Institutionalizing Health Literacy as a Governance Mechanism in Low- and Middle-Income Countries: A Transformative Roadmap from the MENA Region.

Health literacy (HL) is increasingly recognized not merely as an individual asset, but as a structural determinant of health equity and a critical governance instrument for sustainable health systems. While frameworks for "health literate organizations" are well-established in high-income contexts, low- and middle-income countries (LMICs) face similar systemic barriers-including centralized governance, fragile social trust, and resource constraints-that require distinct implementation roadmaps.In this perspective we argue that for health systems in the Middle East and North Africa (MENA) region to succeed, they must pivot from a didactic, education-centric paradigm toward an empowerment-oriented governance model. Accordingly, we articulate a multidimensional framework structured around five interdependent pillars: 1. structural reform and high-level advocacy, 2. mobilizing social capital and trust, 3. human resource empowerment, 4. primary health care transformation, and 5. sustainable financing. Drawing on global evidence-including WHO frameworks, the Ottawa Charter, and Health in All Policies-this paper proposes a multidimensional roadmap that institutionalizes HL as a core accountability mechanism within reginal health governance in the MENA region. This model offering a politically astute and transferable framework for LMICs seeking to embed health equity within the architecture of the state.