Management In Iran Research Articles

Explaining the challenges of resources management and its underlying factors in COVID-19 era in Iran: a qualitative study

BackgroundIdentifying factors affecting health costs can contribute to formulating the best policies for controlling and managing health costs. To this end, the present study aimed to analyze resource wastage and identify the factors underlying it in COVID-19 management in Iran’s health sector.MethodThis qualitative content analysis study was conducted in Iran’s health sector. The participants were 23 senior, middle, and operational managers in the health sector. The data were collected through semistructured interviews with the managers. The participants were selected using purposive, quota, and snowball sampling techniques. The interviews continued until the data were saturated. The collected data were analyzed using MAXQDA software (version 10).ResultsFollowing the data analysis, the factors affecting the wastage of health resources were divided into 4 themes and 13 main themes. Vaccines, diagnostic kits, medicines, and human resources were the main factors underlying resource wastage. The identified main themes were open and unused vials, nonuse of distributed vaccines and their expiration, excess supply and decreased demand for vaccines, expiration of diagnostic and laboratory kits and their quantitative and qualitative defects, and the large number of tests. Inefficiency and the expiration of COVID-19 drugs, poor drug supply and consumption chain management, inaccuracy in inventory control and expiration dates, disorganization and inconsistency in the distribution of healthcare staff, low productivity of the staff, and failure to match the staff’s skills with assigned tasks in selected centers were identified as the most important causes of resource wastage.ConclusionGiven the limited health funds and the increased healthcare costs, effective preparation and planning and making reasonable decisions for unexpected events can minimize unnecessary costs and resource wastage, which requires some revisions in attitudes toward COVID-19 management in the healthcare sector.

Challenges of Budgeting and Public Financial Management in Iran's Health System: A Qualitative Study.

Efficient and effective management of budgets and financial resources is critical for health systems to achieve their goals; in this regard, countries may face budgetary and financial challenges owing to the weak prediction of resources and consumptions, and lack of prioritization for their budget. This study aims to identify the most critical policies and events that have affected public financial management and health budgeting and existing challenges in Iran. We conducted the present study in 2022 using a 2-stage qualitative method. First, by reviewing upstream documents and laws, we identified evidence related to health budgeting. Then, we conducted 13 semi-structured interviews with informed people in the health budgeting field that led us toward the main challenges through thematic content analysis. After reviewing 48 upstream documents related to health budgeting, we identified 85 policies. After reviewing the articles, we achieved 11 themes and 71 subthemes. The most critical challenges of the budgeting cycle were as follows: (I) budget formulation, including inappropriate budget structure, conflicts of interest and infringement, lack of financial sustainability, and transparency; (II) budget execution, including a nonexecutable approved budget, complicated allocation process, and ineffective allocations; and (III) monitoring, reporting, and evaluation (MR&E), including fragmentation of MR&E processes, ineffective monitoring and evaluation, weak evaluation of platforms, and inadequate transparency. Most challenges in the health budgeting system are related to the budget formulation and approval stage that have their roots in implementation, monitoring, and reporting. In addition, Iran's macroeconomic and financial issues have also damaged the budgeting of the health sector. Budget problems affect the goals and outcomes of this sector, especially the health system.

Mapping current and future risk of scorpion sting from a species with low medical concern, Mesobuthus phillipsii (Scorpiones: Buthidae) in Iran.

Scorpion stings are one of the most important health challenges and high priority research topic in public health. In this study, we aimed to model habitat suitability of the Mesobuthus phillipsii (Pocock 1889), a species with low medical concern, under current and future climatic conditions in Iran. We also identified vulnerable populations to scorpion stings in the country. Scorpion sting risk modeling was done using an ensemble approach by considering two species distribution modeling methods: MaxEnt and Random Forest methods. Distribution modeling was performed using the sdm R package. The results showed that due to climate change in 2070, the high-risk areas will increase from 20,839 to 79,212 km2. Habitats with a moderate risk of scorpion stings will also increase from 139,347 to 222,833 km2. Consequently, the number of villages in high-risk areas of scorpion stings will increase from 2,870 to 7,017, while this number will increase from 12,759 to 20,104 in the case of medium-risk villages. The results of this study can be used for scorpion stings management in Iran. This study can be used as an example for similar studies on scorpions with high medical emergency.

