Iranian Health System Research Articles

Identifying and prioritizing inefficiency causes in Iran's health system.

Enhancing efficiency is crucial in addressing the escalating scarcity of healthcare resources. It plays a pivotal role in achieving Universal Health Coverage (UHC), with the ultimate goal of ensuring health equity for all. A fundamental strategy to bolster efficiency involves pinpointing the underlying causes of inefficiency within the healthcare system through empirical research. This study aimed to determine and prioritize the causes of inefficiency in Iran's health system. This mixed-method study comprised three phases. The initial phase involved identifying the causes of inefficiency through a comprehensive literature review of relevant studies published between January 1, 2010, to January 1, 2021. The causes were then aligned and prioritized using criteria derived from the literature and expert opinion. Finally, the identified causes were ranked based on their significance using Multiple-Criteria Decision Analysis (MCDA). From an initial pool of 307 causes of inefficiency, they were reduced to 121 causes in the first round of screening which were categorized into 13 thematic topics. The second screening process further narrowed the list to 48 causes. Among these, the leading causes of inefficiency included the inadequate supply and unequal distribution of hospital beds, the overuse of health services, and the mismanagement of the health workforce. In contrast, the use of traditional treatment methods was determined to be the least significant factor contributing to inefficiency. This study identified key inefficiencies in Iran's health system, such as resource misallocation, overuse of services, and workforce mismanagement. Addressing these issues is essential for optimizing resource utilization, enhancing service delivery, and achieving UHC. The findings suggest that policymakers should prioritize reforms in hospital bed distribution, implement strategies to reduce unnecessary health service use, and strengthen human resource management. Additionally, targeted policies that focus on decentralizing healthcare decision-making and enhancing primary care could significantly improve system-wide efficiency. Future research should evaluate the effectiveness of these interventions and explore the role of digital health solutions in mitigating identified inefficiencies.

Policy options to address the effectiveness of health service management graduates in solving Iranian health system challenges: a mixed scoping review and policy Delphi approach

Iran's healthcare system is grappling with multifaceted challenges, including financial constraints, staffing shortages, infrastructural deficiencies, legal hurdles, and cross-sectoral coordination issues. The integration of health service management graduates into the healthcare workforce is vital to tackle these obstacles effectively. However, the lack of skilled managers can exacerbate problems, leading to inflated costs, and wasted resources. This study aims to propose policy options to improve the effectiveness of healthcare management graduates in exposure to the challenges of Iran's health system. The study used a mixed-methods design that combined a scoping review and interviews with academics specializing in healthcare management and hospital management, as well as key informants of the Ministry of Health and Medical Education (MoHME), the vice chancellor and deans of faculties of management and paramedicine (December 1, 2022 to February 30, 2023), and a policy Delphi technique (April 1, 2023 to Jun 30, 2023). In the scoping review, we searched PubMed, Web of Science Platform, MEDLINE, Scopus, Google Scholar/Academia, and ERIC for articles published from the inception of each database until August 10, 2022, with an update on October 6, 2022. The search terms included "health services," "healthcare organizations," "healthcare management," "health management education," "Iran," "challenges," "issues," "policy," "interventions," "policy options," "solutions," "policy-making," "effectiveness," "efficacy," and similar terms. We incorporated scholarly articles that presented instances or resolutions demonstrating the impact of health service management graduates in addressing the issues encountered by Iran's healthcare system. Non-English research papers, except Persian, were excluded due to translation resource limitations. Articles from peer-reviewed journals were included based on their publication type, while conference abstracts, book reviews, commentaries, and editorial pieces were considered for review. In the present study, the first step of the modified Delphi methodology involved conducting interviews and qualitative content analysis. Then, through two rounds of online surveys, the policy Delphi technique engaged experts and stakeholders in reviewing and prioritising policy options. In the scoping review, our initial search of the main databases retrieved 553 articles, with an additional 14 articles from gray literature and 5 studies from local databases, totaling 572 references. 426 studies remained after removing duplicates and reviewing them. We excluded 339 studies that did not align with our study's objectives, leaving us with 87 articles. We had access to the full text of 63 of these studies and ultimately selected 31 for review and thematic analysis. The study involved 21 participants, with a 100% response rate in the interview phase. In the Delphi phase, 64 experts were invited, with 41 participating in Round 1 (64% response rate) and 32 in Round 2 (78% response rate). The scoping review identified eleven policy options, followed by designing an interview guide and presenting nine more options based on expert insights from the interviews. We evaluated twenty policy options using a 5-point Likert scale and modified Delphi methodology to assess their effectiveness, feasibility, relevance, and acceptance cost. The study produced four policy options that were culturally and ethically appropriate, as well as compatible with the context and target population. These options were: 1) training and capacity building based on Iran's health system model; 2) development of the framework of Entrustable Professional Activities (EPAs) for healthcare management graduates; 3) determining the career pathways of healthcare management graduates and reviewing the job categories approved by the Ministry of Health and Medical Education (MoHME); and 4) providing effective collaboration between healthcare management graduates and professionals, policymakers, and stakeholders for integrated health system improvement. The study provides evidence-based recommendations for improving the education, training, and professional deployment of healthcare management graduates in Iran. This work was supported by the National Agency for Strategic Research in Medical Education (NASR) (Grant Number 4020159).

