Extended Care Paramedics as a vehicle for equity: A scholarly perspective on community-based scabies management in Aotearoa New Zealand

Scabies is a neglected tropical disease with profound public health implications in Aotearoa New Zealand, disproportionately affecting Māori and Pasifika children living in conditions shaped by structural inequities in housing, income and access to health services. Beyond the immediate dermatological burden, untreated scabies is increasingly recognised as strongly associated with bacterial skin infection and acute rheumatic fever (ARF), sustaining preventable inequities in long-term cardiac health. Despite available treatments, community-level management remains fragmented, with persistent problems of misdiagnosis, incomplete household treatment and limited access to primary care among the populations most affected. This paper argues that Extended Care Paramedics (ECPs) are uniquely positioned to address these gaps through in-home, equity-focused scabies management embedded within broader whānau-centred care. This scholarly perspective examines the epidemiology and burden of scabies in Aotearoa New Zealand, considers the limitations of current community management approaches and presents an author-developed pathway for ECP-led scabies care. The diagnostic component is informed by the 2020 International Alliance for the Control of Scabies Consensus Criteria, while treatment and household management recommendations are drawn from current Aotearoa New Zealand and international guidance. The proposed strategy uses ECPs’ capacity for in-home assessment, household-level care, culturally responsive education and planned follow-up to address barriers that commonly undermine treatment completion. The author argues that evaluating ECP-led scabies management within multidisciplinary ARF prevention programmes could provide a scalable, equity-oriented model consistent with the principles of Te Tiriti o Waitangi.