Flooding is an increasing threat in rapidly growing cities, yet evidence on how heavy rainfall affects access to healthcare within cities and whether impacts are greater for vulnerable populations remains limited. This study quantifies how flooding changes walking access to healthcare in Kampala, Uganda, and how these changes are distributed across areas that differ in their population-level risk of undernutrition and poor maternal and child health outcomes. We conducted a cross-sectional ecological geospatial modelling study across Kampala and its whole population (approximately 1.8 million residents). We estimated walking travel time to the nearest public or private not-for-profit healthcare facility and hospitals under baseline and flood conditions. Flood scenarios were based on a hydrodynamic model simulating 15 rainfall events ranging from 20 to 100 mm over 1, 3, or 6 hours. Travel speeds accounted for caregivers walking with young children. Outcomes were population-weighted changes in travel time, summarised at parish level and compared across vulnerability groups. Here we show that flooding increases travel time across all scenarios, with larger effects for hospital access. Population-weighted mean increases in travel time range from 11.5 to 19.3 minutes for all facilities and from 23.4 to 56.3 minutes for hospitals across scenarios. In high-intensity storms, increases are greater in more vulnerable areas, particularly for hospital access, with largest disruptions in peripheral areas. Flooding reduces access to healthcare in Kampala and disproportionately affects more vulnerable populations. These findings show how extreme rainfall can widen inequalities in access to maternal and child health and nutrition services and support planning. Floods can make it harder for caregivers with young children to reach healthcare facilities. We studied Kampala, Uganda, to estimate how floods change walking time to healthcare. We combined maps of land, roads, water, and elevation with realistic walking speeds on wet surfaces and tested fifteen flood situations, from lighter, longer storms to intense, short ones. Here we show that travel times increased in every case: by about 19 minutes on average to the nearest clinic and 56 minutes to the nearest hospital for the most intense one-hour storms. Delays were greatest in high-vulnerability neighbourhoods and outer areas, while central areas changed less. These results can guide service placement. Lubbers et al. conduct a cross-sectional geospatial modelling study across Kampala to estimate how heavy rainfall affects healthcare access. They show that flooding reduces access to healthcare and disproportionately affects more vulnerable populations, resulting in widened inequalities.

Abstract Climate change impacts on health outcomes are increasingly recognized, yet the effects of Extreme Precipitation Events (EPEs) on geographical access to and timely use of health facilities for childbirth remain underexplored. We assess how EPEs influence facility-based births in 21 sub-Saharan African countries by combining Demographic and Health Survey data (2015–2021) with gridded daily precipitation data at 5 × 5 km resolution. Using a linear probability model with a three-day exposure window preceding each date of birth, we analyze 256,101 live births from 12,948 locations and define EPEs as daily rainfall exceeding the 85th percentile of the local historical distribution. We find that each additional day of EPE exposure within the three-day window reduces facility-based births by −10.8 per 1000 live births (95% CI −18.3 to −3.2), representing a 1.9% decrease from baseline. This reduction remains consistent across varying EPE definitions (50th–95th percentile) and becomes less pronounced with longer exposure windows, indicating that events closer to the birth date have greater impact. Sustained moderate to heavy rainfall over multiple days also lowers facility use, indicating that barriers can arise both suddenly and cumulatively. We estimate approximately 29,084 additional non-facility births (95% CI 8660 to 49,508) are attributable to EPEs in 2015. Our findings provide evidence that EPE exposure increases non-facility births that may lack the safety net of skilled attendance and emergency obstetric care.

Human-wildlife conflicts (HWC) can be defined as interactions between humans and wildlife which have harmful consequences for humans or wildlife. Recent inclusion of HWC to the Global Biodiversity Framework highlights the importance of managing HWC to avoid negative impacts on people and wildlife. Effective management requires understanding where and how HWC is occurring and evolving in relation to an established baseline, yet a global baseline is largely unknown. Here, we conduct a global scoping review to identify global trends and gaps in current research and data collection efforts at a subnational scale. We found extensive geographical, taxonomic, and contextual biases when compared to predicted HWC exposure. Importantly, areas of potentially high HWC risk in Africa, China, South America and Asia lack spatially explicit studies. Combined with comparatively shorter study periods in these regions, this presents opportunities for more empirical spatial monitoring and investigation. Taxonomic disparities are exemplified by avian, non-snake reptile species only appearing in 18% of studies amongst 925 species we identify as involved in conflict. Types of conflict vary regionally, with poaching and crop raiding in low-income regions, and roadkill and nuisance wildlife in high-income nations. Differences in the conflict types combined with the geographical disparity in collection efforts are demonstrative of varied ecological conditions but also global socioeconomic inequities and localized cultural drivers of conflict. These identified disparities highlight the need for broader efforts in HWC studies towards sustainable development and biodiversity conservation.