Explaining the barriers to donor participation in the field of health: a qualitative study.

Iran's health system is facing increasing costs and a lack of resources. Developing the financial participation of donors is one of the ways to strengthen the financial health system. This research was done to explain the barriers to donors' participation in the field of health. This qualitative study was conducted in 2022 using semi-structured interviews with 22 experts, health donors, policymakers, and managers in Iran. The conventional content analysis method was also used for data analysis. The review and classification of the interviews showed that the participation of donors in the health system includes four main issues: the incompleteness of legal processes, the lack of continuous communication with the charity, management, and resources problems, and the insufficient awareness of the donors about the problems and needs of the health system and 18 subtopics. Donors play an important role in financing, developing resources, providing health services, and financially supporting patients in Iran's health system. Therefore, by recognizing and removing obstacles to the participation of donors, policymakers and managers of the health system should target the participation of donors with proper planning, organization, guidance, and supervision, and avoid parallel work and waste of resources.

Lessons from Flood Disaster Management of Khuzestan Province, Iran, Based on the Experiences of Policymakers: A Qualitative Study

Background: Floods are among the most destructive crises in various countries, including Iran, and are considered a national issue. To reduce flood damages, the flood management process must be regularly reviewed and its problems be identified. Objectives: Therefore, the present study aimed to focus on flood management in April 2019 in Khuzestan province, Iran, to investigate the flood disaster management in Iran based on the experiences of policymakers, identify problems, improve the process of flood disaster management, and reduce damage in the future. Methods: This study was designed based on qualitative content analysis. Data was collected using one-on-one, semi-structured interviews with open-ended questions. According to the targeted sampling method, six policymakers related to the Khuzestan flood disaster management in April 2019 were selected as interviewees. Interviews continued until data saturation. Results: After data analysis, three main themes were identified, namely 1) actions before the flood disaster, such as provision of infrastructure and public awareness, 2) actions during the flood disaster, such as flood disaster level assessment and coordination of actions, and 3) actions after the flood disaster, such as damage assessment. It should be mentioned that each theme included sub-themes and categories. Conclusion: Increased effectiveness of disaster management requires integration and centralization of disaster management and coordination between organizations involved in the disaster at all stages of disaster management, including before, during, and after the disaster. It is also necessary to pay attention to research and successful models and implement preparedness programs along with disaster drills to prevent disaster damage. Engagement of the participation of people should be considered as well.

Evaluation of scientific productions in the field of health system management in Iran and its comparison with regional countries

ABSTRACT Introduction Recognizing and evaluating studies in the field of health system management can be a solution to achieve better and more people in need of well-being and health. This study aimed to evaluate the scientific production of Iran's health system management compared with other countries. Methods The present applied study was carried out using scientometric techniques. The study population was all the scientific documents available in the Scopus reference database, which were indexed with keywords in the field of health system management from 2000 to 2021. After filtering, 53,794 academic papers from 21 countries of the region were retrieved. Data analysis was done with VOS Viewer and SPSS22 software. Findings By producing 14,152 scientific degrees, Iran has accounted for 26.31% of the total production of the studied countries and 1.15% of the world's production. There was a significant difference between the studied countries in terms of scientific production (p<0.001), citations received (p<0.001), and H index (p<0.001). Conclusion Despite the growth of scientific production in the field of health system management in Iran and the countries of the region, its amount is still low compared to the global scale.

Health risk communication and infodemic management in Iran: development and validation of a conceptual framework

ObjectiveThe COVID-19 pandemic exposed significant gaps in Iran’s and other health systems’ risk communication. The accompanying infodemic undermined policy responses, amplified distrust in government and reduced adherence to public health...

Determinants of health volunteer training in natural hazard management in Iran.

To avoid calamity, a thorough training program is required. Therefore, the most crucial objectives for health education specialists are to identify the factors that determine disaster preparedness, train volunteers and provide fundamental techniques to reduce natural dangers.

