Reform In Iran Research Articles

Assessing urban family physician program challenges in Iran: the insurance organizations’ perspective(2021)

BackgroundThe Family Physician Programme is a key health reform in Iran that faces significant challenges in urban areas, particularly in Mazandaran and Fars provinces The study aims to critically evaluate the challenges encountered in the Urban Family Physician Program, with a particular focus on the perspectives of insurance organizations.MethodsA qualitative approach was adopted, involving semi-structured interviews with 22 experts and managers from basic health insurance funds. Snowball sampling facilitated participant selection, and interviews proceeded until saturation. Data analysis utilized content analysis and Atlas-T software, adhering to COREQ criteria.ResultsImplementation problems of the urban family physician program were categorized into ten Categories and 22 Subcategories, including financing, stewardship, human resources, structure, culture, information system, payment, monitoring and control, the function of insurance organizations, and implementation.ConclusionThe urban family physician program’s implementation challenges, as viewed by health insurance organizations, underscore the necessity for strategic decision-making in financing, payment models, electronic system integration, structural adjustments, comprehensive monitoring, evaluation, cultural considerations, and appropriate devolution to insurance entities.

Muhammad Khatami’s Reforms in Iran from the Perspective of Transitology and the Outlook for Democratic Change

On May 23, 1997, a victory of Muhammad Khatami in the presidential election in the Islamic Republic of Iran started a brief period of liberalization in the country long mired in a repressive and authoritarian political regime. The new government loosened the restrictions imposed on the public space, widened the scope of some civil liberties and under the slogans of “religious democracy”, “rule of law” and “participation” aroused expectations of a further political change. Nevertheless these expectations were futile and the widely popular reform movement was stifled by a repression on the part of the conservative core of the regime. This study attempts to analyze these events as a failed attempt to democratic transition, leaning on the theory of Guillermo O’Donnell and Philipe Schmitter. It demonstrates that the transitive period under Khatami’s presidency followed the typical path of the disintegration of the post-World War II authoritarian regimes, which usually begins by the split within the governing elite of the régime itself and proceed through gradual and contingent introduction of liberalizing and democratizing reforms by its “soft-liner”. On this basis it attempts to capture the overall dynamic of the transitive process, define its turning points, identify the causes of its ultimate successful obstruction by the “hard-line” conservatives and derive from this experience implications for a possibility of democratic change in future.

Analysis of energy policy reform in Iran: Energy and emission intensity changes

The Subsidized energy system of Iran, with its high financial burden, failed to achieve its intended economic goals, resulting in increased energy consumption and pollutant emissions. Energy product subsidies in Iran are among the highest in the world and have important implications for developing countries. This study examines the impact of subsidy removal policy on energy and emission intensities using a Dynamic Computable General Equilibrium model. The findings reveal that after subsidy removal, total output experiences an annual growth of around 1.5%, with output composition changes mainly favoring agriculture and services that are less energy dependent. However, prices soar by at least 10% owing to the higher costs of energy products. The decreasing trend in energy intensity after subsidy reform is accompanied by a decrease in emission intensity. Higher prices of energy after subsidy removal and the corresponding improvement in the efficiency of energy consumption lead to lower emission intensity.

Job adjustment predictive factors of healthcare midwives in health system reform in Iran