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.

Achieving universal health coverage is a key component of the Sustainable Development Goals, focusing on equitable access to quality health services and minimising financial hardship. While strategies often target the demand-side, supply-side barriers such as travel time and facility-level constraints are often overlooked. Accurately quantifying who is affected by these barriers and identifying their locations and specific barriers is critical to improving service delivery. This study examines these barriers in Mali, a country with significant health system challenges exacerbated by high fertility rates and political instability. Using the WHO’s Health Resources and Services Availability Monitoring System, we conduct an analysis of the geographic accessibility of antiretroviral therapy (ART) services. Our aim is to estimate the number of people affected by supply-side barriers by using a geographic accessibility model that calculates travel time to facilities with ART services. The analysis applies a least-cost path algorithm to assess accessibility, where ART services are defined as accessible within 2 hours travel time. People within this range with available services have access while those outside are geographically constrained. For those within 2 hours but without ART access, we identified and quantified facility-specific barriers. The results show that nearly 2.7 million Malians do not have timely access to ART within 2 hours. For about 70%, distance is the main barrier, while the rest face facility-level issues such as the fact that the service is not being planned in the facility, lack of medical supplies and lack of training. This study offers important insights for targeted interventions to scale up ART provision and provides a scalable model for other health services and contexts.

Background and Objectives: New Caledonia, an archipelago in the South Pacific, experienced an unprecedented conjunction of prolonged border closure during the COVID-19 pandemic (2020 to 2022) and marked influence of the El Niño/Southern Oscillation (ENSO). This context provided a unique opportunity to explore how environmental drivers, island isolation, and socio-demographic factors interact to shape infectious disease dynamics. This study aimed to assess the respective and combined effects of climatic variability, travel restrictions, and socio-demographic factors on the dynamics of four priority infectious diseases. Materials and Methods: We retrospectively analysed data from 2017 to 2023 on four infectious diseases: leptospirosis, dengue, influenza, and hepatitis A (HAV). Satellite precipitation data and the Multivariate El Niño/Southern Oscillation Index (MEI) were used. Socio-demographic and economic variables were gathered. Statistical analyses employed descriptive analysis and Generalized Additive Mixed Models to evaluate the associations between climatic events, travel restrictions, and disease circulation using the communal level as a random effect and time (daily) as a spline effect. Results: We analysed 878 cases of leptospirosis, 165 of HAV, 6607 of influenza, and 7377 dengue cases. Influenza was associated with rainfall before lockdown (Odds Ratio (OR) 0.7, Confidence interval 95%, (CI95%), (0.6-0.8)) and disappeared during lockdown but resurged post-reopening losing its meteorological association. Dengue epidemics declined, coinciding with the Wolbachia program and border closure, and were associated with lower MEI (OR 0.78, CI95% (0.6-1) during the 2017 to 2020 period. HAV cases were correlated with the MEI (OR: 1.8, CI95% (1-3.3)). Leptospirosis cases were associated with cumulative rainfall (OR 1.12 (1.1-1.2)) and lower education (OR 1.04, CI95% (1-1.1)) and decreased with water supply (OR 0.7, CI95% (0.5-0.8)). Conclusions: Our findings highlight how climatic conditions, mobility restrictions, and socio-environmental inequities differentially shape infectious disease risks in island ecosystems. These results reinforce the need for integrated One Health surveillance that jointly addresses environmental change, social vulnerability, and infectious disease prevention.

