sustainable method for providing mental health support in challenging refugee camp environments. Methods This article uses a scoping review methodology to compare the impact of two approaches for addressing mental health needs in refugee camps. Drawing upon previous studies, the research investigates the effectiveness and sustainability of recruiting external experts versus empowering refugees as mental health trainers within their communities. Results The analysis suggests that in refugee camps, empowering refugees as mental health trainers within their communities yields more sustainable and culturally appropriate mental health support compared to recruiting external experts. This approach fosters community resilience and addresses the unique social and psychological needs of refugees in challenging camp environments. Conclusion Ultimately, this analysis demonstrates the context-specific nature of health interventions in refugee camps. Empowering refugees as mental health trainers emerges as a promising approach to addressing mental health needs sustainably and effectively within these environments.

Background Health system satisfaction is an important but understudied indicator of health system performance. It has far-reaching implications for sustainability but has been widely understudied particularly for non-European settings. Qatar represents a growing international experience of rapid development requiring steadfast system funding and reorganisation. After decades of unprecedented immigration and nearly free health care, Qatar sought to expand the system by 2016, reorganise it by 2022, and accelerate private funding and health system outcomes by 2030. Aim The aim of this study is to conduct a comprehensive assessment of health system satisfaction in Qatar, in anticipation of the 2024–2030 health reforms, with a particular emphasis on detailed policy attribution and the formulation of recommendations. The overarching aim of this study is to contribute to the limited body of international literature on health system satisfaction, particularly in non-European contexts, with a focus on specific populations such as migrants, labourers, and labour camp residents. Methods We analysed the levels of, and individual inequalities in, health system satisfaction in Qatar between 2012 and 2014. Descriptive statistics were employed to assess satisfaction levels, while inequalities were examined using logit analysis. The satisfaction variables encompass the key aspects of health system provision and management, whereas the individual variables are focused on their attributability to Qatar’s specific health policy context, including regionally distinct socio-economic groups. Findings Health system satisfaction levels in Qatar were relatively high in both 2012 and 2014, particularly regarding service provision, though they did not reach exceptionally high levels. Both satisfaction dimensions—provision and management—improved in 2014, with management showing more rapid progress. However, males, Qatari citizens, individuals with chronic disease, labourers, and residents of the largest labour camps were less likely to express satisfaction with the system. Conclusion Qatar’s satisfaction trends and inequalities between 2012 and 2014 emphasise the significance of both dedicated efforts and effective organisational structures in maintaining high levels of health system satisfaction during periods of rapid development. To ensure continued satisfaction, performance, and sustainability throughout the 2024–2030 reforms, it is essential to address unresolved organisational constraints before eroding dedicated efforts through increased private health funding.

The introduction of the Sustainable Development Goals by the United Nations has set a global target for achieving Universal Health Coverage, requiring resilient health systems capable of addressing public health emergencies and ensuring health security. Public health surveillance, crucial for detecting and responding to infectious disease outbreaks, is key to building health system resilience. Due to the high levels of mobility and political instability in the Middle East and North Africa (MENA) region, unique challenges arise in cross-border health surveillance. This review aims to highlight the importance of cross-border public health surveillance in strengthening health systems across MENA to achieve equitable health outcomes. A mixed-methods approach was utilized, combining a systematic literature review with semi-structured in-depth interviews (IDIs) involving 28 stakeholders from seven MENA countries. The literature review adhered to PRISMA guidelines, while the IDIs provided qualitative insights into current surveillance practices and challenges. Findings from the literature review and IDIs were triangulated and analyzed using the WHO Health Systems Strengthening (HSS) Building Blocks Framework to identify key challenges and recommendations for improving cross-border surveillance. Results indicate that existing cross-border surveillance systems in MENA face challenges in data collection, analysis, and sharing, with disparities across countries based on income levels and political contexts. Key challenges include delayed and incomplete data sharing, insufficient funding across sectors, inadequate training, inconsistent data definitions, and limited integration of health data for mobile populations. Recommendations emphasize strengthened governance and leadership to facilitate regional cooperation and information sharing, sustainable financing for implementing a One Health approach, utilizing innovative information systems, workforce development to enhance data collection and analysis, and secure supply chains for medicines and vaccines and equitable service delivery for all mobile populations. In conclusion, the WHO HSS Building Block Framework provides a comprehensive approach to assessing and improving cross-border public health surveillance and enhancing health security and equity in MENA. Strengthening cross-border surveillance systems may help MENA countries meet IHR requirements, achieve greater health security, and advance health equity among all types of mobile populations. Despite limitations, the study offers critical insights for improving cross-border surveillance strategies in the region.