BackgroundPossessing sensitive and multiple responsibilities in the country's health system, particularly after the implementation of the health reform in Iran, midwives must be able to optimally perform their duties in their new job as healthcare providers. This study aimed to identify the factors that predict job adjustment for Iranian midwives working in healthcare.MethodsIn this cross-sectional study, 310 midwives were recruited from 209 health centers in the Iranian province of West Azerbaijan using the census method and asked to complete research questionnaires. Data were collected using job adjustment, job satisfaction, and organizational commitment scales. SPSS version 25 was used to perform ANOVA and calculate multiple linear regression coefficients for data analysis. In addition, the AMOS software was employed for path analysis and the identification of predictive variables.ResultsThe mean age of the participants was 37.67 ± 7.1 years. Most participants (35.5%) were interested in their occupation as a midwife, and 27.1% were very interest. They had a moderate to strong tendency (76.1%) to remain in their new profession. In addition, 58.1% of participants experienced moderate job adjustment. For healthcare midwives, "desire to remain in the midwifery profession" and "organizational commitment" were significant predictors of job adjustment. "Desire to remain in the midwifery profession" directly affected midwives' job adjustment, while "interest in the new profession" had an indirect effect. Furthermore, "adequacy of income to expenses," "job satisfaction," and "organizational commitment" through the mediating role of "desire to remain in the profession" can, directly and indirectly, influence their job adjustment.ConclusionTo better prepare midwives for their role as healthcare providers, organizational managers should focus their efforts and plan primarily on providing incentives to increase the longevity of staying in the profession of midwifery increase job adjustment, job satisfaction, and organizational commitment, thereby improving the quality-of-service delivery.

The dynamic of discriminatory reform: how does discretionary pricing neutralize the productivity gains of energy subsidy reform in Iran?

ABSTRACT A distortion caused by previous policies could distort the results of reforms. This may explain why policies to reduce industrial fuel subsidies have not necessarily resulted in increases in aggregate productivity in countries with mandated pricing. To identify and measure these distortions’ effects, we estimate a structural dynamic firm model with endogenous technology adaptation using data from the manufacturing firms in Iran. By connecting two price distortions and their results on the real sector, results suggest significant room for a distributional policy. We estimated dispersion elasticity comparable to the price elasticity of energy consumption in the manufacturing sector. Results suggest that the intensive margin is the primary driver of energy price elasticity, whereas the other channels mostly offset it. Moreover, total factor productivity slightly improves in light of a reduction in energy consumption if, at the same time, the redistribution policy boosts the aggregate demands.

Analysis of Compatibility between the Need and Utilization of Health Services in West of Iran: Panel of Two Cross-Sectional Studies

Background: Individuals with the same needs are eligible to use required healthcare services, which is rarely taken into account in health systems. The present research evaluated this issue by investigating the determinants of the need for outpatient healthcare services and subsequent utilization in Kermanshah, western Iran.
 Methods: This was a before-after cross-sectional study which used two utilization surveys before (2006) and after (2015) the Health Transformation Plan (HTP) in Iran. The surveys were performed in a multi-stage sampling manner, and the data were obtained through face-to-face interviews with household members. 2626 (before) and 2089 (after) subjects who were ≤15 years old completed the surveys before and after the HTP, respectively, and were included in the analysis. The logistic regression was used to analyze the determinants of the needs and utilization of outpatient healthcare services.
 Results: The need for outpatient healthcare services increased from 19.73% before the HTP to 27.09% after it. The utilization of such services in this period also increased from 44.78% to 57.95%. The logistic regression analysis showed that most factors caused an inverse relationship between the studied outcomes before and after HTP, except for supplementary insurance, which increased both the need for outpatient services and subsequent use.
 Conclusion: Despite the increased utilization of outpatient services, it seems that some groups still have insufficient access to required healthcare services. Future healthcare reform in Iran must provide enough healthcare services to vulnerable groups.

Healthcare reform and productivity of Hospital: a DEA-based analysis from South West of Iran

BackgroundDifferent healthcare reforms could affect the productivity of hospitals. The aim of this study was to track hospital productivity before and after the recent Iranian healthcare reform in Khuzestan province, South West of Iran.MethodsHospital productivity was evaluated through data envelopment analysis (DEA) and Malmquist productivity index (MPI) from 2011 to 2015 for 17 Iranian public hospitals before and after the health sector transformation plan. We assumed an output-oriented model with variable returns to scale (VRS) to estimate the productivity and efficiency of each hospital. The DEAP V.2.1 software was used for data analysis.ResultsAfter the transformation plan, the averages of technical efficiency, managerial efficiency and scale efficiency in the studied hospitals had negative changes, but technology efficiency had positive changes.44.4% of general hospitals, 25% of multi-specialized hospitals, and 100% of specialized hospitals had positive productivity changes after implementing the health sector evolution plan. The Malmquist productivity index (MPI) had low positive changes from 2013 to 2016 (MPI = 0.13 out of 1) but the mean productivity score had no change after the health sector evolution plan.ConclusionsThe total productivity before and after the health sector evolution plan had no change in Khuzestan province. This and the increase in the utilization of impatient services seemed to be a sign of good performance. But apart from technology efficiency, other efficiency indices had negative changes. It is suggested that in health reforms in Iran, more attention should be paid to the allocation of resources in the hospital.