New experience of implementing patient e-referral in the Iranian health system: a qualitative study.

Implementing an electronic system of service categorization and a referral system in healthcare is a strategic approach to improving overall health outcomes and optimizing resource use. This study aimed to investigate challenges experienced with the electronic patient referral system in Mashhad University of Medical Sciences (MUMS). In this qualitative research, data were collected using semi-structured interviews. Participants included physicians, experts, and stakeholders working in the Family Physician Program and the referral system, selected through purposive sampling. The data were analyzed using a thematic analysis framework, in which a thematic framework was developed, and key themes were identified. Data analysis was performed using Atlas.ti8 software. According to the interviewees, the challenges of digitizing the referral system can be categorized into three main themes: structure, process, and outcomes. These themes include ten sub-themes, such as challenges related to Internet Infrastructure and the Sina System, Patients' Choice of Desired Specialists, Receiving Payment for Services, Appointment Scheduling, Interdepartmental Coordination, Recording Definitive Diagnosis Codes Before Referral, False Referrals, Dissatisfaction, Feedbacks, and Health Indicators. To improve the e-referral in Iran's health system, several strategies can be implemented. These include sustainable resource allocation, designing consequence mechanisms within the referral system to motivate collaboration and improving appointment scheduling systems. Furthermore, addressing these challenges requires a collaborative approach involving healthcare providers, IT professionals, and patient representatives to ensure that the system is efficient, user-friendly, and effectively meets the needs of all parties involved. Not paying enough attention to these issues cause reform failure while solving them requires multi-dimensional, systematic and coordinated interventions with a deep understanding of the obstacles and challenges. Disregarding these factors may result in apathy over time, ultimately impacting both the quantity and, more importantly, the quality of services.

Social Policy and Changes in the Health System in Iran

Social Policy and Changes in the Health System in Iran

Strategic analysis of Iran's climate resilient health system.

Climate change is a long-term systematic climate variability caused by human activities that alters the composition of the global atmosphere. Health systems should be adaptive and resilient to climate change. Hence, this research aimed to strategically analyze the resilience of Iran's health system to climate change. This study utilized a multiple methods approach. First, in-depth semi-structured interviews were conducted with 32 key climate change and health experts to identify the strengths, weaknesses, opportunities and threats of the Iranian health system's resilience to climate change. Purposeful and snowball sampling techniques were used to ensure maximum diversity among the participants. Then, a questionnaire was developed based on the findings of the first stage and was completed by 33 climate change and health experts. Finally, the strategic position of Iran's health system's resilience to climate change was determined using the internal - external factors matrix. A total of 84 internal factors and 101 external factors were identified that affect the resilience of Iran's health system against climate change. The internal factors were categorized into seven dimensions (i.e., governance and leadership; health financing; health workforce; facilities, equipment and medicines; health information system; health services delivery, and key results). The external factors were categorized into six dimensions (i.e., political, economic, social, technological, environmental, and legal factors). The average score of internal and external factors were 2.47 and 2.12, out of 4 respectively. Iran's health system was found to be in the strategic position of V in terms of resilience to climate change. Therefore, precautionary strategies such as strengthening the climate resilience of healthcare facilities, promoting healthcare facilities' adaptation to climate change, public-private partnership, strengthening the health service delivery system, quality management and cost management, should be implemented to strengthen the resilience of Iran's health system to climate change. Iran's health system is facing significant weaknesses and challenges that have hindered its resilience to climate change. Iran's health system can better prepare and respond to the health impacts of climate change, and safeguarding the health and well-being of its population by addressing these challenges and implementing adaptive and resilience strategies.

