ABSTRACT The conceptual article examines the purpose and impact of international agendas (EFA, MDGs, SDGs) against the backdrop of three temporal units of analysis: sequence, future, and historical context. In sequence, each of the three international agreements built on the previous one by extending the years of compulsory schooling and broadening the range of social groups, with each new call for ‘universal access’. The future orientation of multi-year international agreements has a lock-in effect for governments and donors and shields educational development from politicisation, stakeholder replacement, and administrative turnover. However, both the future orientation and the historical context of international cooperation have changed dramatically over the last forty years. The greatest time ordeal for international organisations, however, is the short-termism of governments. This is especially pronounced among autocratic governments that seek re-election in the short term and therefore have little regard for multi-year international agreements and long-term action plans.

Introduction: Despite advances toward universal electricity access in Brazil, pockets of energy exclusion persist, particularly in rural areas and in the Northern region. Accurately identifying these territories is essential to support more effective, evidence-based public policies. Objective: To propose and evaluate a machine learning model to estimate the percentage of households with access to electricity in Brazil, using socioeconomic indicators from the Sustainable Cities Development Index (SCDI). Methodology: The study employed a data science pipeline including preprocessing of SCDI indicators, feature selection, and hyperparameter tuning. Different supervised learning algorithms were tested, with performance evaluated using error metrics, especially RMSE and MAPE. XGBoost was selected as the most suitable model after comparative testing. Results: XGBoost achieved the best predictive performance, with an average RMSE of 3.42 and a MAPE of 1.78%, indicating high accuracy in estimating electricity access. The most relevant variables were income of the poorest population, the proportion of forested and natural areas, and indicators related to youth education. Conclusion: The results demonstrate the potential of machine learning as a tool to support territorial diagnostics and the formulation of public policies aimed at universalizing electricity access. The proposed model helps identify structural determinants of energy exclusion, providing technical evidence to guide more targeted and efficient interventions.

Abstract Title: Prevalence and Factors Associated with Adverse Events Following Immunization (AEFI) among Children (0–16 Years) Receiving Routine Vaccines under the National Immunization Schedule: A Cross-Sectional Study in a Tertiary Hospital, June–September 2025 Introduction India’s National Immunization Schedule (NIS) ensures universal access to vaccines against vaccine-preventable diseases 2. Although vaccines are safe, no vaccine is entirely without risk, and adverse reactions will occasionally occur following immunization 3. Adverse Events Following Immunization (AEFI) require robust monitoring to maintain public confidence and safety surveillance Objectives To estimate the prevalence of AEFI among children (0–16 years) receiving routine vaccines under NIS and to identify sociodemographic and vaccine-related factors associated with AEFI occurrence in a tertiary care setting Methodology A cross-sectional study was conducted from June to September 2025 at the Immunization Clinic of a tertiary hospital in West Bengal.A total of 286 children (0–16 years) and their caregivers were recruited. Data were collected using a pre-tested structured questionnaire capturing: Sociodemographic profile, Vaccine type, dose, and site, Occurrence and type of AEFI within 7 days post-vaccination. Descriptive statistics were used to estimate prevalence, and the Chi-square test assessed associations between independent variables and AEFI occurrence, with p < 0.05 considered significant Results The overall prevalence of AEFI was 25.9% (n=74). The most common AEFI was fever (82.4%), followed by local swelling at the injection site (28.4%). Most AEFIs appeared within 24 hours of vaccination, with fever subsiding by day 3, while 5.4% of swelling cases persisted up to day 7.A majority of AEFIs (63.5%) occurred in the 1 to below 9 month age group, followed by 16–24 months (16.2) Conclusion The study highlights that while most AEFIs are minor and self-limiting. Strengthening AEFI surveillance systems, and ensuring timely management and reporting are crucial to sustaining trust in India’s Universal Immunization Programme