Background To appreciate dental care utilization in ‌the context of socio-economic inequalities, it is imperative to identify sources of inequalities and evaluate the extent to which dental care utilization is still related to socio-economic status. This study aimed to quantify the influence of contributed determinants on dental care utilization in the context of socio-economic inequalities amongst adults residing in Tehran metropolis . Methods In this cross-sectional community-based study, a stratified random sample of 1,510 subjects aged over 18 years was investigated by the zero-inflated Poisson analysis to measure the effect of determinants on utilization of dental care, and concentration index as well as the decomposition approach to identify the contributions of deterministic variables to the socio-economic inequality. Data was obtained by employing a phone interview survey. Individuals who were not willing or able to answer the questions in the telephone interview due to hearing or neurological problems did not participate in the interview. Dental care utilization was measured using the number of dental appointments. Results Gender (male), oral health-related behaviors (such as brushing and dental flossing), experience of toothache, and concern about dental appearance were associated with an increased likelihood of utilizing dental care. Individuals who belonged to advanced age groups and lived alone significantly underutilized dental care. The concentration index equaling 0.05 (SE = 0.05) corroborates a pro-rich inequality. Decomposition analysis demonstrated the impact of oral health-related behaviors (i.e. dental brushing and use of dental flossing), concern about dental appearance, toothache, gender (male), insurance coverage of dental care, and smoking habit on the poor-rich gap in the dental care utilization. Conclusions The influence of socio-economic inequalities on dental care utilization is discernable along the entire spectrum of socio-economic status. Individuals with lower socio-economic status experience more underutilization of dental care. Community subgroups, particularly the more deprived bracket, require consideration from key stakeholders, including policymakers and health professionals for the enhancement of dental care utilization as revealed by underlying determinants.

The situation in Sudan have deteriorated since the ongoing war outbreak in April 2023. This article sheds light on the pharmacological status in Sudan in terms of shortage of supply, rising demands, and regulatory issues. The ongoing civil war has acutely impacted the dilapidated pharmaceutical status of Sudan, patients have suffered from the paucity of medical services forcing an out-of-control rise in underreported morbidity and mortality. To mitigate this uprising issue, an increase in stakeholder communication is crucial to deal with this national threat and establish a system for reporting the shortage.

Background Over time, global health systems have witnessed significant improvements in the delivery and coverage of healthcare services. Nevertheless, the increasing prominence of non-communicable diseases remains a persistent challenge. Diabetes is one such non-communicable chronic disease that poses a threat with respect to both mortality and morbidity. This study investigated the socio-economic determinants and inequalities in the prevalence of diabetes in the Kingdom of Saudi Arabia according to data collected from the 2018 Saudi Family Health Survey conducted by the General Authority for Statistics. Methods The analysis was limited to a sample of 11,528 respondents aged ≥ 18 years, selected across all 13 regions of Saudi Arabia, with complete responses for all variables of interest. Socio-economic determinants in diabetes prevalence were explored with univariate, bivariate, and multivariate logistic regression analyses. Furthermore, inequalities were visualised and quantitatively estimated according to construction of a concentration curve and calculation of the concentration index. Results The prevalence of diabetes among the 11,528 respondents was 11.20%. Age, education, income, and residence area were significant determinants of diabetes prevalence, with a greater risk of diabetes found in older participants (odds ratio [OR]: 12.262, 95% confidence interval [CI]: 9.820–15.313, p < 0.01) compared to younger participants. Inequality analysis showed a negative education-based concentration index (–0.235, p < 0.01), indicating that diabetes prevalence is concentrated among people with relatively less formal education. For males, the income-based concentration index was significantly positive, whereas the education-based concentration index was significantly negative, indicating a greater concentration of diabetes among Saudi men with higher incomes and less education. Conclusion These findings emphasize the need to prioritize policies and strategies for diabetes prevention and control with considerations of the socio-economic inequalities in prevalence. Key areas of focus should include improving education levels across all regions, raising awareness about diabetes and implementing nutritional interventions.

