Hospitals as Anchor Institutions: Adapting a US Framework to Advance Equity in Low‐ and Middle‐Income Countries

ABSTRACT

Hospitals command vast economic and human resources yet remain peripheral to population‐health governance in many systems. The anchor‐institution model, developed in the United States, reframes hospitals as place‐based actors that deploy employment, procurement, and investment to advance equity and inclusion. This paper reflects on the adaptation of this model to low‐ and middle‐income countries, where fiscal and governance constraints require contextual adaptation rather than replication. Drawing on comparative policy insights, it examines how hospitals can embed equity objectives within accreditation, financing and corporate social‐responsibility frameworks. The paper identifies enabling conditions, governance risks and measurement strategies to align institutional performance with community wellbeing. The analysis positions hospitals as political–economic institutions whose governance shapes development outcomes, state–society relations and distributive accountability in mixed welfare regimes. Integrating anchor principles into national health missions and local planning structures can transform hospitals from curative hubs into civic assets that strengthen system resilience. Ultimately, the success of anchoring will depend not on expenditure but on whether it redistributes power and rebuilds public trust, the true measures of public‐health legitimacy.