ABSTRACT The ongoing debate over universal access to full-day kindergarten (FDK) persists in various states. Previous research lacks consensus on its effects, especially beyond the kindergarten year and among various student groups. Studying FDK within specific state contexts is beneficial because FDK experiences vary vastly across contexts. This study examines the impact of FDK in Utah using multiple years of student and school data. Research Findings: Our analysis reveals that FDK attendance is associated with enhanced literacy skills during kindergarten, especially benefiting students from marginalized backgrounds (e.g. Hispanic, African American, English Language Learners, and students from low-income families). However, the initial academic benefits of attending FDK were not sustained beyond the kindergarten year; by first and second grade, performance differences had largely disappeared, and by third grade even showed modest reversal effects. The favorable differential effects of FDK on students from marginalized backgrounds also largely faded out. Nevertheless, it is premature to dismiss FDK’s long-term benefits, as educational factors such as barriers and/or additional support and resources post-kindergarten are not considered in the current study. Practice or Policy: To sustain the benefits of FDK over time, continued support for FDK students beyond the kindergarten year may be essential.

Targeted universalism for long-acting PrEP: an urgent need to avoid risk targeting and build population-level impact.

With the continuous advancement of CGT technologies, therapeutic regimens worldwide are confronting dual challenges: accelerated regulation and innovation in payment models. The United States has established a regulatory framework characterized by early-stage acceleration and late-stage evidence supplementation based on the 21st Century Cures Act, matching a market-driven payment model supported by commercial insurance and Medicare pilots. China adheres to technology-first with strict risk control, experiencing three regulatory phases and forming a government-led payment model via prudent national medical insurance and local supplementary coverage. Both countries face common dilemmas of long-term evidence shortage, payment system adaptation, and regional accessibility inequality. This study objectively clarifies the institutional differences between the two countries and subjectively proposes targeted solutions including risk-adapted hierarchical regulation, cross-border collaborative payment sharing, and industrial synergy, aiming to provide a reference for global CGT universal access.

Achieving universal electricity access in rural areas remains a complex challenge in many developing countries, particularly for communities located within reach of existing distribution infrastructure but not yet connected. In such contexts, decision-makers must often choose between extending the main grid and deploying off-grid systems. This study presents a structured scoping review based on bibliographic sources, aimed at identifying how decision-making processes are supported in selection of rural electrificationstrategies, when both options are technically and economically viable. Following the PRISMA-ScR guidelines, a multi-phase filtering strategy was applied to the Scopus database, covering literature published between 2013 and 2024. A total of 3780 documents were initially retrieved, from which 136 were selected for in-depth analysis. Data extraction, co-citation mapping, keyword clustering, and thematic coding were used to classify the literature into five decision-related domains: technology selection, network configuration, system optimisation, policy frameworks, and multi-criteria methodologies. The review identifies recurring methodological patterns and systematises the decision-making criteria most frequently applied in rural electrification planning. It highlights that current approaches often treat grid extension and off-grid alternatives within isolated frameworks, despite their coexistence in practical planning scenarios. The analysis reveals significant gaps in the integration of technical, economic, social, environmental and institutional dimensions, as well as in the use of unified indicators that enable meaningful comparisons. These findings emphasise the need for more comprehensive frameworks that reflect the complexity of electrification choices in grid-adjacent rural areas and support more consistent, evidence-based planning processes. • A scoping review of 136 studies assesses decision-making in rural electrification planning. • Literature is categorised across five thematic domains using bibliometric and qualitative methods. • Decision-making tools lack integration of institutional and social dimensions. • Criteria used across studies remain heterogeneous and rarely comparable. • Findings reveal fragmented frameworks for planning trade-offs between grid and off-grid options.

The United Nations (UN) has a target for universal contraception access by 2030. Youth (aged 15-29) still have limited contraception access and lower usage. A unified understanding of the barriers youth face in high-income countries (HIC) remains unclear. Synthesized evidence on youth contraception barriers across HIC to identify continued healthcare inaccessibility and knowledge gaps. A search strategy, including terms like "youth" and "barriers," was applied to three databases, identifying articles published between January 2013-September 2024. Primary peer-reviewed quantitative, qualitative, and mixed-methods studies were included if they focused on youth and contraception barriers. Following the Joanna Briggs Institute, articles were screened for inclusion, and data was extracted. Analyses included descriptive statistics and summarizing findings for quantitative and qualitative results. All articles were subjected to inductive and deductive content analysis to map barriers. Article quality was appraised by the Mixed Methods Appraisal Tool. A total of 41 articles were included, of which 88% were from the USA. Youth struggled to receive quality contraception care from multiple access points from health systems and youth perspectives. Barriers included youth minimal knowledge, poor approachability and care appropriateness, physical barriers, costs, stigma, confidentiality concerns, and service gatekeeping. Youth experiences varied by social identities with those from lower economic, rural, and of younger age facing more obstacles. Contraception was inaccessible for many. To meet UN targets, efforts need to address described barriers to ensure accessible and equitable contraception care that respects and supports youth's choices.