Background Timely access to intensive care is a critical determinant of outcomes among patients with life-threatening illness. Although Colombia has expanded intensive care unit (ICU) capacity in recent years, the extent to which the population can reach different ICU subtypes within operationally relevant timeframes remains unknown. This study evaluated travel-time accessibility to intensive care services in Colombia and identified priority areas for the expansion of the critical care network. Methods A national cross-sectional geospatial analysis was conducted using validated ICU facility locations, a harmonized high-resolution population surface, and least-cost path modeling based on the national road network. Travel-time accessibility was estimated for adult, neonatal, pediatric, and burn ICUs. Population coverage was quantified across predefined travel-time intervals. Model validity was assessed using 32 ambulance-reported referral routes. Priority expansion zones were identified using a travel-time threshold of > 60 minutes and a minimum catchment population of 25,000 inhabitants. Results Marked disparities in accessibility were observed across ICU subtypes. Adult ICUs showed the broadest coverage, with 76.5% of the population reached within 120 minutes and 23.5% above this threshold. Access to specialized services was more restricted: 51.0% of the population lived more than 120 minutes from neonatal ICUs, 34.5% from pediatric ICUs, and approximately 65% from burn units. The validation results showed strong agreement between the modeled and observed travel times (r = 0.99), with a mean absolute error of 24.3 ± 49.6 minutes. A total of 45–137 priority expansion zones were identified, depending on the ICU subtype. Conclusions Geographic access to intensive care in Colombia remains substantially constrained, particularly for neonatal, pediatric, and burn services. Installed ICU capacity overestimates functional access to care. Travel-time analysis provides a policy-relevant framework to guide ICU network optimization, referral system strengthening, and targeted expansion of critical care services in geographically heterogeneous settings.

Achieving equitable antenatal care (ANC) is fundamental to China's 'Healthy China 2030' agenda and its universal health coverage (UHC) commitments. Despite measurable national progress, substantial urban-rural and regional disparities in ANC access persist, driven by a complex interplay of financial, geographic, institutional, and digital barriers that disproportionately affect rural, low-income, and migrant populations. This analysis examines the current landscape of ANC in China, identifying core structural challenges including the enduring legacy of the hukou (household registration) system, a widening digital divide, and the maldistribution of healthcare resources. We contend that piecemeal interventions are insufficient to address these deeply rooted inequities. Instead, this Viewpoint advances an integrated 'spatial-technology-institutional' strategy that synergizes innovations across three mutually reinforcing domains: optimizing tiered healthcare delivery through smart payment reforms, deploying geospatial tools for evidence-based resource allocation, constructing an inclusive digital ANC ecosystem, and establishing sustainable talent incentive mechanisms for grassroots healthcare workers. By implementing this coordinated, multi-pronged approach, China can systematically dismantle geographic inequities in maternal health and ensure equitable ANC access for all women.

Objectives: To establish a global academic ranking of Schools of Public Health based on bibliometric data. Methods: Data were extracted and analyzed using InCites Benchmarking and Analytics™ and the Web of Science™ Core Collection database. Bibliometric data were collected on a selection of 145 Schools of Public Health from all continents between June and September 2025. Ten research indicators were included for the period 2019–2023. Both global and continental rankings were established. Results: The leading institutions were the Harvard T.H. Chan School of Public Health in North America, also ranked first globally; the London School of Hygiene & Tropical Medicine in Europe; the Department of Public Health at the National Autonomous University of Mexico in Latin America; the Saw Swee Hock School of Public Health in Asia; the School of Public Health at the University of Cape Town in Africa; and the School of Public Health and Preventive Medicine at Monash University in Oceania. Conclusions: PHAR 2025 provides the first global bibliometric ranking of a selection of 145 Schools of Public Health. It is a measure of research activity and bibliometric impact, rather than an assessment of the overall quality or public health contribution of each school.