Background Young people in the MENA region face significant challenges due to socio-political instability, ongoing conflicts, and inequitable social and economic policies. These factors, combined with global threats like climate change and economic instability, hinder the potential of the region's 140 million young people aged 10–24. Addressing these compounded crises is crucial for the future of the region. It is essential to understand the contextual factors shaping young people's health outcomes through their own perspectives. Photovoice, a participatory research method, has shown promise in engaging young people in research. Objective This scoping review aims to map the literature on photovoice studies that addressed health and its determinants among young people in the MENA region. It also seeks to highlight the challenges and strengths of employing the photovoice methodology in this context. Inclusion criteria The review included literature reporting photovoice projects that addressed young people's health and/or its social determinants, where participants took photos and engaged in discussions based on these images. Studies involving young people aged 10–24 years and focusing on photovoice in the MENA region were considered. Both peer-reviewed journal articles and grey literature with sufficient information addressing the review questions were included. Methodology The review followed the JBI Scoping Review Methodology and involved searches of seven English databases, two Arabic databases, and grey literature through Google search. Results Eleven studies/projects were included in the analysis. Most of the literature came from non-profit organizations, with few studies from peer-reviewed articles. The included studies focused on socio-economically disadvantaged, vulnerable, and marginalized young people, addressing topics such as environment, social integration, safety, and youth empowerment. The implementation of photovoice varied across studies, and there was limited participation of young people throughout the research process. Conclusion The scoping review revealed a scarcity of literature on the use of photovoice among young people to address health inequalities and the factors influencing them in the MENA region. Given the public health value of photovoice as an action-oriented research approach that promotes meaningful participation from young people, further research is needed to leverage this methodology to tackle health inequalities effectively.

From 2014 to 2021, Tunisian government had a firm will to implement a progressive decentralization of welfare state governance, as outlined in its democratic Constitution. The Tunisian public healthcare system was selected as a pilot sector for experimenting with decentralization to reduce disparities in access to and quality of health services across different regions. This paper aimed to formulate an effective strategy for healthcare system decentralization in low- and middle-income countries, drawing on past experiences of its implementation. Country case study resulted the best methodology to achieve that goal. Top heath management, figured out by regional hospitals’ directors, was consulted to describe the technical, managerial and cultural “heritage” collected during the development process of the decentralization reform in public healthcare system in Tunisia. Findings revealed the Tunisian healthcare system decentralization should be, in first instance, the establishment of different decentralization paths according with regional pre-conditions, and then, of common protocols and procedures at national level for overcoming current differences between Tunisian territories. Decentralization process must be tailored to the specific needs of the regional Tunisian contexts to be effective but with a national control on that. Drawing from the Tunisian experience, proposed suggestions were valuable for the definition of an effective national healthcare system decentralization reform strategy more generally in low- and middle- income countries, especially in Middle East and North Africa region’s countries. Due to the common recent democratic history and welfare state approach, these countries could use this “heritage” to apply effective decentralizing reform strategies for reducing territorial inequalities, in this case territorial health inequalities.