Advocating for Equity Inclusion in the Health Accreditation Plan of the Iranian Health System

The Article Abstract is not available.

Future scenarios of palliative care in health system of Iran: a multi-method study.

Paying attention to palliative care has accelerated in Iran in the last 10 years. Considering the trend of aging, increasing burden of chronic diseases and increasing health costs, planning and development of palliative care is necessary in the future. This study was conducted with the aim of explaining the alternative scenarios of palliative care in the health system of Iran until the horizon of 2030. This study was a multi-method scenario planning with a qualitative using multiple methods design, which was conducted in 3 phases in 2018-2020. In the first phase, a list of driving forces was extracted using qualitative interviews and literature review. In the second phase, all factors identified in the previous phase were examined in terms of degree of uncertainty and cross-impact analysis, and two key uncertainties were extracted. In the third phase, based on two key uncertainties, four future scenarios of palliative care were formulated, validated and scenario strategies were presented. The results indicate two uncertainties, including "governance of palliative care in the health system" and "acceptance of palliative care by society," based on which, four scenarios with the names "climbing to the top," "excruciating climb," "edge of the abyss" and "The bottom of the valley" were compiled. The development of palliative care in health system of Iran is faced with serious uncertainties that it is necessary to focus the developmental activities of palliative care on the two axes of acceptance by society and need for coherent governance by considering all the dimensions and influential components by ministry of health. The application of the results of this research can provide reasonable options for effective interventions and implementation of this category of services to the beneficiaries of palliative care.

Factors Affecting Brain Drain and a Solution to Reduce it in Iran's Health System: A Qualitative Study.

Brain drain is an issue of concern in developing countries. Many factors are involved in this issue, and their identification can be a good guide for decision-makers at different management levels. Therefore, the present study was carried out to identify the factors affecting brain drain and solutions to reduce it in Iran's health system. The data for this qualitative study was collected in 2023 through 15 semi-structured interviews with Iranian health experts and emigrant elites. Interviews were collected both face-to-face and virtually (on Skype and Google Meet) and analyzed using the thematic content analysis method. Data analysis of the factors affecting brain drain in Iran's health system yielded seven main categories and 45 subcategories. The main categories were "individual factors," "economic factors," "social and cultural factors," "organizational and administrative factors," "political factors," "attraction factors for destination countries," and "attraction factors of destination countries for elites." Also, the solutions were divided into four categories of "economic," "social," "organizational and scientific," and "political" factors and 19 subcategories. Due to the increase in brain drain in recent years, it is necessary to make a serious decision in dealing with this issue. Solutions such as creating stable economic conditions, creating an atmosphere of hope, increasing respect and dignity for elite students by politicians, using the elites in macro-decisions, and creating the job rank for honorary professors can lead to reducing brain drain and decreasing the costs of the health system.

Study Protocol for Investigating the Impact of Economic Sanctions on Public Health and Healthcare Systems in Iran: A National and Sub-national Analysis from 2000 to 2020

: The economic sanctions imposed on Iran in recent decades have impacted the country's healthcare system and the health of its people. However, there has not been a thorough examination of the full scope and changes in these effects over time. Therefore, we designed a mixed-methods study, comprising a parallel quantitative analysis and qualitative study. The quantitative part assesses the effects of sanctions on public health and the healthcare system using 28 indicators, i.e., macroeconomic, healthcare resources, and health outcomes indicators at both national and sub-national levels from 2000 to 2020. The analyses will include descriptive analysis, change point regression analysis, and mediation analysis, performed using R software. The concurrent qualitative study aims to explore the pathways of the sanction effects by considering the perceptions of both patients and health policymakers. The perceptions and experiences of patients regarding living with and dealing with the long- and short-term health implications of sanctions, and the experiences of health policymakers regarding the effects of sanctions on the healthcare system will be analyzed. This study will provide comprehensive and evidence-informed recommendations for global health policymakers to support countries under economic sanctions to protect and promote the human right to health and well-being.