Background Although Africa experiences the highest burden of infectious diseases, the continent currently produces less than 1% of its vaccine needs. In 2021, the African Union set a target to locally produce at least 60% of the continent’s vaccine needs by 2040. However, at the time of developing this scoping review protocol, there is no consolidated, evidence-based framework for assessing national or regional “readiness” to establish or scale vaccine production. Objective This protocol aims to describe a methodological approach that will be used to review existing literature to identify, map, and synthesize the existing evidence on all relevant frameworks, indicator sets, and policy documents (global or national) developed pre- and post–COVID-19 pandemic (January 1, 2010, to December 31, 2025) that addresses readiness for local human vaccine manufacturing with focus on African countries. Methods This scoping review will be conducted and reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, following the 9-step framework outlined in the Arksey and O’Malley methodology and further informed by guidance from the Joanna Briggs Institute. We will search MEDLINE (PubMed), Scopus, Web of Science, Africa-focused databases (eg, Africa-Wide Information, African Index Medicus, and African Journals Online), and gray literature. Eligibility criteria will follow Population, Concept, and Context guidelines (Population: 55 African Union member states; Concept: readiness frameworks, indices, indicators, and policies for human vaccine manufacturing; Context: African national or regional initiatives or global frameworks applied to Africa). Materials in English, French, Portuguese, or Arabic will be included. Publication types will be limited to frameworks, policies, guidance, and reports. Two reviewers will perform calibrated dual screening (Cohen κ) and standardized data charting. We will create an evidence map and inductive thematic synthesis using a vaccine-specific Political, Economic, Social, Technological, Legal, Environmental, plus Market taxonomy. Consistent with the guidance by the Joanna Briggs Institute, critical appraisal will not be performed. An optional expert consultation will help identify missed sources and validate domains. Results Ethics approval for the expert consultation component was obtained from the University of Geneva Research Ethics Committee (application submitted May 21, 2025; approval September 9, 2025). The initial search strategy has been finalized, and pilot searches were completed (May-August 2025). The screening calibration is planned; dual-review title and abstract screening begins in December 2025, with full-text screening and data charting scheduled for January-March 2026. Thematic synthesis and expert consultation are planned from April to May 2026. We anticipate submitting the completed scoping review paper by June or July 2026. Conclusions This review will generate Africa’s first continent-focused evidence map of vaccine-manufacturing readiness, compiling indicators by domain, comparing frameworks, identifying gaps, and informing a multidomain Country Readiness Assessment Index for policy and investment decisions. Trial Registration Open Science Framework 10.17605/OSF.IO/UVSWX; https://osf.io/uvswx International Registered Report Identifier (IRRID) DERR1-10.2196/81231

This paper describes the chaining of several existing components to measure geographic accessibility to services into a single automated framework called the “AccessMod framework”. It then explains how this framework is exposed on the Internet thanks to the use of a virtual laboratory that transforms it into an integrated and transparent service. To demonstrate the capabilities of this service, a use case allowing to model geographic accessibility to green spaces in specific cities has been implemented in a virtual laboratory using Docker images. An execution of this geographic accessibility modeling to green spaces is done for the city of Yerevan, Armenia. Three ways of running the model are demonstrated: (1) in command line; (2) through the virtual laboratory interface and (3) through the GEOSS portal. The outputs are described, and the advantages, issues, limitations and perspectives are discussed. The possibility to reduce the technical complexity of geographic accessibility modeling thanks to its exposition on a web browser represents an undeniable step towards a wider adoption of this accessibility parameter for various thematics. This paper raises the importance of the availability of global renown datasets (e.g. OpenStreetMap, Worldpop, Copernicus land cover, etc.) for automated workflows, but also highlights the limitations of global models, that need to be customized (e.g. for the travel scenarios that are different among cities). Several perspectives are finally proposed to improve the automatic modelling of geographic accessibility through this framework.

Brazil had the second-largest death toll during the COVID-19 pandemic, with indigenous peoples disproportionately affected among ethnic groups. Parallel to the pandemic, Brazil has recorded the highest rate of deforestation globally, with encroachments into Indigenous territories putting climate stabilization and biodiversity at risk. However, the effects of deforestation on COVID-19 transmission to Brazil’s Indigenous peoples are unknown. This study shows that during the pre-vaccination period, deforestation partially explains COVID-19 transmission among Indigenous populations. Our main results for the pre-vaccination period indicate that a daily increase in deforestation per km 2 is associated, on average, with the confirmation of 0.76 (p < 0.004, 95% CI: 0.240 - 1.276) new daily cases of COVID-19 among Indigenous peoples 14 days after deforestation warnings. Our estimates suggest deforestation explains at least 9.6% of all COVID-19 cases among indigenous populations. The association between the two variables disappears after the vaccination program. Our findings provide empirical evidence on the interplay between environmental degradation and negative health outcomes in a vulnerable segment of society in the context of a pandemic. Furthermore, these findings highlight the importance of the One Health approach to building preparedness for future pandemic threats.

Political leaders have pledged that 60% of Africa's routine vaccines will be produced on the continent by 2040, an ambitious target given that the continent currently produces less than 1% of its vaccine needs. A wave of investments in vaccine manufacturing initiatives, show momentum, yet takeoff challenges expose structural fragilities. The objective of this commentary is to present the rationale and architecture of a composite Country Readiness Assessment Index (CRAI) that will measure ecosystem readiness and thereby guide investments, policy reform needed to achieve Africa's 60% manufacturing target. CRAI's architecture will integrate enabling domains, each of which will be backed by verifiable indicators and then weighted through expert consultations to produce a composite score. This design is novel, and the validation will be the first attempt to test such an index empirically. We here outline CRAI's conceptual foundation, step-wise development plan and validation strategy across preselected countries, arguing that such an index is the missing catalyst for turning Africa's manufacturing ambition into reality.

