Policy Recommendations Research Articles

Pension reform in Morocco: Multi-pillar approaches and informal sector integration

Demographic shifts, fiscal pressures, and the prevalence of informal employment challenge Morocco's pension system. This study uses a dynamic microsimulation model to assess reform scenarios, including parametric adjustments, non-contributory pensions, multi-pillar systems, and incentives for informal worker participation. Key findings highlight the promise of a multi-pillar system—combining a basic social pension, mandatory contributory schemes, and voluntary savings—in achieving financial sustainability, expanding coverage, and ensuring equity. Targeted non-contributory pensions and strategies to formalize informal sector participation are also crucial. Policy recommendations stress phased implementation, institutional capacity building, and financial literacy promotion to ensure inclusive, effective reforms that secure income for all citizens. This study contributes actionable insights for policymakers navigating complex social protection challenges in developing economies.

How Climate Risk Affects Enterprise Liquidity: Configuration Effects Based on NCA and fsQCA

Climate risk, within the context of environmental sustainability, is profoundly affecting global development trends. As critical organizations, enterprises play an irreplaceable role in various stages of economic development, with liquidity being a vital capability for their survival, growth, and sustained value creation. This paper innovatively constructs a framework of climate risk, encompassing three levels: macro background, industry environment, and corporate operation. Focusing on publicly listed companies in China’s eight high energy-consuming industries, this paper employs fsQCA and NCA methods to investigate the factors influencing enterprise liquidity in the context of climate risk. Finally, the study finds and concludes with three main patterns: macro-oriented, industry-adaptive, and management-optimized. These findings suggest related policy recommendations and key strategies to enhance economic resilience by adjusting climate policy uncertainty, controlling technical personnel proportion, and improving financial management.

Causes and risk factors for stillbirth in India: A systematic review protocol.

Stillbirths, the tragic loss of a baby before or during delivery, presents a profound global health concern. Investigating the diverse causes and risk factors is essential to develop targeted interventions, enhance perinatal care, and reduce the incidence of this devastating outcome. The aim of this study was to identify the causes and possible risk factors of stillbirths in India. The study design is a protocol for systematic review. This systematic review will include all types of observational studies, such a cross-sectional surveys, descriptive studies, cohort studies and case-control studies from India. Studies will be retrieved from global databases like CINAHL, Medline through PubMed, EMBASE, SCOPUS, Web of Science, ProQuest Medical Library, Microsoft Academia, DOAJ, and Indian databases like Indian Citation Index, J-Gate, and Neonatal Database using database-specific keywords. Additionally, online hand searching will be done on the websites of the relevant Indian institutions. Primary studies' reference lists will be scrutinized for additional references if required. Two review authors (SN & AR) will independently screen, extract data, and critically appraise included studies. The Joanna Briggs Institute Critical Appraisal Checklist will be used to identify the quality and risk of bias of included studies. Any disagreements will be resolved in consultation with a third reviewer (BSN). Results will be reported as per the PRISMA guidelines. This systematic review will. identify and highlight the causes and potential risk factors of stillbirths in India, which will guide the healthcare team in planning and developing a standard protocol and policies to promote successful antenatal care, implement effective early interventions, and improve access to quality healthcare to reduce stillbirth rates in institutional, rural, and underserved areas as per the Indian healthcare system. These findings on causes and risk factors for stillbirth in India address a crucial gap in th literature and allow us to prepare a foundation for targeted interventions and policy recommendations in the healthcare system trajectory. The Protocol is registered in the International Prospective Register of Systematic reviews PROSPERO (CRD - 42024506186).

The Social Security Fairness Act: Evaluating Potential Impact, Limitations, and Implications for Research, Policy, and Practice.

The impact of laws and policies that involve social determinants of health (SDOH), particularly among older, retired populations, needs to be considered as a public health intervention. The Social Security Fairness Act was signed into law in 2025, as a new amendment to the Social Security Act first introduced in 1935. The Social Security Fairness Act ends two provisions that have reduced benefits for spouses, widows, and widowers and for public service workers, which include teachers, fire fighters, police officers, nurses, and others who are receiving pensions from state or local government. Specifically, this new bill involves economic stability, which is considered an important SDOH for older adults. The purpose of the current article is to evaluate policy changes through the Social Security Fairness Act, including potential impact and benefits, limitations or unintended consequences, and implications and recommendations for future research, policy, and practice. Findings will help guide gerontological nurses and interprofessional researchers, clinicians, and educators promoting healthy aging. [Journal of Gerontological Nursing, 51(2), 7-12.].