Effectiveness of nutritional education on nutritional behavior and anthropometric indexes among patients with hypertension based on the health promotion model

ABSTRACT This study measured the effectiveness of nutrition education on anthropometric indexes and dietary commitment among patients with hypertension based on the Pender Model of Health Promotion. A quasi-experimental study was conducted on patients with hypertension. 40 patients in the control and 40 patients in the intervention group were investigated. Data were collected by distributing valid questionnaires about model constructs and testing 3-day diet record. Education was just conducted in the intervention arm including six sessions during three weeks and follow-up two and six months after education. Nearly three quarters of patients (70% in the intervention, 75% in the control group) were female. According to the educational status, 45% in the intervention and 37.5% in the control group were illiterate. Given the family history of hypertension, 40 and 47.5 % of participants in the intervention and control group had family history, respectively. There was no difference between the two groups regarding constructs of the HPM, anthropometric indexes, systolic and diastolic blood pressure, and nutritional behavior before education, while after education all variables were notably changed in 2 and 6-months’ follow-up. The most important predictor of nutritional behavior was the perceived benefits, while the weakest predictor was the affects related to the nutritional behavior. Education based on Pender Model of Health Promotion is useful to improve nutritional behaviors in patients with hypertension to the Iranian health system.

The Cost Effectiveness of Newborn Hearing Screening Program: New Approach of Iran Ministry of Health and Medical Education in 2022

Background: In Iran’s newborn hearing screening (NHS) program, OAE and AABR are administered to early identify hearing impairment in the primary health care (PHC) system. Objectives: The aim of this study was to conduct a cost-effectiveness analysis of this program integrated into Iran's health system. Methods: We examined the cost-effectiveness of AABR and OAE screening procedures in infants less than 1 month old. TreeAge 2022 software was used for cost-effective modeling. In this study, QoL and QALY were considered as the outcome measures. To evaluate the robustness of the modeling results, we used one-way sensitivity analysis. A ± 20% variation was utilized to determine target variables and estimate the costs per identification. Results: In 2022, a total of 1,106,072 babies were born in Iran, of whom 1,006,293 underwent hearing impairment screening (coverage rate: 90.97%). Overall, 3,359 of the newborns screened were diagnosed with hearing problems, indicating a mean prevalence of 3.3 per 1000 births. The ICER was equal to 3297.2 US PPP (Purchasing Power Parity) per QALY. According to our results, the dominant cost-effective strategy for hearing impairment screening was OAE plus AABR. After 1000 iterations, the second cost-effective strategy was found to be OAE alone, according to Monte Carlo simulation modeling. Conclusions: In this study, we evaluated the cost-effectiveness of the NHS program for detecting hearing impairment in over a million births in Iran. A two-step screening approach, including OAE and AABR, was found to be the dominant cost-effective strategy to identify newborns with hearing impairment.

Pathology of the Research Sector in Iran's Health System with a Focus on Future

Background: Strengthening the functions of health research and taking a systematic approach to the development of science and technology are essential for overcoming current challenges in health sector. Therefore, the functional pathology of current research plays a crucial role in highlighting the gap between what is and what should be, thereby illuminating the path of scientific development in health sector with a focus on current challenges.
 Methods: This study utilized qualitative exploratory approaches, regarding interviews with experts and expert panel formation, to complement the authors' experiences in the field of research. In this process, relevant national upstream documents, experiences from other countries, and reviews of other documents were used to reinforce and analyze the findings. To adopt a future-oriented approach, the Future Triangle framework was employed to depict the tension between future images, the weight of past experiences, and the pressure of the current time.
 Results: The research functions were categorized into seven groups: leadership and guidance, research coordination and policy-making, translating upstream documents policies into operational programs, resource management, performance evaluation and monitoring, empowering the workforce and policy-making based on evidence and pathology. Under each category, strategies for moving away from the current situation were provided.
 Conclusion: The main solutions to address the current challenges in the country's health research system include agreement on concepts, a unified vision and stable procedures, strengthening the relationship between different levels of management (inter-ministerial, ministerial, and university), enhancing education and research at the level of medical ministry and universities, establishing appropriate structures for knowledge translation, strengthening national funds supporting the research, reforming the evaluation system, and undertaking a fundamental review of human resource empowerment model.

