Ministry Of Health And Medical Education Research Articles

Evidence-based practice in traditional persian medicine (TPM): a stakeholder and social network analysis

BackgroundThe utilization of complementary and alternative medicine (CAM) is experiencing a global surge, accompanied by the adoption of national CAM policies in numerous countries. Traditional Persian medicine (TPM) is highly used as CAM in Iran, and the ongoing scientific evaluation of its interventions and the implementation of evidence-based medicine (EBM) encounters various barriers. Therefore, comprehending the characteristics and interactions of stakeholders is pivotal in advancing EBM within TPM policies. In this study, we utilized both classical stakeholder analysis and social network analysis to identify key stakeholders and potential communication patterns, thereby promoting EBM in TPM policy-making.MethodsA cross-sectional nationwide stakeholder analysis was conducted in 2023 using snowball sampling. The interviews were carried out using a customized version of the six building blocks of health. Data were collected through semi-structured interviews. Stakeholders were assessed based on five factors (power, interest, influence, position, and competency). The connections and structure of the network were analyzed using degree, betweenness, closeness centrality, and modularity index to detect clusters of smaller networks.ResultsAmong twenty-three identified stakeholders, the Ministry of Health and Medical Education (MOHME) and the Public were the most powerful and influential. The Iranian Academy of Medical Sciences was the most competent stakeholder. Social network analysis revealed a low density of connections among stakeholders. Pharmaceutical companies were identified as key connectors in the network, while the Public, supreme governmental bodies, and guilds acted as gatekeepers or brokers. The MOHME and Maraji were found to be high-ranking stakeholders based on four different centrality measures.ConclusionThis study identifies powerful stakeholders in the network and emphasizes the need to engage uninterested yet significant stakeholders. Recommendations include improving competence through education, strengthening international relations, and fostering stronger relationships. Engaging key connectors and gatekeepers is essential for bridging gaps in the network.

Obstacles to the Development of Physiotherapy in Iran

Background: Despite the breadth and diversity of physiotherapy healthcare services, the entry of physiotherapists into the field of prevention and also direct access of physiotherapists to patients in the world for 10 years ago, Iranian physiotherapists have not had direct access to clients, yet. One way to overcome the current situation and move towards the growth and development of the profession is to identify the opportunities and threats of the field. The purpose of this study is to explain the obstacles to the professional development of physiotherapy from the point of view of graduates of this field. Methods: In a qualitative study of the content analysis type, the experiences of 12 physiotherapy scholars in three levels of study, bachelor’s, master’s and doctorate were obtained through a structured and semi-in-depth face-to-face interview. Simultaneously, as the data was collected, the data was analyzed based on Granheim and Ludman’s content analysis method. Results: A total of 28 codes were extracted to explain the obstacles to the development of physiotherapy in Iran, which include “low attention to professional ethics”, “inefficient policies of the Ministry of Health, Treatment and Medical Education” and “traditional teaching methods”. Conclusion: If the adherence to the principles of professional ethics is not strengthened, the policies of the Ministry of Health and Medical Education (MHTME) cannot facilitate the growth and development of the profession, and fundamental changes in the education and training of students will not take place, not only will the quality of physiotherapy services be lower than international standards, but many high medical expenses will also be imposed on people and insurances.

Development and Implementation of an Integrated Standard e-Prescription Model in Alignment with Iranian National EHR.

The implementation of an Electronic Prescribing (EP) system offers numerous advantages in enhancing the efficiency of prescribing practices. To ensure successful implementation, a comprehensive understanding of the workflow in paper-based prescribing is crucial. In Iran, the Ministry of Health, and Medical Education (MOHME) has been actively involved in developing an EP system since 2011. The pilot results within MOHME have garnered significant support from all basic insurance organizations, primarily due to the importance of addressing financial considerations. As a result, these insurance organizations have taken the lead in the national development of the EP system, as responsibilities have shifted. The development of an Integrated Care Electronic Health Record (ICEHR or EHR) and the approach adopted by MOHME have paved the way for the creation of a standardized set of Application Programming Interfaces (APIs) based on openEHR and ISO13606 standards. These APIs facilitate the secure transfer of consolidated data from the EP systems, stored in the data warehouses of basic insurance organizations, to the Iranian EHR. This model follows an ICEHR architecture that emphasizes the transmission of this information to the Iranian EHR. This paper provides a detailed discussion of the various aspects and accomplishments related to these developments.