Municipal Wastewater Treatment in Iran: Current Situation, Barriers and Future Policies

With population and economy growth, water usage, wastewater generation and treatment, treatment plants capacity and innovation ability in Iran have increased dramatically in the last decades. Currently, Iran is in the grip of severe water scarcity, with renewable water availability of less than 1700 m3 /capita/y. Total municipal wastewater generated in Iran is 4.61 billion m3 /y out of which only 42% is treated. The conventional activated sludge process accounted for the largest share (&gt;60%) in municipal wastewater treatment in Iran. The treatment plants operational costs usually amount up to 0.2 US $/m3 wastewater. About 55% of treated municipal effluent is reused in Iran, with an emphasis on the agricultural sector. The electricity consumption in municipal wastewater treatment facilities amounts for 0.1% (241 million kWh/y) of the total electricity consumption of the country. Meanwhile, the current laws and policies are sometimes inefficient or do not prompt the ideal outcomes. Thus, the present study provides an overview of municipal wastewater treatment in Iran by describing the current situation and collecting data from 68 treatment plants, and defining key barriers and future policies needs towards Iran’s sustainable municipal wastewater management (up to 2040). Here, the opinions of 50 experts from the governmental sector, industry division, and faculty members were surveyed through the meetings of the technical and steering committee. Overall, sustainable municipal wastewater management in Iran would be obtained by developing water resources, increasing the population covered by wastewater facilities (90%), improving effluent discharge standards, and lowering energy usage to 0.45 kWh/m3 wastewater.

Investigating the Role of Sport in Sustainable Environmental Development: A Case Study

Background: Sport can impact the protection of the environment and energy. Sports activities could gather people in one place, which may negatively affect the environment, such as noise pollution, antisocial behaviors, waste, air pollution, and sharp lighting. Objectives: This paper aims to investigate the role of sport in sustainable environmental development. This applied-developmental study utilized an exploratory qualitative method to collect data. Methods: The statistical population included all top managers of sports organizations (including the National Olympic Committee, Ministry of Sports, and all sports federations), specialists and experts in sport management in Iran, and some managers of the Iranian Department of Environment. Thirteen experts were selected using the purposive sampling method and snowballing technique. The semi-structured interview was used as a data collection tool. Data analysis was done with grounded theory through open, axial, and selective coding. Results: The results indicated that the pattern of sustainable environmental development based on the sport consists of 211 concepts and 26 subcategories. Categories 4, 4, 5, 8, and 4 were related to the causal factors, the fields, and domains, mediating variables, strategies, and consequences, respectively, and one category was also considered an axial phenomenon. Adequacy measure of the research process and quality of data and interpretations was approved based on credibility, transferability, dependability, confirmability, honesty, and data-derived theory criteria, including conformity, comprehensiveness, generality, and controllability. Conclusions: According to the results from the model, the sustainable environmental development based on the sport is affected by foresight, environmental values of sport, environmental requirements of the sport, green sports movement, educational and research factors, communication and promotional elements, economics, structural factors, and organizational factors, which can lead to green productivity in sports and the quality of life and well-being of citizens.

Risk communication and community engagement as an emerging pillar of health emergency management in Iran: Achievements and the way forward.

This article is part of the Research Topic Health Systems Recovery in the Context of COVID-19 and Protracted Conflict. Risk communication and community engagement (RCCE) is an essential component of emergency preparedness and response. In Iran, RCCE is a relatively new area of public health. During the COVID-19 pandemic in Iran, the national task force relied on conventional methods, which is to utilize existing primary health care (PHC) structure to implement RCCE activities around the country. The PHC network and the community health volunteers embedded in it enabled the country to bridge the health system and communities from the very beginning of the COVID-19 pandemic. The RCCE strategy to respond to COVID-19 was adapted over time with the development of a national program, commonly known as the "Shahid Qassem Soleimani" project. This project consisted of six steps including case detection, laboratory testing through the establishment of sampling centers, scale up of clinical care to vulnerable groups, contact tracing, home care for vulnerable population, and COVID-19 vaccination roll out. Nearly 3 years into the pandemic, the importance of designing RCCE for all types of emergencies, allocating a dedicated team to RCCE, coordinating with different stakeholders, improving the capacity of RCCE focal points, practicing more efficient social listening, and using social insight for better planning were identified as some lessons learned. Further, Iran's RCCE experience during the COVID-19 pandemic underscores the importance of continuing to invest in the health system, particularly PHC.