Intensivists' ethical perceptions about decisions to withhold or withdraw treatment: A clinical ethics empirical investigation

BackgroundIntensive care professional societies have issued policy recommendations regarding decisions to withhold and/or withdraw treatment (Wh&Wd) that consistently classify them as ethically equivalent and ethically neutral. However, on the ground they are often perceived as “active” and morally problematic. Moreover, recent studies have highlighted personal “variability” in the way such decisions are made. Therefore, it seemed necessary to explore intensivists' different ethical perceptions about Wh&Wd decisions. MethodsA qualitative retrospective and multicentered study was conducted in seven intensive care units belonging to the Paris Hospital Trust (AP-HP), which involved in-depth interviews with 44 intensivists of different ages and levels of professional experience. An inductive (“grounded theory”-inspired), multidisciplinary clinical ethics approach was used that aimed at eliciting and retrieving practitioners' ethical intuitions about different Wh&Wd decisions. Interview transcripts were analyzed using a “thematic analysis” approach. ResultsPractitioners' perceptions of Wh&Wd decisions vary along two continuous dimensions: active/passive and ethically problematic/unproblematic. Three groups have been identified: those who consider Wh&Wd decisions 1) as passive and unproblematic, 2) as active and problematic, and 3) as active and unproblematic. More interestingly, these groups can be differently characterized with respect to three other ethically relevant considerations: the role of consensus during the collegial decision-making procedure, the difference between withholding and withdrawing decisions, and the definition of one's own overarching professional goal. ConclusionThe study results allow for recognition of intensivists' moral distress about Wh&Wd decisions and open new perspectives to deal with their deep-rooted variability, most notably by working on the rationale and format of the collegial decision-making procedure.

Incentives and the Replication Crisis in Social Sciences: A Critical Review of Open Science Practices

The replication crisis in the social sciences has revealed systemic issues undermining the credibility of research findings, primarily driven by misaligned incentives that encourage questionable research practices (QRPs). This paper offers a comprehensive and critical review of recent empirical evidence on the effectiveness of Open Science initiatives—such as replication studies, reproducibility efforts, pre-registrations, registered reports, and megastudies—in addressing the root causes of the replication crisis. Building upon and extending prior analyses, we integrate recent theoretical models from economics with empirical findings across various social science disciplines to assess how these practices impact research integrity. Our review demonstrates that while measures like pre-registration and data sharing have advanced transparency, they often fall short in mitigating QRPs due to persistent incentive misalignments. In contrast, registered reports and megastudies show greater promise by fundamentally reshaping the incentive structure, shifting the focus from producing statistically significant results to emphasizing methodological rigor and meaningful research questions. We argue that realigning incentives is crucial for fostering a culture of integrity and offer policy recommendations involving key stakeholders—including authors, journals, editors, reviewers, and institutions—to promote practices that enhance research reliability and credibility across the social sciences.

Urban-Rural Carbon Emission Differences in China’s Urbanization: Spatial Effects and Influencing Factors

Coping with climate crisis and promoting urbanization are important parts of the Sustainable Development Goals (SDGs), thus controlling carbon emissions in the urbanization process becomes the crux of achieving the SDGs, and the increase of carbon emissions due to urban-rural differences and intra-provincial rural-urban migration are important and neglected parts of the study on carbon emissions during the urbanization process. Utilizing China 2017 cross-sectional data and environmentally extended multi-regional input-output model (EEMRIO) to account for China’s urban-rural household consumption carbon emission differences (HCCEDs) and carbon emission increments (CEIs) due to intra-provincial rural-urban migration, this research integrates spatial lag model (SLM) and threshold regression (TR) model to investigate the spatial effects, individual differences and influencing factors of HCCED in the context of urbanization. The results indicate that HCCEDs are higher in the north and lower in the south, with significant spatial aggregation effects. Household consumption expenditure ratio (q = 2.03) becomes the determining factors in moderating the influence degree of other factors, with consumption difference and demographic difference emerging as the pivotal exacerbating and inhibiting factors. The results of this study will provide data, methodological basis and policy recommendations for the development of new urbanization and low-carbon cities, facilitating further investigation the driving mechanisms of HCCEDs.