Bayesian estimation of the time-varying reproduction number for pulmonary tuberculosis in Iran: A registry-based study from 2018 to 2022 using new smear-positive cases

IntroductionTuberculosis (TB) is one of the most prevalent infectious diseases in the world, causing major public health problems in developing countries. The rate of TB incidence in Iran was estimated to be 13 per 100,000 in 2021. This study aimed to estimate the reproduction number and serial interval for pulmonary tuberculosis in Iran. Material and methodsThe present national historical cohort study was conducted from March 2018 to March 2022 based on data from the National Tuberculosis and Leprosy Registration Center of Iran's Ministry of Health and Medical Education (MOHME). The study included 30,762 tuberculosis cases and 16,165 new smear-positive pulmonary tuberculosis patients in Iran. We estimated the reproduction number of pulmonary tuberculosis in a Bayesian framework, which can incorporate uncertainty in estimating it. Statistical analyses were accomplished in R software. ResultsThe mean age at diagnosis of patients was 52.3 ± 21.2 years, and most patients were in the 35–63 age group (37.1%). Among the data, 9121 (56.4%) cases were males, and 7044 (43.6%) were females. Among patients, 7459 (46.1%) had a delayed diagnosis between 1 and 3 months. Additionally, 3039 (18.8%) cases were non-Iranians, and 2978 (98%) were Afghans. The time-varying reproduction number for pulmonary tuberculosis disease was calculated at an average of 1.06 ± 0.05 (95% Crl 0.96–1.15). ConclusionsIn this study, the incidence and the time-varying reproduction number of pulmonary tuberculosis showed the same pattern. The mean of the time-varying reproduction number indicated that each infected person is causing at least one new infection over time, and the chain of transmission is not being disrupted.

A proposed dietary policy package for the health sector in Iran

BackgroundInsufficient physical inactivity and an unhealthy diet are significant health risk factors globally. Dietary risk factors were responsible for approximately 16.5% of all deaths in Iran in 2019. This paper aimed to propose a dietary policy package for the health sector to reduce the risk of an unhealthy diet, which might effectively help prevent and control non-communicable diseases (NCDs) in Iran.MethodsIn this qualitative study, we conducted semi-structured, face-to-face, and in-depth interviews with 30 purposefully selected experts, including policymakers, high-level managers, and relevant stakeholders, during 2018–2019 in Iran. All interviews were digitally recorded, transcribed verbatim, and thematically analyzed, facilitated by MAXQDA 11 software.ResultsWe developed several dietary recommendations for different stakeholders. These include traffic light labeling reforms, i.e., the need to make the signs large and readable enough through utilizing advanced technology, cooperation with other sectors, promoting healthy symbols and supporting food products with them, food basket reforms, updating dietary standards, adopting appropriate mechanisms to report violations of harmful products laws, scaling up mechanisms to monitor restaurants and processed foods, and creating an environment for ranking restaurants and other relevant places to support a healthy diet, for instance through tax exemption, extra subsidies for healthy products, Non-Government Organizations (NGOs) alliances, and using influential figures.ConclusionIran’s health sector has developed a practical roadmap for the prevention and control of NCDs through promoting healthy nutrition. In line with the sustainable development goal (SDG) 3.4 pathway to reduce premature mortality due to NCDs by 30% by 2030 in Iran, we advocate for the Ministry of Health and Medical Education (MoHME) to adopt appropriate evidence-informed interventions for improving public health literacy and reducing consumption of unhealthy food.

Strategic Framework for Strengthening Health Laboratory Services in the COVID-19 Pandemic in Iran.