BACKGROUND:Healthcare service provision, planning, and management depend on the availability of a geolocated, up-to-date, comprehensive health facility database (HFDB) to adequately meet a population's healthcare needs. HFDBs are an integral component of national health system infrastructure forming the basis of efficient health service delivery, planning, surveillance, and ensuring equitable resource distribution, response to epidemics and outbreaks, as well as for research. Despite the value of HFDBs, their availability remains a challenge in sub-Saharan Africa (SSA). Many SSA countries face challenges in creating a HFDB; existing facility lists are incomplete, lack geographical coordinates, or contain outdated information on facility designation, service availability, or capacity. Even in countries with a HFDB, it is often not available open-access to health system stakeholders. Consequently, multiple national and subnational parallel efforts attempt to construct HFDBs, resulting in duplication and lack of governmental input, use, and validation. MAIN BODY:In this paper, we advocate for a harmonized SSA-wide HFDB. To achieve this, we elaborate on the steps required and challenges to overcome. We provide an overview of the minimum attributes of a HFDB and discuss past and current efforts to collate HFDBs at the country and regional (SSA) levels. We contend that a complete HFDB should include administrative units, geographic coordinates of facilities, attributes of service availability and capacity, facilities from both public and private sectors, be updated regularly, and be available to health system stakeholders through an open access policy. We provide historical and recent examples while looking at key issues and challenges, such as privacy, legitimacy, resources, and leadership, which must be considered to achieve such HFDBs. CONCLUSION:A harmonized HFDB for all SSA countries will facilitate efficient healthcare planning and service provision. A continental, cross-border effort will further support planning during natural disasters, conflicts, and migration. This is only achievable if there is a regional commitment from countries and health system stakeholders to open data sharing. This SSA-wide HFDB should be a government-led initiative with contributions from all stakeholders, ensuring no one is left behind in the pursuit of improved health service provision and universal health coverage.

Although highly efficient, the Swiss healthcare system accounts for 6.7% of the country's greenhouse gas emissions. In Geneva, our study assessed its carbon footprint for the first time, estimating it at 436,831 tCO2e in 2022. Hospitals (47%) and medications (58.6%) are the main factors and sources of these emissions. Various scenarios, including health promotion and prevention, underscore the importance of direct and indirect measures to cut these emissions by 70% by 2040. These approaches are adaptable to other cantonal healthcare systems.

BACKGROUND:Mapping health facility catchment areas is important for estimating the population that uses the health facility, as a denominator for capturing spatial patterns of disease burden across space. Mapping activities to generate catchment areas are expensive exercises and are often not repeated on a regular basis. METHODS:In this work, we demonstrated the generation of facility catchment areas in Blantyre, Malawi using crowdsourced road data and open-source mapping tools. We also observed travel speeds associated with different means of transportation were made in five randomly selected residential communities within Blantyre city. AccessMod version 5.8 was used to process the generated data to quantify travel time and catchment areas of health facilities in Blantyre city. RESULTS:When these catchments are compared with georeferenced patients originating communities (based on malaria records), an average of 90.3 percent of the patients come from communities within the generated catchments. CONCLUSIONS:The study suggests that crowdsourced data resources can be used for the delineation of catchment areas and this information can confidently be used in efforts to stratify the burden of diseases such as malaria.

Introduction Research on modelling geographical accessibility to healthcare services has witnessed rapid methodological advancement and refinement. One of the contributing factors is the increasing availability of big data detailing the link between the population in need of care and the health facility such as infrastructure, travel modes and speeds, traffic congestion and the quality of road network. This has allowed more granular computation of geographic access metrics, particularly in low-and-middle income countries where data are scarce. However, there are no reviews providing a comprehensive overview of the availability and use of big data for assessing geographical accessibility to healthcare. This protocol aims to describe a methodological approach that will be used to review the existing literature on the application of big data (past or potential) in evaluating geographical accessibility to healthcare.Methods and analysis To characterise the big data that can be used to model geographical accessibility to healthcare, a scoping review will be undertaken and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extensions for Scoping Reviews guidelines. We will search seven scientific databases (PubMed, Scopus, Web of Science, EBSCOhost-CINAHL, Cochrane, Embase and MEDLINE via Ovid), grey literature, reference lists of identified publications and conference proceedings. Search engines will be used to identify relevant big data services not yet used in published academic literature. All literature published in English or French will be included, regardless of publication type, geographical location or year of publication provided it describes or mentions big data that may be useful for evaluating geographical accessibility to healthcare. Study selection and data extraction will be performed independently by two researchers with a third resolving any discrepancies. Analysis will be conducted to summarise big data providers, their characteristics and their usefulness in terms of types of spatial accessibility metrics that can be derived.Ethics and dissemination Formal ethical approval is not required, as primary data will not be collected in this review. Findings will be disseminated through peer-reviewed publication in a journal, conference presentation and condensed summaries for stakeholders through professional networks and social media summaries.Registration Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/S496F.