Influenza and influenza-like illness (ILI) place a heavy burden on UK healthcare. Vaccination programmes are shown to be effective but impeded by socioeconomic and demographic inequalities in uptake and outcomes. This paper examines why some neighbourhoods show atypical patterns of vaccination and illness beyond just deprivation. Electronic health records covering influenza seasons between 2018 and 19 to 2023-24 were used to explore trends in influenza vaccination and ILI among adults aged 50+ years. Multi-level negative binomial regression models were used to examine how vaccination uptake and neighbourhood-level deprivation were associated with ILI admissions, as well as to identify outlier neighbourhoods, which were further profiled. Most ILI hospital admissions occurred among adults aged 75+. Higher vaccination coverage was linked to fewer admissions, although this association weakened after adjusting for neighbourhood deprivation, which itself showed a strong social gradient with more deprived areas experiencing two to three times higher admission rates. Vaccination uptake was consistently lower in more deprived areas, with the steepest declines in uptake seen in younger age groups during 2023-24. The temporary provision of universal access of vaccinations for the 50-64 age group between 2020 and 21 and 2022-23 was associated with the largest increases in the least deprived areas. Additional neighbourhood factors predicted little of the residual variation in ILI beyond deprivation, though communal establishments, distance to nearest general practice and older housing showed some associations. Reducing influenza harms will require both boosting vaccination uptake in disadvantaged communities and addressing the wider structural determinants of health.

Impact of Hepatitis C screening and treatment among incarcerated populations in Alberta, Canada on population-level Hepatitis C elimination efforts.

The optimal diagnostic approach for indeterminate pulmonary lesions in the middle lung zone remains unclear, particularly in settings without advanced bronchoscopic technologies. This study explores factors influencing diagnostic approach selection and differences in diagnostic flow in facilities operating without such advanced technologies, aiming to clarify practice patterns that may help bridge the technological gap in current clinical guidance. We retrospectively analyzed patients referred to a tertiary thoracic oncology program for middle lung zone lesion diagnosis between January 2015 and June 2016. Patients were grouped by the initial diagnostic approach: transbronchial-first (TBF) or transthoracic-first (TTF). We compared diagnostic yield, complications, diagnostic workup duration, and costs. The study included 108 TBF and 99 TTF patients. TBF had larger lesions (P = 0.0087) and more pulmonary lesions with a positive bronchus sign (P < 0.0001). TBF had a lower initial diagnostic yield (77.8% vs 89.9%, P = 0.0238), but a lower pneumothorax rate (P < 0.0001) and shorter workup duration (P = 0.0001). Overall costs were similar (P = 0.6773), but TBF was more cost-effective for cases requiring pathologic nodal staging (P = 0.0002). Experienced clinician-driven triage of middle lung zone lesions, based on lesion characteristics, effectively guided initial diagnostic approaches. When appropriately triaged, an initial transbronchial approach resulted in fewer complications, shorter workup duration, and lower costs for pathologic nodal staging, even in an era predating advanced bronchoscopy. Although limited by its retrospective and historical design, these findings provide descriptive insights and underscore the continued value of established diagnostic practices in settings without universal access to newer technologies.

MedQA-MA: A Moroccan Arabic medical question-answering dataset for virtual healthcare assistants and large language models.