Providing equitable access to good quality, timely, and affordable laboratory testing has always been a top priority for the Ministry of Health and Medical Education (MoH-ME) and the Reference Health Laboratory (RHL). Considering the significant role of medical laboratories in disease surveillance, RHL developed a strategic plan to manage laboratory services during the COVID-19 pandemic based on the "Strategic Framework for strengthening health laboratory services, 2016-2020" proposed by the World Health Organization (WHO). This article describes the steps taken to establish the strategic framework in Iran. Firstly, a National Laboratory Committee was formed in MoH-ME and a situation analysis was conducted to explore the strengths, weaknesses, opportunities, and threats in different components of our laboratory system. Gaps and resources needed to address those gaps were determined; then, RHL outlined operational processes and mechanisms for monitoring the activities. The WHO strategic roadmap and its six strategic goals concerning leadership, quality, human resources, safety and security, laboratory networking, and rational use of laboratory testing, helped us to promote national laboratory services in accordance with health system requirements in the COVID-19 pandemic. The establishment of a national molecular laboratory network with more than 500 laboratories from different sectors may result in timely access to countrywide laboratory services and would be beneficial for future COVID-19 and/or other viral outbreaks. Continual evaluation of the COVID-19 laboratories' performance, production of PCR test kits by the local manufacturers, and development of a platform for virtual training would be other accomplishments that Iran achieved in coping with the recent pandemic.

Implementation of thyroid eye disease registry in Iran: rationale and research protocol.

To describe the implementation of a registry system for patients with thyroid eye disease (TED) in Iran to obtain more information about its nature, prevalence, and annual incidence, as well as extend insight into the etiology, pathogenesis, and eventually make an accurate prognosis of different medical or surgical treatment methods. After receiving approval from the Disease Registry Committee of Iran University of Medical Sciences (IUMS) in 2019 and the Ministry of Health and Medical Education (MOHME) in 2020, the protocol was introduced in three consecutive phases at regional, provincial and national levels. The establishment of a registry committee in Rassoul Akram Hospital, one of the medical centers affiliated to IUMS, was the first step to organizing the registry project's main core. The steering committee included six subgroups of required subject fields. The members are experts in developing a guideline, providing a new dataset, drawing an outline for the next steps, and structuring user-friendly software through several panel discussion meetings. The data is collected from clinical and para-clinical/imaging findings, laboratory evaluations, and their selected treatment strategy, retrospectively and prospectively. The purpose is to broaden our knowledge about the profile of TED; accordingly, data related to patients' demographics, thyroid gland disease (status, duration, treatments, and function tests), general medical and ocular history, along with visual/ocular exams resulting TED status are collected and recorded in a 2- language software. The web-based software system is accessible at https://orc.iums.ac.ir . To maintain data security, prioritized user access was defined for different members. Furthermore, diverse methods, such as employing trained staff and utilizing software validation rules, were implemented to control data quality in every step of data collection, entry, and registration. Medical records of retrospective subjects were also evaluated and entered after accuracy verification. Iran's TED registry provides practitioners with comprehensive data on natural history and phenotype variations in clinical features and outcomes. It facilitates patient recruitment and, consequently, earlier diagnosis on a large scale which helps improve treatment and quality of life for patients.

Exploring the landscape of health technology assessment in Iran: perspectives from stakeholders on needs, demand and supply