Hydrological Drought Severity in Different Return Periods in Rivers of Ardabil Province, Iran

Hydrological drought (HD) characterization with different return periods is essential to appropriately design the best water management practices. In particular, characterizing the interactive relations of discharge, drought, and return periods using a novel triple diagram can deepen the interpretation of regional droughts, which have not been adequately considered, especially in semi-arid areas. Considering the critical role of HD in water exploitation and management in Iran, this study was therefore conducted to analyze the HD in different return periods in rivers of the Ardabil Province (area = 17,953 km2). To this end, the streamflow drought index (SDI) was computed using DrinC software at 1-, 3-, and 6-month time scales for 25 hydrometric stations during 1981–2014. Then, the drought severity was evaluated by CumFreq software in different return periods (2, 5, 10, 25, 50, and 100 years). Finally, the relationship between discharge, SDI, and return periods was analyzed using triple diagram models. The results revealed that the drought events had mild (−1 ≤ SDI &lt; 0) and moderate (−1.5 ≤ SDI &lt; −1) severity for most study stations in the study area. The mean values of SDI in the 1-, 3-, and 6-month time scales were 1.08, 0.80, and 0.55, respectively. At all study time scales, the drought severity in both rivers with low and high flows increased with increasing return periods. In such a way, the maximum drought severity has been found for rivers with high flow at a 100-year return period. The current results can be considered a screening tool for the distinctive conservation and directive management of watershed resources.

A Cost-effectiveness Analysis of Adding Cetuximab to the First-line Treatment of Metastatic Colorectal Carcinoma in Iran; Considering Genetic Screening for Precision Medicine.

This study aimed to evaluate the cost-effectiveness of cetuximab in different genetic populations of metastatic colorectal carcinoma patients, including KRAS and RAS wild types and mutants, when added to FOLFIRI treatment regimens for evidence-based disease management in Iran. A Markov decision model was designed in TreeAge software with the three states of stable, progress, and death. Clinical outcomes were extracted from published clinical studies, and costs were extracted from the Iranian local data. The primary outcome was an incremental cost-effectiveness ratio (ICER) in the simulated population. The cost-utility model from the perspective of the health system indicated that the average direct medical costs of a patient that has not been genetically screened are $56,985.27 and $20,767.74 in FOLFIRI + cetuximab and FOLFIRI regimens, respectively. However, costs per patient in the KRAS wild-type population were $21,845.52 in FOLFIRI and $78,321.22 in FOLFIRI + cetuximab. In RAS wild-type patients, FOLFIRI and FOLFIRI + cetuximab costs per patient were $23,111.62 and $84,976.39, respectively. Incremental QALYs for the above scenarios were 0.069, 0.193, and 0.285, respectively. Therefore, the ICER of add-on cetuximab in Iran compared to the treatment alternatives in the scenarios with and without KRAS screening was $520,771.55/QALY, $292,768.16/QALY, and $217,460.51/QALY. Although genetic screening in precision medicine reduces costs per outcome, according to the willingness-to-pay threshold of $4349.50 in the Iranian health system, add-on cetuximab to the FOLFIRI regimen is not a cost-effective strategy even with genetic screening and a 20% price reduction.

Elements of management and leadership strengthening in health systems: a qualitative study from Iran

PurposeThe importance of management capacity in the health sector has been increasingly recognized. The World Health Organization (WHO) (2008) has claimed that limited “management capacity” in low-income countries is one of the main obstacles toward achieving health-related goals. The aim of this study is to answer the research question: “What are the elements of management and leadership capacity of senior managers from the perspective of senior managers.”Design/methodology/approachSemi-structured individual interviews were conducted with 20 senior health managers. Sampling method was purposive. Data were collected using a researcher-made interview guide. The transcribed text was analyzed using framework analysis.FindingsFive main themes emerged from the analysis are: (1) competencies required for managers; (2) selection and appointment of managers; (3) establishment of managers' database; (4) deployment of functional support system; and (5) environmental sensitivity. Each of these themes contains sub-themes.Research limitations/implicationsDue to the COVID-19 pandemic, the interviews were conducted virtually. This may have had an impact on obtaining wealthy data because in a face-to-face interview, it is possible to question and answer, get additional explanations and understand the interviewee's mentality.Practical implicationsExtracting elements of management and leadership capacity helps managers to assess management capacity and leadership comprehensively and effectively. In addition, effective and useful operations can be done to strengthen the management and leadership capacity.Originality/valueThis is the first study that has identified the main elements of management and leadership capacity from the perspective of senior health managers in Iran. This article provides the components of the health system management and leadership capacity that can be used at top management level.

