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LANKARANI KAMRANBAGHERI, HONARVAR BEHNAM, SHAHABI SAEED, ZAREI FATEMEH, BEHZADIFAR MASOUD, HEDAYATI MARYAM, FARDID MOZHGAN, Rafiee FATEMEH, MARTINI MARIANO, NEJAD SOHEILARAFIEI. The challenges of urban family physician program over the past decade in Iran: a scoping review and qualitative study with policy-makers. J Prev Med Hyg 2023; 64:E232-E264. [PMID: 37654860 PMCID: PMC10468186 DOI: 10.15167/2421-4248/jpmh2023.64.2.3029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023]
Abstract
Introduction Despite all the advantages of urban family physician program (UFPP), there is still a gap between UFPP and what is actually achieved by the community after its implementation in Iran. In response, this study attempted to review published studies related to the barriers to the implementation of the UFPP in Iran as well as potential solutions to improve it. Further, a qualitative study was conducted to learn the perspectives of experts at the national level and in the Fars province in order to better understand the program's challenges. Methods This study was conducted in two phases. First, a scoping review was done, aiming to identify the common barriers and potential solutions to implementing UFPP in Iran. Second, a qualitative study using semi-structured interviews was conducted to investigate the views of decision- and policy-makers regarding barriers to and solutions for implementing the UFPP in the Fars province over the last decade. The findings were classified using the five control knobs framework (organization, financing, payment, regulation, and behavior). Results The most common barriers to UFPP were: 1) organization (ununited stewardship function of the Ministry of Health, weak management and planning, inadequate training of human resources, and a weak referral system); 2) financing (fragmented insurance funds, insufficient financial resources, and instability of financial resources); 3) payment (inappropriate payment mechanisms and delay in payments); 4) regulation (cumbersome laws and unclear laws); and 5) behavior (cultural problems and conflict of interests). On the other hand, several solutions were identified to improve the implementation of UFPP, including: enhancing the role of government; improving the referral system; providing comprehensive training for UFPP providers; considering sustainable financial resources; moving towards mixed-payment mechanisms; employing appropriate legal and regulatory frameworks; enhancing community awareness; and elevating incentive mechanisms. Conclusion Our research found that, despite the UFPP having been in place for a decade in Iran, there are still significant challenges in all five components. Therefore, the promotion of this program requires solving the existing implementation challenges in order to achieve the predetermined goals. The ideas in this study can be used to improve the current program in Fars Province and bring it to other cities in Iran.
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Affiliation(s)
- KAMRAN BAGHERI LANKARANI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - BEHNAM HONARVAR
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - SAEED SHAHABI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - FATEMEH ZAREI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - MARYAM HEDAYATI
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - FATEMEH Rafiee
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - SOHEILA RAFIEI NEJAD
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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DOSHMANGIR LEILA, BEHZADIFAR MEYSAM, SHAHVERDI ALI, MARTINI MARIANO, EHSANZADEH SEYEDJAFAR, AZARI SAMAD, BAKHTIARI AHAD, SHAHABI SAEED, BRAGAZZI NICOLALUIGI, BEHZADIFAR MASOUD. Analysis and evolution of health policies in Iran through policy triangle framework during the last thirty years: a systematic review of the historical period from 1994 to 2021. J Prev Med Hyg 2023; 64:E107-E117. [PMID: 37293450 PMCID: PMC10246607 DOI: 10.15167/2421-4248/jpmh2023.64.1.2878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/21/2023] [Indexed: 06/10/2023]
Abstract
Background Health policy analysis as a multi-disciplinary approach to public policy illustrates the need for interventions that highlight and address important policy issues, improve the policy formulation and implementation process and lead to better health outcomes. Various theories and frameworks have been contributed as the foundation for the analysis of policy in various studies. This study aimed to analyze health policies during the historical period of the almost last 30 years in Iran using policy triangle framework. Method To conduct the systematic review international databases (PubMed / Medline, Scopus, Web of Sciences, CINAHL, PsycINFO, Embase, the Cochran Library) and Iranian databases from January 1994 to January 2021 using relevant keywords. A thematic qualitative analysis approach was used for the synthesis and analysis of data. The Critical Appraisal Skills Programme for Qualitative Studies Checklist (CASP) was conducted. Results Out of 731 articles, 25 articles were selected and analyzed. Studies used health policy triangle framework to analyze policies in the Iranian health sector has been published since 2014. All the included studies were retrospective. The main focus of most of studies for the analysis was on the context and process of polices as the elements of the policy triangle. Conclusion The main focus of health policy analysis studies in Iran over the last thirty years was on the context and process of polices. Although range of actors within and outside the Iran government influence health policies but in many policy processes the power and the role of all actors or players involved in the policy are not recognized carefully. Also, Iran's health sector suffers from lack of a proper framework for evaluating various implemented policies.