BackgroundThe evaluation of health technologies plays a crucial role in the allocation of resources and the promotion of equitable healthcare access, known as health technology assessment (HTA). This study focuses on Iran’s efforts to integrate HTA and aims to gain insights into stakeholder perspectives regarding capacity needs, demand and implementation.MethodsIn this study, we employed the HTA introduction status analysis questionnaire developed by the International Decision Support Initiative (iDSI), which has been utilized in various countries. The questionnaire consisted of 12 questions divided into three sections: HTA need, demand and supply. To identify key informants, we conducted a literature review and consulted with the Ministry of Health and Medical Education (MOHME), as well we experts in policy-making, health service provision and HTA. We selected stakeholders who held decision-making positions in the healthcare domain. A modified Persian version of the questionnaire was administered online from September 2022 to January 2023 and was pretested for clarity. The analysis of the collected data involved quantitative methods for descriptive analysis and qualitative methods for thematic analysis.ResultsIn this study, a total of 103 questionnaires were distributed, resulting in a favourable response rate of 61% from 63 participants, of whom 68% identified as male. The participants, when assessing the needs of HTA, rated allocative efficiency as the highest priority, with a mean rating of 8.53, thereby highlighting its crucial role in optimizing resource allocation. Furthermore, healthcare quality, with a mean rating of 8.17, and transparent decision-making, with a mean rating of 7.92, were highly valued for their impact on treatment outcomes and accountability. The importance of budget control (mean rating 7.58) and equity (mean rating 7.25) were also acknowledged, as they contribute to maintaining sustainability and promoting social justice. In terms of HTA demand, safety concerns were identified as the top priority, closely followed by effectiveness and cost-effectiveness, with an expanded perspective on the economy. However, limited access to local data was reported, which arose from various factors including data collection practices, system fragmentation and privacy concerns. The priorities of HTA users encompassed coverage, payment reform, benefits design, guidelines, service delivery and technology registration. Evidence generation involved the participation of medical universities, research centres and government bodies, albeit with ongoing challenges in research quality, data access and funding. The study highlights government support and medical education as notable strengths in this context.ConclusionsThis study provides a comprehensive evaluation of Iran’s HTA landscape, considering its capacity, demand and implementation aspects. It underlines the vital role of HTA in optimizing resources, improving healthcare quality and promoting equity. The study also sheds light on the strengths of evidence generation in the country, while simultaneously identifying challenges related to data access and system fragmentation. In terms of policy priorities, evidence-based decision-making emerges as crucial for enhancing healthcare access and integrating technology. The study stresses the need for evidence-based practices, a robust HTA infrastructure and collaboration among stakeholders to achieve better healthcare outcomes in Iran.

Strengths, Opportunities and Challenges of Health Transformation Plan as a Policy of Universal Health Coverage: A Qualitative Study in Kurdistan

Background: In 2014, the Iranian Ministry of Health and Medical Education (MOHME) has introduced Health Transformation Plan (HTP) to guarantee the provision of high-quality healthcare services. This study aimed to determine the viewpoint of policy-makers, and health system managers affiliated to Kurdistan University of Medical Sciences about the opportunities and challenges of this plan.
 Methods: In this qualitative case study, a purposive sampling method was used to select study experts in the field of health system. Research data was collected through semi-structured interviews with 18 participants and two focus group discussions associated with health-care reform issues with policy-makers, and health system managers of the province. Data was analyzed using content analysis method and MAXQDA 10.0 software.
 Results: As a whole, study findings revealed 8 main themes and 19 sub-themes and 156 codes regarding HTP factors. Three themes were dedicated to opportunities, strengths and opportunities, with seven subthemes and four themes were dedicated to stewardship, Cultural and educational, infrastructural, staffing and service delivery challenges with twelve subthemes.
 Conclusion: The HTP should include effective interventions to overcome existing challenges in the provision of healthcare services through establishing new health facilities, offering recruitment and retention incentives for healthcare professionals, expanding primary health care services to urban and peri-urban as well as rural and remote areas.
 

Popular diffusion as an instrument for overcoming barriers to digital health in Iran: the critical role of the pandemic

