According to Health XXX surveillance data, the incidence of first-episode acute rheumatic fever (ARF) hospitalisations among Māori has declined by approximately 35% when comparing 2007/2008 with 2024/2025.Guided by Te Tiriti o Waitangi and an explicit equity-focused approach, a comprehensive framework of prevention and care initiatives has been implemented. This includes regular updates to national clinical guidelines for sore throat management, ARF, and rheumatic heart disease, alongside ongoing review and prioritisation of actions within the Rheumatic Fever Roadmap 2023–2028.Community-embedded services work in prevention and further care Hauora providers, school clinics, Mana Kidz programme, providing nurse-led care for >34,000 children across 88 South Auckland schools, and a targeted “swab and treat” local  pharmacy programme in high incidence rate areas  (June 2024–June 2026), delivering timely sore throat assessment, swabbing, and antibiotic treatment. In parallel, support of  community-centred clinical studies strengthens prevention and management strategies. For example, a recent study published, which is under review,  in PLOS Global Public Health demonstrates that subcutaneous benzathine penicillin (SCIP), administered 10-weekly, is safe, well tolerated, and improves adherence.Despite this reduction, the risk profile has remained unchanged, with the highest incidence consistently observed among children aged 5–14 years. In 2024/2025, a total of 194 first-episode ARF hospitalisations were reported nationwide; Māori were approximately 18 times, and Pacific peoples 70 times, more likely to be hospitalized than the non-Māori, non-Pacific population.These inequities are further amplified in rural and remote communities, positioning rural general practitioners as a critical component of the coordinated, multi-organisational response to ARF in XXX.Despite these advances, rural GPs remain pivotal, as they encounter the main gaps in care delivery. Their experiences and insights must actively inform the implementation of national programmes and integration of local initiatives, ensuring that ARF prevention strategies are both effective and contextually relevant across rural XXX.