Tabriz University of Medical Sciences Health Promotion Perspectives 2228-6497 16 1 2026 06 06 Institutionalizing Health Literacy as a Governance Mechanism in Low- and Middle-Income Countries: A Transformative Roadmap from the MENA Region 8 13 10.34172/hpp.45753 EN Parisa Hajibadali https://orcid.org/0000-0001-5114-9540 Hamid Allahverdipour https://orcid.org/0000-0003-3700-6185 Journal Article 10.34172/hpp.45753 2026 02 17 2026 03 31 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.