Vanishing Voices: Tracing the Trade Networks and Distribution Pathways of Songbirds in Banda Aceh Markets

Tracing the trade and distribution pathways refers to the systematic analysis of the origins, movement routes, and distribution patterns of a commodity, such as songbirds, from its source to the final market or end consumer. This study explored the dynamics of bird trade in the markets of Banda Aceh city, focusing on species diversity, conservation status, species origin, and trade patterns. The study was conducted in nine sub-districts, covering 18 bird shops, using a descriptive qualitative approach. Data were collected through direct observation, market surveys, and structured interviews with traders. Species identification was conducted using the Birds of the Indonesian Archipelago guide, while conservation status was evaluated based on the IUCN Red List and CITES Appendices. In addition, Geographic Information System (GIS) software was used to map bird trade distribution channels. The results showed the presence of 54 bird species with a total of 638 individuals, mostly from the Passeriformes order. The most commonly traded species was Acridotheres javanicus (kerak kerbau), with 132 individuals, reflecting its high demand due to its adaptability and affordability. Conservation analysis showed the vulnerability of species such as Gracula religiosa (Nias parrot), which is listed in Appendix II of CITES, and Rubigula dispar (yellow finch), which is categorized as Vulnerable. This research highlights the complex relationship between the local bird trade and conservation efforts, and the importance of stricter regulation and increased public awareness to protect threatened species. The findings make an important contribution to policy recommendations in order to promote sustainable bird trade and biodiversity conservation in Banda Aceh.

Assessment of residential renewable energy investment under dynamic market environment: Aspect from household benefits.

The adoption of residential renewable energy is pivotal for achieving the 'Net Zero' goal, yet financial assessments of household investments in this area remain complex due to dynamic market conditions. This study introduces a novel closed-form financial valuation framework for residential solar photovoltaic (PV) systems, explicitly addressing the uncertainties of electricity market price fluctuations (market risk) and energy policy changes (policy risk) using Geometric Brownian Motion (GBM). A case study in France demonstrates the framework's application, revealing that the discount rate is the most influential factor in solar PV valuation, followed by system lifespan and policy-driven Feed-in Tariff (FiT) rates. Sensitivity analyses further highlight how these variables interact to influence investment outcomes under various market scenarios. Key findings include (1) the identification of critical thresholds for solar PV investments, ensuring financial viability even under fluctuating conditions; (2) the validation of GBM as an effective tool for capturing long-term market and policy dynamics; and (3) actionable policy recommendations emphasizing market efficiency, policy stability, and end-of-life management. These insights contribute to advancing both household investment decision-making and policy design, addressing a significant gap in understanding the economic dynamics of residential renewable energy adoption. By bridging theoretical valuation models with empirical evidence, this research provides practical guidance for promoting decentralized renewable energy systems globally.

Behaviours and drivers of diagnosis-related group upcoding in China: A mixed-methods study.

As a highly destructive gaming behaviour in Diagnosis-Related Group (DRG), upcoding has garnered increasing scholarly attention. This study considers the prevalence, types and risk characteristics of upcoding during the pilot implementation of DRG payments in China, and it also explores the drivers of upcoding and provides corresponding policy recommendations for improving the system. Quantitative research data were sourced from the DRG payment audit database in City Z between the dates of June 1, 2019 and May 31, 2020, encompassing audit results comprising 200 medical records randomly selected from 28 hospitals. Qualitative research methods were used, including semi-structured interviews conducted with 10 stakeholders with interests in the DRG payment system, and thematic framework of the consequent data. 5,157 (92.01%) valid records were re-abstracted. 666 (12.91%) evaluated records were found to be upcoded, resulting in an additional payment at a rate of 45.27%. Several factors emerged as shedding light on the probability of upcoding, including cases with comorbidities, those undergoing non-operating room procedures and internal medical treatments, cases in for-profit hospitals and cases in tertiary hospitals. The main drivers of upcoding were found to be financial and administrative pressures, dysfunctional attitudes towards upcoding, technical facilitation and lack of supervision. This paper provides a comprehensive analysis of the behaviours and drivers of DRG upcoding in China, considering the unique hospital management system and incentive mechanisms in place. The results demonstrate that, following the initiation of the DRG payment system, providers have begun to engage in upcoding behaviour under various drivers, leading to additional health care expenditures and undermining the effectiveness of the scheme. In terms of mounting a response to this behaviour, understanding it and what drives it can aid in its prevention. This study suggests implementing intelligent audits to strengthen supervision and supporting hospitals in cost management.