PurposeThe importance of champion leaders including tech-savvy leaders to digital government has been highlighted in the literature. Meanwhile, what was in the authors’ interest to explore was the role of business-savvy leaders or non-governmental digital champions as units of analysis, those who mobilized people's interest in digitalization and bypassed governmental barriers through this popular mobilization. They could be considered policy entrepreneurs for understanding policy change in the digitalization of the health sector. This study sought to shed light on the barriers and drivers of digital health in Iran.Design/methodology/approachThe researchers conducted interviews with actors of digital health businesses in Iran, including the Health Information Technology Center affiliated to the Ministry of Health and Medical Education (MOHME) administrative body and authorities, private companies active in digital health and health service providers. The purposive sampling method was applied, and 15 experts with relevant and valuable experiences as well as maximum variation to obtain representativeness and rich data were interviewed. Trustworthiness criteria were also used to assure the quality of the results. The data were analyzed based on directed content analysis using the MAXQDA10 software.FindingsIt was found out how popular diffusion was effective to overcome barriers to health digitalization. Access to the internet and diffusion of information technology helped the net-enabled businesses to connect directly to people and provide services to them. Diffusion of these services forced the public sector to adjust itself, and thus MOHME banned digital consultation services because of the so-called “insecure and unknown physicians”, following the increased popularity of digital services diffusion, but they were not able to resist popular diffusion of new technology. Hence, it was allowed to work. The main barriers to telemedicine spreading in Iran have been divided into five main categories including government incapacity for digital health governance, conflict of interest, professional obligations for information transparency, protection of patients' rights and data security and privacy.Originality/valueAs a game changer in digital health governance in Iran, popular diffusion will determine the future of digital health. To the best of the authors’ knowledge, this study is among the first ones to explore digital health governance in relation to the private digital health business in Iran with a public policy approach.

Health Workforce Development Policies in Iran: A Study of In-service Training Policies

Background: In-service training is one of the requirements for developing health workforce skills and providing quality services to patients. Objectives: This study aimed to determine the policy formulation of in-service training for the health workforce in Iran. Methods: In this qualitative policy analysis study, semi-structured interviews with key informant persons and document analysis were used to gather data. Interviews were conducted with 12 informed people about health system policies, experts, and managers of in-service training centers of medical universities and the Ministry of Health and Medical Education (MOHME) selected purposively. Targeted and snowball sampling was used to identify the participants. Data analysis was performed using the MAXQDA10 software, and framework analysis was run using the Kingdon model. Results: Centralized planning, lack of access in rural and remote areas, and the inability to use the potential of universities in staff training were the most frequent problems in in-service training of the health workforce. Establishing the Board of Trustees for universities affected the opening of the opportunity window to policy-making, and political entrepreneurs in MOHME took advantage of it and developed policies for in-service training. Conclusions: The development of policies has created a suitable platform for medical universities to increase the number of training hours and develop the skills of the health workforce. It also seems that policymakers' attention can lead to improving processes and using new approaches in the continuous development of health professions.

Accreditation of the Family Medicine Residency Training Programme in Universities of Medical Sciences(UMS) of Iran

Introduction: Family medicine expertise as one of the most important policies have been proposed in the field of education and health system in the last decade.The aim of this study is the accreditation of the family physician residency in medical sciences universities in Iran. Method: This is an accreditation and evaluation study that was implemented by the General Medical Council Secretariat of the Ministry of Health and Medical Education (MOHME) in collaboration with the Medical Education Research Center of Guilan University of Medical Sciences and the World Health Organization. The implementation process of this project was in two stages of internal evaluation and external evaluation in 12 universities of medical sciences of the country that were training the specialized course of family medicine and the sampling method was based on the entire research community. The family medicine specialty standards questionnaire designed by WONCA (2013 and 2016 editions) was used for internal evaluation. The translation and localization of the said questionnaire was done using the Backward- Forward method. After translation, the questionnaire was provided to the universities through the correspondence of the secretariat of the General Medical Council with 12 universities of the country. At the beginning of the internal evaluation, the self- evaluation forms were sent to universities. After the internal evaluation by the universities, an external evaluation was conducted. Then the members of the scientific committee determined the external evaluators to monitor the activities of the twelve universities. Data were analyzed in two quantitative and qualitative methods through SPSS. The information obtained from documents and interviews was analyzed qualitatively. In order to match the results of internal and external evaluation as well as the compatibility of documents with reports, a comparative evaluation was done by external evaluators and the research team. Results: According to the results of the internal and external evaluations and the opinions of the evaluators, the final decision regarding the accreditation of the specialized family medicine residency by universities was issued by the research team. Based on this decision, 2 universities of medical sciences partially approved the program (3 years); 3 University of Medical Sciences partial approval of the program (2 years); 2 University of Medical Sciences partial approval of the program (1 year); And 1 University of Medical Sciences received conditional approval of the program (6 months) and 4 Universities of Medical Sciences received non- approval. Conclusion: The results of this study are a guide to promote the strengths and eliminate the weaknesses in the implementation of the existing program for universities of medical sciences and a source for decision-making at the macro level and the Ministry of Health, Treatment and Medical Education to grant permission to continue the work, and the activity of the universities is to train the specialized course of family medicine.

