The World Health Organization recommends a benchmark for uncorrected visual acuity of ≥ 6/12 in 80% of patients at 4 to 6 weeks following cataract surgery. In low-resource countries, reaching this benchmark is challenging and assessing progress is difficult.

Umbrella protocols have recently come to be widely used in clinical trial designs. However, the value of this approach in public health is less well recognized. The coronavirus disease 2019 (COVID-19) pandemic highlighted the need for rapid, reliable and scalable evaluation of diagnostic technologies. In the United Kingdom of Great Britain and Northern Ireland, this need prompted the development of an umbrella research protocol enabling multiple clinical evaluation studies of similar designs to be undertaken under a single overarching preapproved ethics and governance framework. We describe the development, implementation and evolution of this protocol, which was designed to support timely assessment of the performance of in vitro diagnostic devices and associated testing approaches in various settings. The umbrella protocol allowed studies to be started quickly during the pandemic, reduced administrative burdens, supported regulatory submissions and enabled prospective collection of samples for surveillance. While the system described reflects British governance structures, the principles underpinning this approach, including proportionality (ensuring oversight requirements are appropriate to the risk level), standardization and preapproved flexibility, are applicable to many settings. The protocol now forms part of the United Kingdom's wider pandemic preparedness structure and illustrates how preapproved, adaptable research frameworks can accelerate evidence generation during outbreaks. The world is now assessing lessons from the COVID-19 pandemic and it is timely to consider how research systems can support innovative designs such as umbrella protocols. We therefore summarize lessons learnt and practical considerations to support other countries seeking to adopt similar approaches within their own ethical and regulatory systems.

A 6.4-magnitude earthquake struck Jajarkot district in Karnali province, Nepal, on 3 November 2023, disrupting electricity supply at essential birthing centres and health posts. The loss of power disabled baby warmers and heating systems, putting mothers and babies at risk.

Low- and middle-income countries face a rapidly escalating, alcohol-related public health crisis spanning cancer, injury, liver disease, mental health disorders and the complications of human immunodeficiency virus infections. Despite compelling evidence that alcohol is a leading risk factor for premature death and disability, few countries include comprehensive alcohol control policies in their public health agenda. This gap between evidence and policy is critical because evidence-based interventions could decrease the alcohol-attributable disease burden by up to 30% within a decade. We conducted a policy analysis to synthesize evidence from low- and middle-income countries and propose a comprehensive multicomponent framework for alcohol control adapted from experience with tobacco control. Documented achievements show that simultaneously integrating alcohol control into the existing health-care system, introducing regulation, and building institutional capacity can reduce consumption and generate substantial economic returns. However, interference from the alcohol industry in policy, mirroring the historical approach of the tobacco industry, underscores the need for explicit protections. Evidence-based recommendations on implementing alcohol control policies are presented for international agencies, national governments, health-care systems and civil society. These recommendations also draw on global lessons from the World Health Organization's Framework Convention on Tobacco Control. Today, the convergence of robust scientific evidence, proven interventions, successful implementation models and growing political support present an opportunity to advance alcohol control in low- and middle-income countries. The question is not whether comprehensive alcohol control is feasible in resource-constrained settings but whether the global health community will act decisively on the evidence available.

In 2024, the Lancet Commission on Investing in Health proposed targeting investment in 15 priority conditions through 19 modular interventions to improve global health by 2050. While pragmatic, this approach may not fully capture the complex-adaptive nature of health and health systems, nor their social, economic and political determinants. In an iterative, interpretive analysis, proposed global health investment frameworks were mapped against complexity, systems thinking and health epistemology frameworks; five thematic areas were identified for further development: (i) health as emergent from interdependent, social-biological systems; (ii) the non-biomedical determinants driving inequities; (iii) health systems' adaptive requirements; (iv) epistemic injustices that marginalize non-Western perspectives; and (v) the need for context-sensitive, community-led implementation of health measures. Recent major disruptions to international aid financing, while challenging, present a unique opportunity to redesign health investment on more sustainable and locally grounded foundations, where national governments deliberately invest in the social determinants of health as direct health improvement strategies rather than merely as adjacent social policy. To seize this opportunity, we propose five guiding principles for policy-makers: (i) community co-production of interventions; (ii) adaptive governance structures; (iii) complex systems literacy in workforce training to navigate interdependencies and uncertainty; (iv) cross-sectoral partnerships to address determinants of health; and (v) context-sensitive metrics that incorporate community engagement to support learning within health systems. These are not optional enhancements to existing approaches; they are the foundations without which any health investment strategy will continue to treat the symptoms of inequity rather than its causes.

Shifts in global aid funding threaten the sustainability of programmes addressing childhood wasting and population-based surveys used to inform their geographic targeting. Re-evaluating how priority regions are identified is essential to ensure constrained resources reach the greatest number of affected children. We examined how the Global action plan on child wasting prioritization strategies aligned with the geographic distribution of childhood wasting in four countries: Burkina Faso, Ethiopia, Kenya and Malawi. We used the two most recent Demographic and Health Surveys of each country to estimate the annual absolute burden of wasting in global action plan priority and non-priority areas. Prioritized areas consistently captured the highest wasting prevalence and, except in Kenya, experienced larger reductions in wasting prevalence over time. However, in Burkina Faso, Kenya and Malawi, between 43.6% (142 631/327 349) and 69.8% (992 370/1 422 301) of children with wasting lived in non-priority areas, largely in more populous regions with a lower prevalence of wasting but a high absolute burden. These findings highlight a key limitation of prevalence-based prioritization: low-prevalence areas can contain numerous affected children if they are more densely populated. While prevalence-based targeting has successfully delivered nutritional services to millions of children, targets of the global action plan and sustainable development goals are unlikely to be met without addressing the burden of wasting in non-priority areas. With global nutrition financing increasingly constrained, countries must adapt data systems to enable flexible prioritization that balances prevalence and burden, while implementing context-adapted strategies to cost-effectively expand coverage where the largest numbers of affected children live.