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Affiliation(s)
- LEILA DOSHMANGIR
- Department of Health Policy & Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - MEYSAM BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - ALI SHAHVERDI
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - SEYED JAFAR EHSANZADEH
- Department of English Language, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - SAMAD AZARI
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
| | - AHAD BAKHTIARI
- Health Equity Research Center (HERC). Tehran University of Medical Sciences, Tehran, Iran
| | - SAEED SHAHABI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - NICOLA LUIGI BRAGAZZI
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
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BEHZADIFAR MEYSAM, AZARI SAMAD, SHIRKHANI SOMAYEH, GHOLAMREZAEI SHIRIN, SHAHABI SAEED, DOSHMANGIR LEILA, EHSANZADEH SEYEDJAFAR, MARTINI MARIANO, BRAGAZZI NICOLALUIGI, BEHZADIFAR MASOUD. Hepatitis B vaccination in Iran: Historical policies and programs. J Prev Med Hyg 2022; 63:E618-E624. [PMID: 36891002 PMCID: PMC9986976 DOI: 10.15167/2421-4248/jpmh2022.63.4.2731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/29/2022] [Indexed: 03/10/2023]
Abstract
Hepatitis B virus (HBV) infection is a main challenge of the health system worldwide. Health policymakers in most countries attempt to help HBV patients by implementing support programs in addition to controlling HBV in their community so that the economic burden caused by HBV do not deprive the patients of accessing health services and reducing their quality of life. There are several health interventions for the prevention and control of HBV. Providing the first dose of the HBV vaccine within 24 hours after the infant is born is the most cost-effective way to prevent and control HBV. The purpose of this study is to review the nature of HBV, its epidemiology in Iran and worldwide, and to review the various policies and programs in Iran regarding the prevention and control of HBV, especially the use of vaccination. One of the goals of Sustainable Development Goals (SDGs) is to consider hepatitis as a threat to human health. In this regard, one of the top priorities of WHO is the prevention and control of HBV. In connection with the prevention of HBV, it is claimed that vaccination is the most effective and best intervention. Thus, vaccination in the safe's program of countries is highly recommended. According to the Ministry of Health and Medical Education (MOHME) reports, Iran has the lowest prevalence of HBV among the countries in Eastern Mediterranean Region Organization (EMRO). There is a hepatitis unit in MOHME whose responsibility is to coordinate and implement the hepatitis prevention and control programs. The HBV vaccine has been officially included in the vaccination program for children in Iran since 1993, and three doses of the vaccine are given to all infants. In 2007, during a large-scale program in Iran, 17-year-olds received the HBV vaccine, followed by adolescents born in 1990 and 1991. In recent years, the health system in Iran has made significant progress in preventing and controlling HBV. Over 95% coverage of the HBV vaccination is one of the achievements that have had a great impact on reducing the trend of HBV infection. In order to achieve the 2030 goals, the Iranian government, in addition to paying more attention to HBV elimination programs, should encourage other organizations to cooperate more effectively with MOHME.