Despite unprecedented medical advances, global healthcare systems are failing to deliver universal, equitable and quality care. Many systems also have low resilience to surges in demand, are highly fragmented, or suffer from unsustainable funding models. The crisis of poor accessibility of healthcare services, which includes both lack of availability and unacceptably long waiting times, stems from systemic failures: inadequate provision of primary healthcare, suboptimal deployment of human and non-human healthcare assets, metric- and profit-centric models that exacerbate inequality, fragmented and siloed services, unsustainable costs and a reactive focus on treatment over prevention. Climate change and demographic shifts threaten to overwhelm already strained systems. In this discourse we argue that achieving the fundamental human right to healthcare requires a radical reconstitution of primary healthcare, centred on unlocking previously un- and under-exploited resources, capacities and productivity, governed by the principle of 'Networked Agency with a Safety Net'. We propose a holistic transformation that increases accessibility, resilience, integration, sustainability and, crucially, equity, centred on three synergistic pillars. First, a digital and patient-agency revolution, designed to radically increase access to, and the productivity of, primary healthcare. This involves creating self-care ecosystems such as Do-It-Yourself Digital Medical Centres and Home Clinics, supported by a National Clinical Informatics Centre. By enabling patients to manage routine care, this system frees highly trained healthcare professionals to focus on the complex clinical work that demands their full expertise. This enables and fosters patient empowerment while ensuring continuous clinical oversight (to prevent any misunderstanding: clinical oversight means that all clinical recommendations/decisions are made by healthcare professionals; patient agency involves inter alia implementing such recommendations/decisions). Second, acceleration of the strategic exploitation of microbial technologies-frugal, sustainable tools for diagnostics, prophylactics and therapies, including and especially mental health interventions, and environmental health (One Health). Third, a decisive shift towards disease prevention and health creation, integrating 'Health in All Policies', targeted comprehensive health education, and a comprehensive and systematic dismantling of healthcare accessibility barriers-such as transport impediments-and legacy forms of discrimination like restricted sexual/reproductive healthcare and failure to adequately care for the most chronically underserved, including the ageing population. This model is inherently sustainable and designed to drastically reduce the healthcare sector's carbon footprint and environmental impact through service consolidation, transport-oriented siting and green infrastructure. The measures constitute a technical upgrade and also a fundamental recasting of the primary healthcare system and mindset. This is also a moral imperative. Governments, while increasingly delegating service provision to commercial actors, hold a non-delegable duty of care. Fulfilling this duty necessitates a covenant that transitions healthcare from a market commodity to a publicly-accountable system sustainably designed for long-term resilience, equity and dignity. The roadmap we provide-encompassing governance, infrastructure, innovation and education-charts a course from crisis to a sustainable future where universal access to quality healthcare can finally be realised.

Universal access to drinking water is a key challenge for sustainable development (SDG 6), particularly in rural Sub-Saharan Africa where decentralization struggles to produce expected outcomes. This study analyzes the relationship between local governance and inequalities in access to drinking water in Zagnanado municipality (Benin),characterized by a paradox: the coexistence of dense hydraulic infrastructure (179 manual pump boreholes and 4 village water schemes) alongside over 70% of households relying on non-potable sources. A mixed-methods approach combining a quantitative survey (250 households), semi-structured interviews (85 local actors), and infrastructure assessment was used. Data were analyzed through SWOT analysis and a spatial typology of water vulnerability. The analysis reveals territorial inequalities, with functionality rates ranging from 28.57% (Don-Tan) to 77.14% (Kpedekpo). These disparities stem from structural governance weaknesses: lack of specific regulatory frameworks, institutional fragmentation, lack of maintenance financing (43.58% of boreholes out of order), and limited local capacities. Domestic water treatment is virtually non-existent (3.1%), exacerbating health risks. Inequalities in access to drinking water are more a result of institutional incapacity to maintain and equitably distribute resources than of investment deficits. Establishing regulatory frameworks and sustainable financing mechanisms is crucial for equitable and durable access.