Assessing the impact of stigma reduction interventions in Iran: A qualitative study from the perspective of mental health stakeholders.

The fear and embarrassment associated with stigmas discourage patients from help seeking behavior, which may explain why even the patients' loved ones advise them to discontinue treatment to avoid being labeled. In addition, stigmas can lead to personal and family issues, causing patients to disregard their illness. As such, their disease may develop into a chronic condition. This being said, the present study aims to investigate the challenges, solutions, and successes associated with stigmatization in Iran from the perspective of mental health stakeholders. A qualitative study was conducted in the summer of 2022. Purposive sampling was utilized to recruit participants. The primary data collection method involved a focus group interview that lasted 110 min. The project manager monitored the interviews, and all research team members attended the meetings, took notes, and made the necessary preparations. After explaining the study's purpose and ensuring the data's confidentiality, the interviewer led a focus group discussion. The interviews were recorded with the participants' consent. A focus group was used to conduct interviews with 13 individuals until data saturation was reached. Ten psychologists, psychiatrists, and managers responsible for mental health, two patients, and one patient's family member participated in the current study as eligible participants. Repeated readings led to the emergence of three main classes under the headings of challenges, solutions, and successes of stigma management in Iran, each containing subclasses. The majority of the proposed solutions in this study centered on raising awareness and training diverse individuals and groups to lessen stigmas. The most crucial de-stigmatization measure is to offer training that will cause the current stereotypes to change. This must be taken by patients and their families as well as therapists, leaders, policymakers, the general public, and the media. Ideally, younger members of the target groups should be considered for these pieces of training, which must be based on research and derived from cultural and localized needs.

Evaluation of Agricultural Waste Management Mechanism in Iran

The unfavourable situation of waste management in Iran can be seen in different sectors, and agriculture is not excluded from these sectors. The wastes of the agricultural industry can be used in a beneficial way in various agricultural applications and other industrial processes. However, the cost of collection, processing, and transportation can be much higher than the income from the beneficial use of such waste. Incineration of crop residues creates numerous environmental problems. The most important side effects of burning crop residues include the emission of greenhouse gases that lead to global warming, air pollution, and things like soil degradation, loss of soil fertility, loss of beneficial microorganisms, intensification of soil erosion, etc. In the current research, which is a review based on library sources, the mechanism of agricultural waste management in Iran has been evaluated. There are other consequences of such actions. The criteria for action are laws regarding the burning of product residues in Iran, the most important of which are the Waste Management Law and the Clean Air Law. Among these methods are sustainable management methods for product residues, including compost production, biochar production, and waste management at the production site.

Drought monitoring by downscaling GRACE-derived terrestrial water storage anomalies: A deep learning approach

The current study proposes a new method to downscale the monthly GRACE-derived Terrestrial Water Storage Anomaly (TWSA) to 10 km spatial resolution over Iran using deep learning methods. First, the growing neural gas (GNG) method is utilized to cluster the TWSA data to find similar patterns. The Silhouette Chou Davies (SCD) validity measure, a combination of three robust cluster validity measures, is used to evaluate the performance of the GNG method. Then, the feasibility of deep learning Convolutional Long Short-Term Memory (ConvLSTM), shallow learning Feed Forward Neural Networks (FFNN), and Random Forest (RF) are examined in downscaling GRACE-derived TWSA using only remote sensing images. The results indicate that the deep learning method outperforms the RF and FFNN models by 7 % and 18 %, respectively. Then, the Ground Water Storage (GWS) data are isolated from TWSA, showing an agreement between the GRACE-derived GWS and ground-based measurements with R2 = 0.76. Additionally, the downscaled TWSA is used to generate annual drought frequency and change detection maps for the GWS from 2002 to 2016. Annual standardized precipitation index (SPI) drought frequency maps are also produced to gain deeper insight into the water resource scarcity of Iran. The results indicate that Iran has experienced water resource overexploitation since 2011 for agricultural activities, while meteorological drought is a trigger and intensifier for the water crisis in Iran. According to the results, Iran experienced exceptional drought in some regions, and the GWS has decreased all over the country. In addition, further analysis of Iran’s water resources is provided until 2022. The current study calls for integrated sustainable water resources management in Iran; otherwise, irreversible water and environmental problems with higher frequencies will be expected in the near future.

