Assisted reproduction in the public sector: why secondary-level hospitals matter for equity and continuity of care
7 affiliations
- 1Facultad de Ciencias Políticas y Jurídicas, Universidad Técnica Particular de Loja , ,
- 2Teaching and Research Coordination, Hospital Provincial General Pablo Arturo Suárez , ,
- 3Faculty of Health and Social Services, Universidad Estatal de Milagro (UNEMI) , ,
- 4Facultad de Ciencias de la Salud, Universidad Técnica Estatal de Quevedo (UTEQ) , ,
- 5Facultad de Ciencias Sociales y de la Salud, Universidad Estatal Península de Santa Elena , ,
- 6Facultad de Medicina, Universidad de las Américas , ,
- 7Facultad de Ciencias de la Salud y Bienestar Humano, Universidad Tecnológica Indoamérica , ,
Abstract
Background: Infertility is a major public health challenge, yet access to assisted reproductive technology (ART) remains unequal, particularly where public provision is limited. This Policy and Practice Review examines the role of secondary-level hospitals in integrating ART into public health systems.
Methods: A structured literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and LILACS, without publication-date restrictions, including literature in English, Spanish, and Portuguese. Evidence on access, service organization, referral pathways, continuity of care, workforce, health information systems, governance, and financing was synthesized thematically and interpreted through expert-informed policy analysis.
Results: The review identified geographic, financial, organizational, and health-system barriers to equitable ART access. Integrated models may allow specialized centers to retain high-complexity procedures while secondary-level hospitals support infertility assessment, referral coordination, follow-up, and pregnancy surveillance. Eight policy priorities were identified: integration of secondary-level hospitals; standardized referral pathways; workforce development; national ART registries; equity-oriented evaluation; patient and community participation; integrated governance and quality assurance; and sustainable financing. An implementation framework specifying responsible actors, minimum resources, implementation phases, barriers, and monitoring indicators was developed.
Conclusion: Integrating secondary-level hospitals into coordinated ART networks may strengthen continuity of care, geographic accessibility, and use of specialized resources. These potential benefits require prospective evaluation during implementation.
Related
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BibTeX
@article{endaramina2026assisted,
title = {{Assisted reproduction in the public sector: why secondary-level hospitals matter for equity and continuity of care}},
author = {Jesús Endara-Mina and Javier Bermúdez-Gavilanes and Franklin-Rafael Salazar and Lisset A. Manzano-Gallegos and Jessica M. Figueroa-Andrade and Dayan N. Ortega-Parraga and David E. González-Naranjo and Fernando Maldonado-Montalvan and Claudia Reytor-González and Daniel Simancas-Racines},
journal = {Frontiers in reproductive health},
year = {2026},
month = oct,
doi = {10.3389/frph.2026.1974930},
url = {https://europepmc.org/article/PMC/PMC13724580},
note = {CC BY},
}
RIS
TY - JOUR
TI - Assisted reproduction in the public sector: why secondary-level hospitals matter for equity and continuity of care
AU - Jesús Endara-Mina
AU - Javier Bermúdez-Gavilanes
AU - Franklin-Rafael Salazar
AU - Lisset A. Manzano-Gallegos
AU - Jessica M. Figueroa-Andrade
AU - Dayan N. Ortega-Parraga
AU - David E. González-Naranjo
AU - Fernando Maldonado-Montalvan
AU - Claudia Reytor-González
AU - Daniel Simancas-Racines
PY - 2026
DA - 2026/10/19
JO - Frontiers in reproductive health
DO - 10.3389/frph.2026.1974930
UR - https://europepmc.org/article/PMC/PMC13724580
AB - Background: Infertility is a major public health challenge, yet access to assisted reproductive technology (ART) remains unequal, particularly where public provision is limited. This Policy and Practice Review examines the role of secondary-level hospitals in integrating ART into public health systems. Methods: A structured literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and LILACS, without publication-date restrictions, including literature in English, Spanish, and Portuguese. Evidence on access, service organization, referral pathways, continuity of care, workforce, health information systems, governance, and financing was synthesized thematically and interpreted through expert-informed policy analysis. Results: The review identified geographic, financial, organizational, and health-system barriers to equitable ART access. Integrated models may allow specialized centers to retain high-complexity procedures while secondary-level hospitals support infertility assessment, referral coordination, follow-up, and pregnancy surveillance. Eight policy priorities were identified: integration of secondary-level hospitals; standardized referral pathways; workforce development; national ART registries; equity-oriented evaluation; patient and community participation; integrated governance and quality assurance; and sustainable financing. An implementation framework specifying responsible actors, minimum resources, implementation phases, barriers, and monitoring indicators was developed. Conclusion: Integrating secondary-level hospitals into coordinated ART networks may strengthen continuity of care, geographic accessibility, and use of specialized resources. These potential benefits require prospective evaluation during implementation.
SN - 2673-3153
ER -