Psychiatric conditions among women during pregnancy and postpartum can seriously impact the mother, child, and family. Building upon previous studies, we evaluated the incidence of psychiatric conditions during pregnancy and one year postpartum between fiscal years (FY) 2019 and 2023 in beneficiaries of the U.S. Military Health System (MHS), which provides universal access. Retrospective cohort study of female TRICARE beneficiaries ages 15-49 who delivered a baby between FY 2019 and 2023 utilizing claims data from the MHS Data Repository to identify deliveries and mental health conditions. Multivariable logistic regression was used to determine patient likelihood of having an incident psychiatric condition during pregnancy and postpartum. We identified 200,623 deliveries from FY 2019 to 2023, including 43,625 (21.7%) where the mother had an incident psychiatric condition, of which 18,560 (9.2%) were during pregnancy and 25,065 (12.5%) were within a year of delivery. Compared with their referent groups, women who were more likely to have an incident psychiatric condition included those ages 15-24, of active duty status, and unmarried. Mothers with hypertension, diabetes, severe maternal morbidity, and preterm delivery were more likely to have an incident psychiatric condition. This study found that more than one in five deliveries in the MHS were associated with an incident psychiatric condition during pregnancy or one year postpartum. Incidence of psychiatric conditions in women receiving care in the MHS was comparable with the American population. Despite universal access to care, variations in patient likelihood of having psychiatric conditions across different characteristics were observed.

Background: The vision of the Alma-Ata Declaration sought to achieve universal health access, yet no country has fully attained “health for all.” Healthcare financing remains a persistent global challenge, with substantial differences in expenditure, insurance coverage, and out-of-pocket (OOP) payments across countries. While medical insurance has been shown to reduce OOP expenditure and improve access to healthcare services, evidence from Mbagathi Hospital and similar settings remains limited regarding how insured patients simultaneously utilize insurance and direct OOP payments. Methods: A sequential explanatory mixed-methods design was used, combining quantitative and qualitative approaches. Quantitative data were collected from 306 insured outpatients through structured questionnaires using stratified systematic sampling, while qualitative data were obtained from 50 purposively selected healthcare providers, policymakers, and departmental heads through focus group discussions and interviews. Quantitative data were analyzed using descriptive and inferential statistics, including chi-square, t-test, and ANOVA, while qualitative data were analyzed thematically. Results: The study revealed that socio-demographic factors significantly influenced the choice and utilization of healthcare financing. Age (χ² = 18.47, p = 0.024), education level (χ² = 21.89, p = 0.014), and income (χ² = 26.12, p = 0.030) were all associated with the type of financing used. Notably, out-of-pocket (OOP) expenses disproportionately burdened lower-income groups (F = 11.23, p &lt; 0.001), reflecting a regressive effect. Awareness of healthcare financing models also significantly affected model adoption (χ² = 16.89, p = 0.002). Capitation was the most frequently utilized financing model (45%)². Overall satisfaction with financing models was moderate, with 39.4% satisfied and 37.8% dissatisfied³; satisfaction did not vary significantly across insurance providers (p = 0.9999)³. Qualitative findings indicated that higher education and formal employment facilitated effective insurance use, whereas low-income and informal sector patients often relied on OOP payments due to irregular contributions or limited understanding⁴. Conclusions: Medical insurance limits direct financial burden, but important inequities remain, particularly among low-income populations who continue to experience substantial OOP costs in Mbagathi Hospital. Policy recommendations include expanding tiered insurance schemes, improving health insurance literacy, broadening outpatient coverage, strengthening public-private partnerships, and promoting community and workplace-based schemes to enhance equity and access, which are essential for advancing universal health coverage in urban Kenya.

Cities and urban planning are crucial for a sustainable future. However, challenges such as urban sprawl, limited data, and methodological issues hinder effective monitoring of urban green spaces (UGS). UGS are essential for enhancing liveability, public health, and climate resilience, yet rapid urbanization threatens their accessibility and equitable distribution. Hereafter, we present a reproducible, scalable, and open data-based approach to assess accessibility to UGSs in support of SDG 11.7, which calls for universal access to safe, inclusive, and accessible green and public spaces. Building on the data-information-knowledge-wisdom (DIKW) framework and FAIR principles, we implemented, within the ESA-EU Horizon 2020 GEOSS Platform Plus (GPP) project, a web-based service integrating two open-source tools inAccessMod and AccessMod for automated data preparation, travel-time modelling, and accessibility estimation. The resulting indicator provides estimates of the share of urban populations lacking access to green spaces within defined walking distances, enabling comparison across cities and possibly monitoring over time. Results demonstrate the feasibility of generating harmonized, reproducible knowledge products that could ultimately support science-based decision-making and climate adaptation. Despite current limitations in datasets and simplified travel scenarios, the proposed approach provides a cost-effective, replicable, and possibly policy-relevant solution for global UGS monitoring.