A SWOT analysis of the development of health technology assessment in Iran.

Health systems need to prioritize their services, ensuring efficiency and equitable health provision allocation and access. Alongside, health technology assessment (HTA) seeks to systematically evaluate various aspects of health technologies to be used by policy- and decision-makers. In the present study, we aim to identify strengths, weaknesses, opportunities, and threats in developing an HTA in Iran. This qualitative study was conducted using 45 semi-structured interviews from September 2020 to March 2021. Participants were selected from key individuals involved in health and other health-related sectors. Based on the objectives of the study, we used purposive sampling (snowball sampling) to select individuals. The range of length of the interviews was between 45 to 75 minutes. Four authors of the present study carefully reviewed the transcripts of interviews. Meanwhile, the data were coded on the four domains of strengths, weaknesses, opportunities, and threats (SWOT). Transcribed interviews were then entered into the software and analyzed. Data management was performed using MAXQDA software, and also analyzed using directed content analysis. Participants identified eleven strengths for HTA in Iran, namely the establishment of an administrative unit for HTA within the Ministry of Health and Medical Education (MOHME); university-level courses and degrees for HTA; adapted approach of HTA models to the Iranian context; HTA is mentioned as a priority on the agenda in upstream documents and government strategic plans. On the other hand, sixteen weaknesses in developing HTA in Iran were identified: unavailability of a well-defined organizational position for using HTA graduates; HTA advantages and its basic concept are unfamiliar to many managers and decision-makers; weak inter-sectoral collaboration in HTA-related research and key stakeholders; and, failure to use HTA in primary health care. Also, participants identified opportunities for HTA development in Iran: support from the political side for reducing national health expenditures; commitment and planning to achieve universal health coverage (on behalf of the government and parliament); improved communication among all stakeholders engaged in the health system; decentralization and regionalization of decisions; and capacity building to use HTA in organizations outside the MOHME. High inflation and bad economic situation; poor transparency in decisions; lack of support from insurance companies; lack of sufficient data to conduct HTA research; rapid change of managers in the health system; and economic sanctions against Iran are threats to the developmental path of HTA in Iran. HTA can be properly developed in Iran if we use its strengths and opportunities, and address its weaknesses and threats.

Why has the taxing policy on sugar sweetened beverages not reduced their purchase in Iranian households?

This study aimed at analyzing the effectiveness of the policy of taxing Sugar-Sweetened Beverages (SSBs) on their purchases during the last decade in Iranian households. The present mixed method study was done in 2017 in four phases: (1) A meta-review of the fiscal policies during the last decade, (2) Collecting existing data on soft drinks' production, price, and household expenditure during the last decade, (3) Conducting 19 semi-structured interviews with key informants, and (4) Facilitating a national meeting to achieve a consensus on the recommendations and future implications. Document reviews showed that based on the Permanent Provisions of National Development Plans of Iran, the Ministry of Health and Medical Education (MOHME) should announce the list of health threatening products to increase taxation for them. The government is allowed to impose taxes on domestically produced and imported SSBs. The average household expenditure on SSBs increased in the rural and urban households of Iran during 2006-2016 in spite of taxation. In the different key informants' opinion, only value-added tax (VAT) was implemented among different fiscal policies, and the other parts, including tax and tolls were debated. The present research findings further proposed some suggestions for increasing the effectiveness of financial policies in reducing the prevalence of NCDs in Iran.