Near Two Decades of the Family Physician Program in Iran and the Structural Challenges: A Systematic Review

The family physician program (FPP) is one of the most significant health care reforms in Iran; however, many studies showed that this program has not been able to achieve its intended objectives because of a variety of challenges. This program, despite the existing challenges, is going to be expanded across the country. To improve the likelihood of its success, identification of the structural and infrastructural challenges is necessary. This systematic review was conducted to assess the structural and infrastructural challenges of FPP in Iran. This systematic review of the literature was conducted in order to investigate the infrastructure and structure needs of the current program in Iran. All published articles related to the FPP in Iran were the subject of this study. The eligibility criteria included original articles, reviews, or case studies published in English or Persian during 2011–2021 related to the challenges in the referral system of FPP in Iran. Data were extracted based on Sample, Phenomenon of Interest, Design, Evaluation, Research type technique and were reported based on the structure of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. International credible scholarly databases were searched. The search strategy was defined based on keywords and the search syntax. This study identified different challenges of the referral system in the areas associated with legal structure, administration, and social structure. The identified challenges in this program should be addressed in order to ensure that this program will lead to improved quality of care and equity in Iran health care system.

A Comparative Study on the Components of the Revised M.A. English Translation Curriculum in Asian Universities

The current master’s curriculum in English Translation major in Iranian universities has not satisfied the demands of the society in which it was developed. Translation students have complained that some essential skills are not considered in the curriculum. Therefore, this study is aimed at proposing some guidelines for curriculum reformers in Iran to update the curriculum. To investigate effective components for updating the curriculum, it is necessary to focus on the curricula of other universities in foreign countries and compare them with that of Iran. For this aim, a qualitative-comparative analysis is used to compare the revised master’s curriculum of English Translation in Iran with seven prominent Asian universities, to investigate the strength and weaknesses of the curriculum in Iran, and to recognize the effective components included in the curriculum of those seven prominent universities to be recommended to update the curriculum of Iranian universities. Hence, the curricula of eight universities have been compared with five criteria, including the title of the Master’s degree, the number of credits, the course structure, the instructional objectives, and the course content. Results show that to update the curriculum of Iranian universities, a list of courses and instructional objectives needs to be added to train translators who can work with technological tools. To achieve this objective, a course named “co-translator software” should be added to the curriculum. The other objective is to improve students’ interpretation skills, which are accessible by adding a course in interpretation. The findings provide novel information for Iranian curriculum reformers to work on updating the curriculum.

Reforming Islamic Education in Iran: Creating An Emancipated and Creative Generation

This research focuses on the theme of Islamic education reform in Iran, which aims to produce an emancipated and creative generation. The Islamic Republic of Iran has implemented a series of education reforms that prioritize the development of technical and vocational skills, entrepreneurship, interpersonal skills, and the cultivation of students' character and morality. The goal of these programs is to prepare students to face the challenges of the global job market and to advance the Iranian economy. Moreover, the Iranian government has introduced a series of initiatives to promote critical thinking and creativity in its education system. For instance, it has integrated modern technology into its educational system, established research centers and incubators, and encouraged student participation in extracurricular activities. As a result of these reforms, many Iranian students have emerged as successful graduates in various fields, including technology, science, business, and arts. Therefore, this abstract concludes that the Islamic education reform in Iran has been successful in creating a generation of students who are equipped with the skills and knowledge necessary to compete in the global job market and contribute to the advancement of their country's economy. Furthermore, it has also fostered a culture of critical thinking, creativity, and innovation among students, which will be critical to the country's continued progress in the future.