Impact of dual-carbon attention competition from local government on regional carbon emissions in China.

Extreme climate change induced by carbon emissions has received extensive attention from governments worldwide. Strong competition in local governments' dual-carbon attention (GCA) produces an effective influence on the reduction of regional carbon emissions, confirming crucial policy implications. In this study, textual content analysis is employed to measure the GCA level and GCA competition, and the mechanism by which GCA competition reduces regional carbon emissions in China is explored from the perspective of competition behaviors. The findings demonstrate that the increase of GCA competition positively influences the reduction of regional carbon emissions. Influence mechanism analyses verify that increasing GCA competition primarily stimulates the greater reduction of regional carbon emissions by intensifying competition in energy consumption reduction and the optimization of the energy consumption structure. The influence of GCA competition on reduced regional carbon emissions is significantly related to industrial structure upgrading, the energy consumption structure, and environmental governance investment, as well as inter-government competition in these areas. The detailed findings of this research can provide economic and environmental benefits for policymakers, and can provide corporations with more targeted policy recommendations related to dual-carbon attention and carbon emission reduction.

System Dynamics-Based Integrated Benefit Analysis of Low-Carbon Management Process of Municipal Solid Waste

With rapid economic development, the amount of the municipal solid waste (MSW) generated has increased dramatically. To improve the socio-economic benefits and environmental impacts of the low-carbon management of MSW, it is crucial to identify the drivers of Greenhouse Gas (GHG) emissions from MSW treatment and assess their systematic and comprehensive benefits. The factor decomposition method is one of the most commonly used methods focused on identifying GHG emission-influencing factors, while the system dynamics (SD) method is commonly used to analyze the causal relationships between linear and nonlinear variables in complex dynamic systems. Unlike existing studies that account for and evaluate MSW from a static perspective, this paper innovatively combines the LMDI-SD model to identify and quantify the GHG emission drivers of MSW and evaluate the benefits of decarbonizing the MSW management in China from a comprehensive and systematic perspective. The results show that the dominant factor driving MSW GHG emissions from 2010 to 2022 is the economic development factor, ∆EED, while the intensity of MSW generation ∆EGI and the structure of MSW treatment ∆ETS play a stronger inhibiting role. Based on this, the SD model is constructed to simulate different scenarios, and the analysis shows that increasing the waste separation rate (S3) is the most effective measure to improve the socio-economic benefits and environmental impacts of the system. Compared with the base scenario, the socio-economic benefits and environmental impacts in 2050, for example, are increased by 82.8% and 43.4%, respectively. Improving the utilization rate of landfill gas (S1), reducing the per capita amount of MSW generated (S4) and increasing the incineration rate of MSW (S2) also have significant advantages for the improvement of benefits. Finally, some policy recommendations for the improvement of the comprehensive benefits of low-carbon MSW management systems are proposed to help policymakers make appropriate decisions.

Policy recommendations for building a circular Ukraine

Policy recommendations for building a circular Ukraine

The economic inequality effect of environmental policies--a case from China's "authoritarian environmentalism" actions.

Command-and-control environmental policies are crucial for achieving sustainable development across environmental, economic, and social dimensions. However, these policies often neglect the impact on vulnerable populations and impoverished regions. This paper reveals the mechanisms and impacts of CAC exacerbating regional economic inequality under resource endowment differences through empirical analysis of county panel data in China from 2010 to 2021. Taking the "closure and relocation" policy of chemical enterprises along the Yangtze River as an example, the study finds that in economically developed regions, the policy realizes a win-win situation regarding environmental quality improvement and economic growth by upgrading the industrial structure. Economic growth is significantly inhibited in areas with high chemical dependence despite improving environmental quality. Residents experience increased economic pressure and cannot enjoy the benefits of environmental improvements. The study also shows that despite policies aimed at improving environmental quality, they have failed to realize the expected goals in some regions fully and have dampened regional economic activities. Through systematic empirical analysis, this study deepens the understanding of the impacts of CAC. It highlights the trade-offs and differential impacts in the implementation of testimonies. This study provides empirical references for policy design and optimization in related fields, theoretical support, and policy recommendations for global sustainable development.