Obstacles and opportunities to implement the IPBES Framework in Iran

To make a significant contribution to halt global biodiversity losses, a worldwide breaking down of the IPBES findings at national scales is indispensable. So far, in some world regions and countries, this process is at the very beginning. Iran is a country with many different ecosystem types and high biodiversity. Still, the concept of ecosystem services (ES) has not yet been introduced as the main concept for policy and decision-making. We investigated the implementation of IPBES-oriented ES and biodiversity assessments for this country with desktop research. Based on a thorough literature review of Iranian publications, we answered this question “How can the IPBES framework be implemented in Iran?”. Our finding showed that there is a need to address the status of ES in the ecosystems of Iran using internationally accepted methods and frameworks. In order to facilitate the implementation of IPBES, we offer a main strategy as evaluation of ES for development programs in Iran. Based on the result, several organizations can contribute to IPBES capacity-building. Additionally, Iranian NGOs and local communities presenting the deliverables, activities and outputs to target audiences are under development to ensure implementation of comprehensive ES projects. Thus, we can improve communications and outreach for target stakeholders in ES projects in Iran. Based on this, we suggest the establishment of an Iranian stakeholders network (ISN) using a web-based infrastructure for ES assessment performance, participatory exercises, data sharing and information management in Iran. It seems that almost none of the stakeholders are aware of ES concepts, theories and policies, and this is a fundamental challenge in the implementation of the IPBES framework in Iran. Advanced work on policy support tools, methodologies, scenarios and models needs to develop a policy support web portal. In Iran, some non-governmental companies have sufficient capacity to perform it. The following organizations can help implement the strategy in different stages: Environmental organizations, local governments, science and technology ministry, power ministry, agricultural organizations, natural resources organizations, universities and research institutes. Also, local knowledge could be recognized and implemented as a participatory mechanism for strengthening the knowledge foundations of ES assessment in Iran.

Responses and Learning from Covid-19: Integrating Chaos and Complexity Theories in the Event and Tourism Sector in Iran

COVID-19 has impacted the events, tourism, and hospitality industries throughout most parts of the world, prompting the need for empirical work to explore the perspectives and responses of industry stakeholders towards the pandemic. To characterize how managers in this space evaluated the impacts of the pandemic and the associated response system(s) and learning stories, in-depth interviews with N = 24 senior event and tourism managers in Iran were conducted. The findings revealed that COVID-19 was a complex external crisis that significantly fueled other internal crises, impacting the complex event and tourism system. The data revealed that understanding the full effects of the pandemic depends on how sufficiently Iranian stakeholders acquired knowledge of the virus and the scope of its outcomes on the layered event and tourism system. The profound structural and transformational changes to this system necessitate the call for a uniform, coevolving responses from multiple events, tourism, sport, and associated management/industrial sectors. Adaption to the new normal and transformational opportunities were recommended by interviewees as influential strategies extracted from crisis lessons learned.

The COVID-19 Pandemic Response and Its Impact on Post-Corona Health Emergency and Disaster Risk Management in Iran

This paper examines the COVID-19 pandemic response in Iran and offers speculations on the possible impact of its experience on the future response to other health emergencies and disaster risk management based on the lessons learned. The COVID-19 experience in Iran is unique in several aspects, including the significant role played by the healthcare workers’ sharing and exchange of information through Internet-based networking applications, and a sociocultural environment that was weakening public trust and cooperation in the use of preventive strategies such as less than the optimum wearing of face masks and attending large social gatherings. There was also hesitation in receiving the necessary vaccine doses due to public skepticism over the effectiveness of domestic COVID-19 vaccines. Furthermore, healthcare workers and health services were afflicted with a lack of sufficient manpower and material resources to fight the pandemic. Moreover, a strong and mostly negative influence of political agenda and religious influence on preventive health policies, especially an initial governmental ban on the import and use of Western vaccines and the pressure to hold religious festivals during the outbreaks, were prevalent. The lessons that can be learned from this ongoing crisis include the value of independent healthcare information networks, transparency in the communication of health information to the public to get their trust and cooperation, and an emphasis on the separation of health policies from political and religious interference.