Key Indicators for Monitoring the Efficiency of Iranian Health System: A Synthesized Design Study.

A significant share of medical care, primary health care, and health-related education and research in Iran is provided by the Ministry of Health and its affiliated universities of medical sciences. We aimed to identify a set of key metrics for monitoring their efficiency in the four areas of medical care, primary health care, education and research. A combination of scoping review, expert panel and Delphi method was used. First, the relevant keywords were searched in the appropriate databases between 2000 and 2020. The final extracted indicators then reviewed, reduced and refined through the expert panel meetings. The last metrics were established following a three-stage Delphi study. Out of 2327 studies, 155 were selected following the different screening stages of scoping review. After summarizing and refining the indicators via several expert panel meetings and the Delphi method, a total of 36 key indicators were considered appropriate for measuring efficiency of the health system, 23 of which were for the sub-systems of public health (4 indicators), medical services (10 indicators), education (4 indicators) and research (5 indicators) and 13 indicators for the whole system efficiency. The set of indicators presented representing both the technical and allocative efficiency, might be a reliable basis for designing information systems and management dashboards for periodic monitoring of health system efficiency at national, regional and local levels.

Developing a model of public health system strengthening during pandemic of new emerging respiratory diseases for Iran: A protocol study.

The objective of this article is to propose a protocol for developing a model for strengthening the public health system in Iran. Currently, there is no clearly articulated model for strengthening public health systems during the pandemic of new emerging respiratory diseases in Iran. The protocol described here aims to: (1) identify components for strengthening public health systems, during the pandemic of new emerging respiratory diseases worldwide, (2) identify components for strengthening Iran's public health system, and (3) design a model for strengthening the public health system in Iran during the pandemic of new emerging respiratory diseases. The protocol proposes three phases. In the first phase, a realistic review will be conducted to identify components for strengthening public health systems worldwide based on six building block framework. In the second phase, a qualitative study will be used to identify components for strengthening public health systems in Iran during the pandemic of new emerging respiratory diseases. In the third phase, an initial model will be designed, and the Delphi technique will be used to finalize the model. Due to fragility and the significant strain that public health systems experienced during the pandemic, it is imperative to introduce a model that strengthens public health systems through some initiatives and strategies and explains the mechanisms by which they operate. A realist review and qualitative study will provide the evidence needed to support the effective implementation of public health interventions, taking into consideration the diverse contexts of these interventions in Iran.

Evaluation the Strategies for Explaining the Managed Care Model for Emerging Respiratory Infectious Diseases(COVID-19) in Iran's Health System

Evaluation the Strategies for Explaining the Managed Care Model for Emerging Respiratory Infectious Diseases(COVID-19) in Iran's Health System

Identification of key factors affecting the future of knowledge translation in Iranian health policy-making.

Production, publication, and effective of academic research in health policy-making are tools to strengthen interactions between policy-makers, the scientific community, and the public. The purpose of this study was to identify the key factors of knowledge translation in the policy-making of the health system in Iran using the structural analysis method. This future study was conducted using the foresight structural analysis method for a 10-year horizon in Iran from 2022 to 2031. Initially, 183 factors were identified by literature review and interviews with experts. In the next step, factors were reduced to 34 factors based on the research team's opinions by merging similar items and removing fewer related items. Then, 34 factors were sent to the experts through an online questionnaire. Nineteen factors were identified with importance and uncertainty above the average. Then, the average degree of cross-impact of the selected factors in the matrix was scored by 11 experts in a focus group meeting, ranged from 3 (strong) to 1 (weak). The cross-impact of these factors was analyzed using MICMAC software. Five factors, including "policy-making method," "role and function of universities," "specialized services of knowledge brokering," "international conflicts," and "policy-makers' trust in university researches," were identified as key factors due to their high influence and effectiveness. The results of this study will help the research managers of the universities to be more informed and, therefore, more successful in their planning for more efficient utilization of the knowledge and evidence from academic research by knowing the factors influencing the translation of knowledge.