Background Equitable access to surgery remains a challenge in low-resource settings. In Uganda, National and Regional Referral Hospitals (NRHs, RRHs) and District Hospitals (DHs) are the primary providers of bellwether surgical procedures, while some Health Centre IV (HCIV, mini-hospitals) currently mostly offer cesarean sections. Expanding HCIV capacity to perform all three bellwether procedures (emergency cesarean section, laparotomy, and open fracture fixation) could significantly improve timely surgical access. The “golden hour” for trauma care and the two-hour standard for bellwether procedures are key benchmarks for surgical access. Objective To model population coverage under 1h and 2h access to existing facilities providing Bellwether surgical procedures in Uganda and to evaluate the impact on coverage of equipping HCIVs to perform all Bellwether procedures. Methods Using AccessMod 5, we modeled travel times to surgical facilities under two scenarios: (1) Main hospitals comprising National and Regional Referral Hospitals (NRHS, RRHs) and District Hospitals (DHs) only, and (2) Expanded scenario - Main hospitals, and upgraded HCIVs as fully bellwether-capable. Inputs included gridded population count, road networks, land cover, hydrography, and elevation. Expert-based travel speeds were stratified by land cover and road class. We compared unimodal (walking only) and bimodal (walking plus motorized) travel scenarios, estimating population coverage within 1-hour and 2-hour intervals stratified by region. Results In the unimodal (walking-only) model, 9.7% of Uganda’s population could reach a main hospital within 1 hour, and 20.4% within 2 hours. When HCIVs were included in the expanded scenario, coverage increased to 18.4% within 1 hour and 37.9% within 2 hours. In the bimodal model, 1-hour access improved from 74.9% with main hospitals alone to 91.6% with HCIVs, a gain of 16.7%. The Northern and Western regions experienced the largest improvements in 1-hour access, with increases of 20.6% and 26.9%, respectively. In the bimodal model, 2-hour access rose from 96.7% with main hospitals only to 98.7% after adding HCIVs. Conclusion Geospatial modeling shows that motorized transport substantially improves timely access to surgical care, and equipping HCIVs to perform all bellwether procedures markedly increases 1-hour access, particularly in underserved northern and western districts. Strategic investment in emergency prehospital systems and upgrading HCIVs to bellwether-capable facilities can enhance equity, close regional gaps, and align Uganda with global surgical benchmarks, addressing critical needs in trauma and emergency surgery. Trial registration Not applicable

Switzerland, a wealthy country, has a cutting-edge healthcare system, yet per capita, it emits over one ton of CO2, ranking among the world’s most polluting healthcare systems. To estimate the carbon footprint of the healthcare system of Geneva’s canton, we collected raw data on the activities of its stakeholders. Our analysis shows that when excluding medicines and medical devices, hospitals are the main greenhouse gas emitter by far, accounting for 48% of the healthcare system’s emission, followed by nursing homes (20%), private practice (18%), medical analysis laboratories (7%), dispensing pharmacies (4%), the homecare institution (3%), and the ambulance services (<1%). The most prominent emission items globally are medicines and medical devices by far, accounting for 59%, followed by building operation (19%), transport (11%), and catering (4%), among others. To actively reduce Geneva’s healthcare carbon emissions, we propose direct and indirect measures, either with an immediate impact or implementing systemic changes concerning medicine prescription, building heating and cooling, low-carbon means of transport, less meaty diets, and health prevention. This study, the first of its kind in Switzerland, deciphers where most of the greenhouse gas emissions arise and proposes action levers to pave the way for ambitious emission reduction policies. We also invite health authorities to engage pharmaceutical and medical suppliers in addressing their own responsibilities, notably through the adaptation of procurement processes and requirements.