Cash instead of subsidy: Assessing the impact of the iranian energy subsidy reform on households

The 2010 energy subsidy reform in Iran is a unique case of redistributive policy as the savings from the subsidy cut have been redirected to households as unconditional, universal cash transfer. While theoretically, the cash transfer was large enough to keep the utility of the average household at the initial level, this study explores the practical impacts of the reform. We analyze panel data on income/expenditure of Iranian households for the period 2010–2012. Since this is a universal reform, we exploit the time dimension and the intensity of energy consumption in the identification and assess the robustness of the results with sub-sample and placebo analyses. Overall, the energy subsidy reform caused a significant shrinkage (7%–9%) in households' real consumption. The cash transfer failed to fully compensate the negative impact of the subsidy removal. The impact is heterogeneous, varying along the intensity of energy consumption, geographical location, income and the share of the cash transfer in a household's income. A non-negligible policy accomplishment of the reform is that within its first two years poverty was mitigated in absolute and relative terms and income inequality slightly improved. Nevertheless, the government is under pressure because inflation counteracts these gains.

KAŞKAY TÜRKÇESİ SÖZ VARLIĞINDA HAYVANCILIKLA İLGİLİ KELİMELER

Linguistic data are the most source to make inferences about the culture, history, lifestyle and national identity of a society. Based on these linguistic data, it is known that the Old Turks had a nomadic lifestyle and thus a nomadic culture. Animals carry great importance for nomadic cultures. Albeit the Old Turks’ adaptation of a settled life in the following centuries, animals continued to have an important place in their lives, similar to those in nomadic cultures. The Qashqai people part of the Oghuz Turkish branch, either led a semi-nomadic life in the South of Iran, around the Zagros Mountains, or settled down following some reforms in Iran. The main occupations of the Qashqais are animal husbandry and agriculture. Therefore, a close look at their vocabulary established that there are many words related to animals and husbandry. Based on field work, we compiled a database of these words. This paper provides information about the Qashqai Turk and then examines the nomenclature of words related to animals and husbandry used by the nomadic Qashqai Turks.

Dynamics of fuel demand elasticity: Evidence from Iranian subsidy reforms

We exploit three major transport fuel (gasoline and diesel) subsidy reforms in Iran, as quasi-experiments, to investigate the impact of permanent upward price changes on the responsiveness of fuel consumption. We employ monthly regional-level data of fuel consumption in Iran and also explicitly account for outbound cross-border smuggling from Iran to estimate the short, intermediate, and long-term price elasticity of demand. We find that price elasticity and price levels are inversely related to each other. All of our estimations also suggest a substantial impact of subsidy reforms on consumers’ behavior such that the magnitude of price elasticities consistently increases after each of the three major reforms. Finally, we find that fuel consumption is more responsive to a change in domestic price in the longer run. Our paper provides quantitative evidence of behavior change after a subsidy reform program, which can be used to better set fiscal and environmental targets.

The Effect of Iran's Health Transformation Plan on Job Involvement of the Clinical Faculty Members in Ahvaz Jundishapur University of Medical Sciences

Introduction: Given the role of job involvement in job satisfaction and improving the organizational performance of the staff, the present study was conducted to evaluate the effect of Iran's Health Transformation Plan (HTP) on job involvement of the clinical faculty members.
 Methods: This descriptive study was conducted in the academic year of 2018-2019 and in educational hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences in Iran, and finally, 90 clinical faculty members participated in this study by using a convenience sampling method. To collect data, a researcher-made questionnaire was based on the standard Lodahl and Kejner's job involvement questionnaire. The data were analyzed using descriptive statistics (mean, standard deviation, percentage), inferential statistics (independent t-test and analysis of variance), and SPSS22 software.
 Results: The results revealed that the level of Iran's Health Transformation Plan on job involvement of the clinical faculty members was moderate (48.73 ± 14.40).Variables such as gender, age, education, academic rank, employment history, and having a private clinic and hospital where faculty members work, did not have a significant effect on their job involvement.(P-value > 0.05)
 Conclusion: The HTP is currently one of the most important and costly health care reforms in Iran, and for better success and the staff's satisfaction, it is recommended to pay more attention to effective and influential factors in improving and increasing job involvement of service providers, especially clinical faculty members in their periodic evaluation.