Resilience of Iran's health system workers in the covid-19 epidemic: a field review

Resilience of Iran's health system workers in the covid-19 epidemic: a field review

Developing A General Framework for National Health Information Network for Developing Countries

Background: The National Health Information Network (NHIN) is one of the key issues in health information systems in any country. However, the development of this network should be based on an appropriate framework. Unfortunately, the conducted projects of health information systems in the Ministry of Health of Iran do not fully comply with the concept of NHIN. The present study was aimed to develop a general framework for NHIN in Iran. Materials and Methods: In this study, in the first stage, the required information about the concept of the NHIN framework and related NHIN documents in the USA and the UK were collected based on a literature review. Then, according to the results of the first stage and with regards to the structure of the Iranian health system, a general framework for Iranian NHIN was proposed. The Delphi technique was conducted to verify the framework. Results: The proposed framework for Iranian NHIN includes three dimensions; components, principles, and architecture. Over 80% of experts have evaluated all three aspects of the framework at an acceptable scale. In total, the proposed framework has been evaluated by 83.8% of the experts at an acceptable scale. Conclusion: The proposed framework was expected to serve as the starting point for moving towards the design and creation of Iranian NHIN. At any rate, the framework could be criticized, and it could only be used for the countries whose health system is similar to the structure of the health system in Iran. [GMJ.2020;9:e1792]

A Qualitative Study of Barriers, Facilitators, and Challenges of Providing High-Quality Hypertension Care in Health Centers in Iran: Perspectives of Healthcare Care Workers, Patients, and Health Center Managers

Background: Although the vital role of early diagnosing, and properly controlling hypertension has been emphasized for decades, a large number of hypertension patients still encounter barriers and challenges in accessing qualified cares. This study examined and identified barriers, facilitators, and challenges of providing high-quality care for patients with hypertension in health centers in Tabriz, Iran. Methods: A descriptive qualitative study was conducted based on purposive sampling. The participants in this study included health care workers at health centers, patients with hypertension, and health centers managers at official positions (n=19). Data was gathered through semi-structured interviews. Collected data was analyzed thematically. Results: The mean duration of the interviews was 40 minutes (range: 30 to 60 minutes). The barriers were categorized into areas (sub-themes) of patient-related and health-center barriers. Facilitators included patient-related factors, external and environmental activities of health centers, and activities of Iranian health system. Furthermore, the challenges were categorized into (sub-themes) patient-related, environmental, and health system challenges. Conclusion: There are major barriers and challenges in providing qualified and comprehensive services for patients with hypertension. Stakeholders should consider removing these barriers and challenges, and facilitators should be used to provide health services to hypertension patients.

Assessing the Iran Health System in Making Progress towards Sustainable Development Goals (SDGs): A Comparative Panel Data Analysis.

Sustainable development goals' (SDGs) analysis can be caused a better understanding of factors contributing to access to health services and help shape policies to attain health goals. This review aimed to measure and compare the SDGs between Iran and selected categories. This study was a comparative cross-sectional study. We identified indicators of health status based on the SDGs report 2019. The status of SDGs indicators was compared in Iran to four categories, including selected countries with similar social, economic, and health status, six regions of the WHO, the average of each income level group. SPSS 20 and Excel 2019 software were used for descriptive data analysis. The average life expectancy and healthy life expectancy were 75.7 years and 65.4 respectively in Iran. Iran's mortality rate in indicators named road traffic (32.1 per 100000 population), suicide (4.1 per 100000 population), and unintentional poisoning (1.2 per 100000 population) were higher than most of the categories. Iran's status in morbidity indicators had an approximately lower rate than all categories. Iran had full coverage in three immunization indicators like DTP3 immunization, MCV2 immunization, and PCV3 immunization, which was higher than all categories. Coverage of UHC in Iran (65%) was near to the global average (64%) and higher than the eastern Mediterranean Region (53%). Moreover, the prevalence of tobacco smoking (10.95%) and alcohol consumption (1%) were lower than global (6.4%) and the WHO regions (1.8%) average. Health status measurement is a trend that requires the collection, processing, analysis, and dissemination of data by a set of indicators. There are several weaknesses in reported data in the SDGs for some indicators, the data collection process should be noticed seriously by policymakers.