The Influence of Financial Literacy and Access to Financing on the Profitability of MSMEs in Gorontalo: An Empirical Analysis

This study aims to analyze the influence of financial literacy and access to financing, primarily through People's Business Credit, on the profitability of Micro, Small, and Medium Enterprises (MSMEs) in Indonesia. In the context of the significant development of MSMEs in various regions, good financial literacy is expected to increase financial inclusion and, in turn, support business growth. The method used in this study was a survey with a questionnaire distributed to 100 MSME actors in Bandar Lampung and Gorontalo. Data analysis used linear regression techniques to identify the relationship between variables. The study results indicate that high financial literacy and reasonable access to financing positively increase MSME's profitability. These findings emphasize the importance of increasing financial literacy and access to funding for MSMEs to encourage local economic growth. Policy recommendations are aimed at the government and financial institutions to improve financial education programs and facilitate access to financing for MSMEs.

Street vending in times of crisis: exploring insecurity and spatial dynamics in Aizawl, Mizoram, India

Purpose This paper aims to explore the influence of spatial dynamics on street vendors and examines the insecurities and coping mechanisms they faced and adopted during the pandemic. It examines the precarious nature of street vending during a global economic shock, highlighting the vulnerabilities and resilience of this informal sector. Design/methodology/approach This study uses a case study approach, conducting semi-structured face-to-face interviews with 74 street vendors in two key markets: Bara Bazaar (natural market) and Treasury Square (non-natural). The authors use the Gioia method, renowned for its systematic rigour in exploring the challenges and adaptations of street vendors during periods of economic uncertainty and crisis. Findings This study reveals that COVID-19 lockdowns profoundly impacted the security of tribal street vendors operating in natural and non-natural markets. It sheds light on the mechanism of shadow security, observed as a form of diverse coping mechanisms adopted by vendors during the pandemic, such as collective fund pooling, poultry farming and adapting new business models – from changing the goods they sell to transitioning between regular and mobile vending or from retail shops to street vending. Social implications This study used the grounded theory framework of sustainable livelihood strategies and explores how street vendors can achieve sustainability through street vending. It further proposes recommendations for urban policies tailored across various dimensions. Originality/value This paper highlights indigenous mechanisms to secure livelihoods, which act as safety nets and facilitate a form of shadow security. The paper also determines how the spatial dynamics of a vending location can preferably change the security of the street vendors in times of crisis. This research challenges the oversimplified notion that the social security of street vendors cannot be neatly categorised as secure or insecure. Instead, it underscores vendors’ dynamic strategies and resilience to sustain their livelihoods amidst economic disruptions.

Ultra-Processed Food Intakes and Health Outcomes in Adults Older Than 60 Years: A Systematic Review.

Relationships between ultraprocessed food (UPF) intakes and health have been well described in adults, but evidence of these relationships in older adults is rather limited. Demographic shifts in aging emphasize the importance of understanding the role of diet in maintaining health during later life. The aim of this systematic review was to identify health outcomes associated with UPF consumption in those aged ≥60 years. The Medline, Web of Science, Scopus, and Embase databases were searched from inception until June 2023, using search terms representing UPF and any health outcome. Observational studies restricted to individuals aged ≥60 years using the Nova food classification were included. Articles were screened independently by 2 researchers using PECOS inclusion criteria. Two-thirds of the studies in the present review were prospective cohort studies (n = 4) and the rest were cross-sectional (n = 2). The number of participants ranged from 652 to 2713 across the 6 studies. The mean age of participants ranged between 67 and 73 years. In the prospective cohort studies, the highest consumption of UPF was associated with incident frailty, incident dyslipidemia, renal function decline, and abdominal obesity. For cross-sectional studies, the highest intake of UPF was associated with negative outcomes similar to young and middle-aged cohorts, with the addition of nutritional frailty and worse cognitive performance. Currently, the limited understanding of how high UPF intakes could be associated with negative health outcomes for older adults influences the ability to inform policy and practice recommendations. More research is required owing to the very limited number of studies, specifically in older adults. PROSPERO registration no. CRD42023442783.