Purpose Health-care affordability and accessibility represent as a complicated worldwide concern, creating major impediments to universal access to health care, eventually impacting individual health outcomes and economic stability. The research seeks to analyze the scholarly literature on accessibility and affordability of health insurance between 2000 and 2024 through a comprehensive scientific mapping approach. Design/methodology/approach Bibliometric analysis was conducted on 498 research papers based on a search strategy from Scopus database from 2000 to 2024. The study uses both R and VOSviewer to identify major authors, documents and nations while evaluating conceptual, intellectual and social systems. Findings The concept of health insurance has evolved throughout a period of time as a multidisciplinary discipline. The United States dominates in terms of publications and citations, indicating a significant role in driving global medical research. Keyword co-occurrence analysis reveals that “health services accessibility”, “healthcare cost” and “healthcare policy” are the most prominent keywords, confirming the central focus of the literature. Trend analysis indicates that inequality, COVID-19, catastrophic health expenditure and health-care disparities have emerged as rapidly growing research topics, particularly in the post-2020 period. Practical implications This research provides important insights on health insurance for policymakers, highlighting the most critical issues and emerging frontiers in this sector. By identifying the major gaps and emerging areas, it will be useful to the academic researchers to develop a future research agenda. Originality/value The research makes a substantial addition by consolidating the scattered literature in subject, highlighting the concept and issues which serves as a vital resource for informed decision-making.

In recent years, the number of displaced persons due to conflict, persecution, and environmental crises has significantly increased, leading to a large influx of refugees and asylum seekers in European countries, including Portugal. While the Portuguese National Health Service guarantees universal access to healthcare, numerous barriers still hinder the effective access and use of health services by refugee populations, particularly for the prevention and management of non-communicable diseases. This qualitative study aimed to explore the perspectives of professionals involved in refugee reception and integration regarding barriers to accessing and utilizing healthcare, with a particular focus on non-communicable diseases. A qualitative study informed by phenomenological principles was conducted. Semi-structured interviews were conducted with individual participants from December 2022 to March 2023, transcribed verbatim, and analysed using reflexive thematic analysis, informed by phenomenological principles. Thirteen professionals from healthcare, reception, and integration sectors participated. Participants described a high burden of non-communicable diseases, particularly mental health conditions, alongside common risk factors such as unhealthy diets, sedentary lifestyles, and psychosocial distress. Barriers to healthcare access included cultural and linguistic challenges, bureaucratic complexity, and socioeconomic constraints. Facilitators - though less mentioned - included the involvement of cultural mediators, flexible service delivery, and intersectoral collaboration. Both refugees and professionals were described as adopting informal strategies to navigate systemic barriers. This study provides insight into how professionals perceive refugees and asylum seekers’ health needs and their access to healthcare in Portugal. Findings highlight the interplay of structural, linguistic, cultural, and socioeconomic factors shaping healthcare utilisation, informing the development of more equitable and culturally responsive health strategies.

Indonesia's elderly population (aged 60+) now exceeds 7% of the total population, creating challenges for equitable health service delivery. The National Health Insurance (JKN) program, supporting SDG 3.8, has achieved 98% population coverage over its decade-long implementation. Longitudinal Susenas survey data were used to evaluate the utilization of healthcare services among older individuals by examining their use over time and correlating it with relevant factors, which were categorized into potential predictors as defined by the Andersen model, based on demographic, socioeconomic, and healthcare need indicators. Logistic regression was conducted, and propensity score matching with a caliper of 0.05 was used to ensure statistical rigor in the study. Furthermore, the impact of JKN membership on healthcare consultations was estimated over the past decade using a difference-in-differences method. Factors influencing JKN enrollment shifted over the decade, with education and urban residence becoming more important, while internet access and health-related factors declined. JKN membership was not significant in 2013 but became significant by 2023, with a 7.71% average treatment effect. Difference-in-differences analysis shows a 5.85% increase in healthcare utilization attributable to JKN. JKN has produced modest gains in elderly healthcare utilization (5.85%). Further progress requires addressing quality perceptions and geographic inequities to achieve universal health access for Indonesia's aging population.