Socioeconomic Inequalities in Cancer Incidence: A Comparative Investigation Based on Population of Iranian Provinces.

Cancer is the second important cause of death worldwide. Cancer is one of the top health priorities in Iran. We aimed to study the socio-economic inequality of cancer incidence in Iran provinces. We conducted this cross-sectional study using provincial data. We obtained the required data from the statistical yearbook report, the Statistics Center Report and the National Cancer Registration Program Report of Iran's Ministry of Health and Medical Education (MoHME) for 2018. Socio-economic inequality of cancer incidence was analyzed by estimating the concentration index and extracting the concentration curve. Statistical analyzes were performed using STATA 14. Our findings revealed that cancer incidence was unequally distributed in terms of the socio-economic status in Iranian provinces. Cancer incidence is slightly concentrated in the provinces with higher than average literacy, per capita income and insurance coverage and household size below average. The concentration of cancer incidence has been to the detriment of the provinces that have a slightly better ranking in terms of the socio-economic index. The employment rate did not significantly affect cancer's distribution burden. We recommend policymakers facilitate early cancer detection by providing insurance coverage for screening services, payment exemptions, and public awareness.

An overview of Iran's actions in response to the COVID-19 pandemic and in building health system resilience.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. The considerable human, social, and economic impacts of COVID-19 have demonstrated a global lack of health system resilience, highlighting gaps in health system capacities due to fragmented approaches to health system financing, planning, and implementation. One of the key actions for ensuring equitable essential health services in all countries in normal situations as well as emergencies is through strengthening the primary healthcare (PHC) system. In the context of the unfolding pandemic, the Iranian Ministry of Health and Medical Education (MoHME) undertook a variety of strategic actions to ensure the sustainability of health services during the current health emergency and to promote health system resilience against future shocks. Right after the Alma-Ata declaration in 1978, MoHME pursued the PHC philosophy incorporating the principles within the WHO health system framework and its six building blocks. In response to the evolving pandemic, MoHME put in place several interventions to ensure the maintenance of essential health services in addition to the provision of response. Some interventions were new, informed by global experience with COVID-19, while others leveraged existing strengths within the existing health system. Those were taking a whole-of-government approach; leveraging the PHC capacity; supporting the workforce; strengthening preparedness and response; improving access to medicines, vaccines, and health products; and leveraging the health information system into the pandemic response. Health system strengthening that promotes resilience is imperative for governments as health systems are fundamental to sustainable socioeconomic development. In recognition of this, the WHO Eastern Mediterranean Regional Office (EMRO) has recently outlined regional priorities for advancing universal health coverage (UHC) and ensuring health security. Iran's approach both prior to and during the pandemic is strongly aligned with those regional priorities, which are "primary health care-oriented models; enhancing health workforce; promoting equity; enabling environment for research; improving access to countermeasures; and fostering health system resilience."

The health system barriers to a healthy diet in Iran.

Decreasing calories, salt, sugar and fat intake is considered the golden solution to reduce obesity and cardiovascular diseases (CVDs) related to unhealthy diet. This study aimed to investigate the health system induced barriers to a healthy diet in Iran. This is a qualitative health policy analysis. We collected data through 30 semi-structured, face-to-face interviews with purposefully identified experts, including policy-makers, top-level managers and related stakeholders. All interviews were transcribed verbatim, and analyzed with qualitative content analysis, facilitated by MAXQDA 11 software. We identified six categories of barriers: structural problems within the Ministry of Health and Medical Education (MoHME), i.e. Supreme Council of Health and Food Security (SCHFS); the MoHME's inadequate stewardship of public health, the short life of the deputy of social affairs within the MoHME and its possible impact on the National Health Assembly; inefficient traffic lights labelling for foods; lack of adequate policies and guidelines for monitoring restaurants and fast foods and insufficient incentive policies for the food industry. In line with the World Health Organization (WHO) Global Action Plan, in 2015, Iran defined its roadmap for prevention and control of NCDs, i.e. some nutritional interventions. However, different stakeholders including MoHME and other sectors need to provide series of interventions to change people's approach about food choice so that they might reduce the consumption of foods with excessive salt, fat and sugar.