State Fragility, Social Contracts and the Role of Social Protection: Perspectives from the Middle East and North Africa (MENA) Region

Social contracts and state fragility represent two sides of one coin. The former concept highlights that governments need to deliver three “Ps”—protection, provision, and political participation—to be acceptable for societies, whereas the latter argues that states can fail due to lack of authority (inhibiting protection), capacity (inhibiting provision), or legitimacy. Defunct social contracts often lead to popular unrest. Using empirical evidence from the Middle East and North Africa, we demonstrate how different notions of state fragility lead to different kinds of grievances and how they can be remedied by measures of social protection. Social protection is always a key element of government provision and hence a cornerstone of all social contracts. It can most easily counteract grievances that were triggered by decreasing provision (e.g., after subsidy reforms in Iran and Morocco) but also partially substitute for deficient protection (e.g., by the Palestinian National Authority, in pre-2011 Yemen) or participation (information campaign accompanying Moroccan subsidy cut; participatory set-ups for cash-for-work programmes in Jordan). It can even help maintain a minimum of state–society relations in states defunct in all three Ps (e.g., Yemen). Hence, social protection can be a powerful instrument to reduce state fragility and mend social contracts. Yet, to be effective, it needs to address grievances in an inclusive, rule-based, and non-discriminatory way. In addition, to gain legitimacy, governments should assume responsibility over social protection instead of outsourcing it to foreign donors.

Health Transformation Plan Achievements and Outcomes in Iran (2014-2020): A Scoping Review.

Background: The Health Transformation Plan (HTP), the latest reform in Iran's health system to achieve the 3 main goals of financial protection, equity, and quality of health care, was started on May 5, 2014. This study aimed to review all available literature regarding the achievements and outcomes of this reform after 6 years of its implementation. Methods: The 5 English databases were examined by using appropriate keywords to find documents published on the HTP between June 5, 2014, and the end of April 2020. Out of 532 recovered articles, 137 were included in the study. The study's organization was based on the Arkesy and O'Malley framework and data analysis was done using the content analysis method. Results: The findings of the study were divided into 11 sections. Studies on the plan's impact on financial protection (22.6%), performance indicators (14.5%), and natural delivery promotion (14.5%) were the most frequent, respectively. Regarding the impact of the HTP on patient satisfaction ,performance indicators, and efficiency, mostly positive results have been obtained. However, in terms of the impact of the HTP on financial protection and informal payments, the outcomes have been different, contradictory, and sometimes negative. Conclusion: Although the HTP has successfully achieved a number of its goals, in some of the goals, the results are not significant. Given the changing health conditions and funding constraints, it is better to consider measures to fundamentally review the HTP and executive packages.

Changing physicians’ incentives to control the C-section rate: Evidence from a major health care reform in Iran

We evaluate the effect of a major health care policy in public hospitals which changed the demand and supply side incentives for c-section procedures in 2014 in Iran, where the c-section rate at the time was 55%. Following the reform, vaginal delivery became free for patients. The policy also introduced financial incentives to doctors for performing vaginal deliveries and set a cap on their maximum c-section rate. We show that supply side incentives had a major role in the effectiveness of the programme, after which the national rate reduced by 6 percentage points. This reduction was mainly driven by first-birth mothers. The reform also shifted doctors with high c-section rates out of public hospitals. We cannot find any adverse effect on Apgar score, hospitalisation or mortality; however, gestation length and birth weight significantly increased.