Investigating the Interplay Between Sleep, Anxiety, and Depression in Chronic Kidney Disease Patients: Implications for Mental Health

Background/Objectives: This study aims to determine the level of anxiety, depression, and sleep disturbances in patients with chronic kidney disease, as well as the interactions between the three comorbidities, and the implications it has for health practitioners. Methods: A descriptive cross-sectional study, following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, was implemented whereby 179 patients with chronic kidney disease attending a government hospital were recruited to this study. Results: Our results showed that 65.9% of the participants had the metrics of severe anxiety while 34.1 percent had moderate anxiety. Further, it was reported that more than half 51.4% of participants had poor sleep quality. The levels of depression reported by the patients were roughly 40.2% minimal depression, 29.6% mild, 21.2% moderate, and 8.9% depression that was severe. There was a significant correlation between mental health disease together with sociodemographic variables such as gender, marital status, educational status, and nationality (p < 0.05). Cut points of those aged 26–35 found younger patients experiencing higher anxiety levels (cut point (AOR = 2.792; p = 0.021)), and they also had poorer sleep quality (AOR = 0.403; p = 0.020). Conclusion: Our findings illustrate the importance of more frequent early mental health measures and strategies that help patients with chronic kidney diseases. The main study limitation was the cross-sectional design, which allows for correlational but not causal statements to be made. We address a gap in the literature with our results by noting specific demographic characteristics that are associated with poor mental health in chronic kidney disease populations and discuss practical and policy recommendations aimed at enhancing the mental well-being of chronic kidney disease patients.

Public-Private Collaboration in Sustainable Tourism Destination Management: Case Study of MaxOne Resort and Hotel Makassar

Public-private collaboration is a vital strategy in managing sustainable tourism destinations, integrating diverse stakeholders to balance economic growth, environmental sustainability, and social equity. Despite the hospitality sector’s key role in tourism governance, research on its collaboration with public institutions, particularly in Makassar, Indonesia, remains limited. This study examines MaxOne Resort and Hotel Makassar to explore the mechanisms, challenges, and outcomes of public-private partnerships (PPPs) in sustainable tourism destination management (STDM). Using a qualitative case study approach, the research employs in-depth interviews, participatory observation, and policy analysis to investigate how MaxOne Resort collaborates with local government and communities to implement sustainability initiatives. The findings reveal that structured mechanisms such as formal agreements, joint projects, and stakeholder committees facilitate sustainable governance. MaxOne Resort actively engages in environmental conservation, community empowerment, and responsible tourism practices, positioning itself as a sustainability model within the hospitality sector. However, regulatory misalignments, funding constraints, and inconsistent stakeholder engagement present significant challenges. The study underscores the relevance of the Penta-Helix framework, highlighting how collaboration among government, private sector, academia, community, and media enhances the legitimacy and effectiveness of sustainability initiatives. This research contributes to the literature by providing a localized analysis of PPPs in Makassar, bridging the gap between theoretical models and practical applications. The findings offer policy recommendations to strengthen stakeholder collaboration, optimize governance structures, and support sustainable tourism development in emerging destinations.

Perceptions of primary care services among Afro-Peruvians in Lima, Peru.

The Peruvian public healthcare system is characterized by various shortcomings that adversely affect healthcare quality as perceived by the general and minority populations, including the Afro-Peruvian community. This population has demonstrated reduced healthcare access due to discrimination and differential treatment, reflecting broader societal inequities. This study explores the experiences and perceptions of Afro-Peruvian individuals regarding the treatment they receive from public primary healthcare providers in metropolitan Lima. In-depth qualitative interviews were conducted with Afro-Peruvian individuals recruited from Lima. They were selected based on their responses to a survey conducted in a previous study, which indicated a high or low perception of intercultural adaptation in healthcare. The interviews explored their experiences with healthcare services and their perceptions about their interactions with health providers. The qualitative analysis involved topic coding to interpret the data. We interviewed 19 Afro-Peruvians, including 15 women and 4 men, ages 26 to 70. The findings reveal that Afro-Peruvians generally experience mistreatment in the healthcare system. In their opinion, this is associated with systemic issues such as poor infrastructure, low salaries, and insufficient time allocated for patient care. Furthermore, participants perceive receiving poor quality and inefficient service not only from providers but also from the system presents difficulties in other processes, such as getting the appointment. This study highlights significant areas for improvement in the public healthcare system, specifically enhancing the quality of patient care, improving communication, and upgrading healthcare infrastructure to serve the Afro-Peruvian community better. These insights could guide the development of targeted policy recommendations and practical interventions to address healthcare disparities and improve access to quality healthcare services for minority populations.