National Plan for Chronic Respiratory Diseases Prevention and Control in Iran.

Lower respiratory tract infections, chronic obstructive pulmonary disease (COPD), tuberculosis, and lung cancer are among the leading 10 causes of death worldwide. The Board of Respiratory Diseases Research Network (RDRN), a sub-committee of the Iranian Non-Communicable Diseases Committee (INCDC) is particularly concerned that there should be a coordinated National strategy to address the burden caused by chronic respiratory diseases. Iranian Ministry of Health and Medical Education (MoHME) has decided to give promotion to the establishment of research networks and use them as the milestones for research management, particularly for the national health priorities. National Service Framework (NSF), which was designed for Chronic Respiratory Diseases, is one of the main outcomes of the chronic respiratory diseases sub-committee of INCDC. The main seven strategies were represented by the Steering Committee in 2010 for a period of 10 years. Successful development and implementation of our goals provide the CRDs sub-committee of INCDC with the opportunity to develop a paradigm to prevent chronic respiratory diseases. A stronger national plan for controlling chronic respiratory diseases will ensure stronger advocacy to support respiratory health at national, sub-national, and regional levels.

Impact of operational planning implementation on performance of Iranian medical sciences universities

ABSTRACT Objectives In 2015, the Iranian Ministry of Health and Medical Education (MoHME) developed and introduced an operational plan (OP) mandatory for implementation for all medical sciences universities. Through this program, a set of indicators were defined for the annual assessment of the universities’ performance. This study examined the effect of OP implementation on universities’ performance and the healthcare system. Methods We compared seven key performance indicators before and after OP implementation related to public health, education, research, nursing, treatment, food and drug and student affairs. Descriptive statistics, paired t-tests and Wilcoxon tests were used for data analyses using SPSS 26. Results Of 32 studied indicators, ten indicators were not affected by the OP. Of 22 indicators, including public health (7 indicators), education (2 indicators), research (2 indicators), nursing (5 indicators), treatment (1 indicator), food and drugs (4 indicators), and student (1 indicator) that changed, 17 have improved. Conclusion OP implementation reached some of its intended goals. The existing OP program process should be replaced with evidence-informed health policies and programs to achieve significant changes in health system functioning and overall public health.

Establishing the Mortality Rate of under Five-Year-Old Children by Capture-Recapture Method

Background. Under count is a common phenomenon in health systems. One of the methods used for sensitivity identification of care system or identification of cases in registry is capture recapture method. Using two resources, this study aimed to estimate the actual mortality rates of under five-year-old children. Methods. This study was conducted by capture-recapture method (two resources), using the recorded data in death cause systems of the Iranian Ministry of Health and Medical Education (MOHME) and Treatment and Registry Office. The population included all children aged five years in Tabriz, Iran. We also considered all the death cases in the target population from 2020.03.20 to 2021.03.20. The death cases were extracted from two resources and entered into the Microsoft Excel software. After removing duplicate cases with a special formula, we obtained the actual mortality rates using capture-recapture method with 95% confidence interval (CI) and estimated the actual mortality rates and death cases. Results. In 2020, the death rate of under five-year-old children was calculated to be 344 cases (338 to 350 with 95% CI). The sensitivity rate of causal registry system for all death cases in the target population was 43.17%. Also, the mortality rate of under one-year-old children was calculated as 275 cases (271 to 280 with 95% CI). While the sensitivity rate of causal death for the mortality of under one-year-old children was 92.72%, it was 82.28% for the Registry Office. Conclusion. A combination of different software for death information registry and the registration of information in the occurrence location could be efficient techniques to reduce under count registrations. It is believed that better and more reliable information could be obtained on death case numbers through using two lists and capture-recapture method compared to using one of the two resources.