‘Abbas Mirza, A Counternarrative

ABSTRACT For two centuries, the image of the Crown Prince ʽAbbas Mirza (1789–1833) has remained unblemished in Iranian history. He has been portrayed as perfect in character, progressive in advancing the cause of reform in Iran and bold in fighting the superpower of Russia. This paper offers a revisionist account by questioning this image and aims to portray ʽAbbas Mirza as someone who, operating during one of the most critical periods in Iranian history, was burdened by a long war, internal rivalries and the competition of foreign powers. The account written by a long-serving French officer, Louis Gaspard Barrachin, at the court of ʽAbbas Mirza during the interim years between the two wars with Russia, rejects the simplistic conventional narrative and presents a lonely figure with weaknesses and a complex real character. The paper also reveals the French officer’s main objective of attempting to find a firm foothold in Iran for France so as to advance French interests in the Middle East.

A scoping review of public hospitals autonomy in Iran: from budgetary hospitals to corporate hospitals

BackgroundOrganizational reforms of hospitals in Iran are mainly aimed at improving efficiency, reducing government spending on health care, and improving the quality of services. These reforms began with hospital autonomization and have continued with other initiatives such as formation of board of trustees, independent and corporatized hospitals.ObjectiveThe purpose of this scoping review was to summarize and compare the results of studies conducted on organizational reform of hospitals in Iran to paint a more clear picture of the status quo by identifying knowledge gaps, inform policymakers, and guide future studies and policies.MethodThis review’s methodology was inspired by Arksey and O’Malley’s methodological framework to examine the extent, range, and nature of research activity about organizational hospital reforms in Iran. A literature search was performed using PubMed, Scopus, Web of Science, and Google Scholar for English papers as well as SID, IranDoc, Magiran, and the Social Security Research Institute Database for Persian papers from 1991 to April 2020.ResultsTwenty studies were included in the review. Studies were grouped by the types of organizational reform, study’s objective, setting, methodology, data collection and analysis techniques, and key findings. Thematic construction was used based on the types of organizational reform to present a narrative account of existing literature.ConclusionsThe autonomy granted to the hospitals was unbalanced and paradoxical in terms of key effective dimensions. Poor governance and regulatory arrangements, low commitment to corporate governance, Inappropriate board composition, weak internal controls, unsustainable financing and inefficient payment mechanisms, poor interaction with stakeholders and ignoring contextual factors have been cited as the main reasons for the failure of organizational reforms in Iran. The limited use of evidence and research was obvious at different stages of policymaking, especially in the policy formulation phase and evaluation of its results.

An Explanation on Role of Educational System in Ali Shariati Books from the Perspective of Critical Theory: A Comparative Review

The aim of present study is to explain role of educational system in the books of famous Iranian writer and revolutionary Ali Shariati from the perspective of critical theory. The method of research was qualitatively comparative (deductive approach) and method of data collection and analysis was documentary and content analysis respectively. In order to collect data, in addition to Shariati’s books and lectures (primary sources), books and articles available in Iranian and international libraries and information homepages (secondary sources) were used. Findings showed that Shariati's thoughts on role of the education system have been greatly influenced by views of critical theory’s proponents. There are also similarities between Shariati's views and critical education thinkers on negative role of education system in exacerbating social injustice and inequality and promoting a culture of silence. In addition, the research findings showed few differences. Shariati's attention to Eastern education and Islamic education as an alternative to Western education, the disregard of critical education advocates for the liberating role of religion, and Shariati's low emphasis on role of race and gender in analyzing the performance of educational system can be the most important differences between Shariati and critical theory scholars. The last point is that although the Western countries influenced by theory of critical education were able to establish a critical atmosphere of criticism, questioning, and active dialogue in their schools, but the fulfillment of Shariati's aspirations to change the political system did not lead to a fundamental reform in Iran's education system and challenges such as a centralized structure, a prescriptive curriculum, a passive teacher-student relationship, and a lack of critical and questioning space still persist