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Affiliation(s)
- MEYSAM BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - SAMAD AZARI
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - SOMAYEH SHIRKHANI
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - SHIRIN GHOLAMREZAEI
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - SAEED SHAHABI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - LEILA DOSHMANGIR
- Tabriz Health Services Management Research Center, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - SEYED JAFAR EHSANZADEH
- English Language Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - NICOLA LUIGI BRAGAZZI
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
- Correspondence: Masoud Behzadifar, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran. Lorestan University of Medical Sciences, Anooshirvan Rezaei Square, Khorramabad, Lorestan, Iran. Tel.: +98-066-33302033 - E-mail: ;
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BEHZADIFAR MASOUD, GHANBARI MAHBOUBEHKHATON, RAVAGHI HAMID, BAKHTIARI AHAD, SHAHABI SAEED, DOSHMANGIR LEILA, ALIDOOST SAEIDE, AZARI SAMAD, MARTINI MARIANO, EHSANZADEH SEYEDJAFAR, BRAGAZZI NICOLALUIGI. Health policy analysis in Eastern Mediterranean region using a health policy triangle framework: Historical and ethical insights from a systematic review. J Prev Med Hyg 2022; 63:E351-E373. [PMID: 35968073 PMCID: PMC9351417 DOI: 10.15167/2421-4248/jpmh2022.63.2.2450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/07/2022] [Indexed: 11/16/2022]
Abstract
Background Health policy can be defined as an agreement and consensus on a health-related program and set of actions taken to achieve the goals expected by programs in the area of policy. Policy analysis involves a wide range of methods, techniques, and tools in a way to reach awareness of the impacts of the developed and implemented policies. Whereas policy analysis in developed countries has a long history, in developing countries, it is instead in its first developing stages. Our paper aimed to collect systematically the studies using health policy triangle framework in doing analysis in one of the health policy issues in the Eastern Mediterranean region organization. Methods To conduct our literature search, ISI/Web of Science, PubMed/MEDLINE, Embase, The Cochrane Library, Global Health Database, Scopus, as well as Google Scholar from 2003 up to June 2020 were systematically mined. To evaluate the methodological quality of the included studies, the Critical Appraisal Skills Program checklist was used. Results We selected 30 studies, conducted between 2011 and 2020. According to the findings of these studies, in the Eastern Mediterranean region, organization region, and the role of evidence-based research in policy-making has been repeatedly emphasized, but its use in health program decision-making has been limited, and health research systems in Eastern Mediterranean region organization are still under scrutiny. There is still a gap between evidence-based research in health systems and its use in policy-making. Discussion Based on the present systematic review, studies based on policy analysis should focus on all the elements of health policies and provide evidence to inform decisions that can strengthen health systems, improve health and improve existing inequalities.
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Affiliation(s)
- MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | - HAMID RAVAGHI
- School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
- Correspondence: Hamid Ravaghi, School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran. E-mail: ;
| | - AHAD BAKHTIARI
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - SAEED SHAHABI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - LEILA DOSHMANGIR
- Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - SAEIDE ALIDOOST
- School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - SAMAD AZARI
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - SEYED JAFAR EHSANZADEH
- English Language Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - NICOLA LUIGI BRAGAZZI
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
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BEHZADIFAR MASOUD, SHAHABI SAEED, ZEINALI MOHAMMAD, GHANBARI MAHBOUBEHKHATON, MARTINI MARIANO, BRAGAZZI NICOLALUIGI. A policy analysis of agenda-setting of Brucellosis in Iran using a multiple-stream framework: health policy and historical implications. J Prev Med Hyg 2021; 62:E544-E551. [PMID: 34604598 PMCID: PMC8451350 DOI: 10.15167/2421-4248/jpmh2021.62.2.2041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022]
Abstract
Background Brucellosis, a major zoonotic disease, is highly present in Iran, especially in Lorestan province. The aim of this study was to understand the issues related to Brucellosis utilizing the multiple streams framework. Methods A two-step method was adopted: 1) assessment of brucellosis-related documents and 2) interviews with stakeholders. As a first step, all documents related to Brucellosis were reviewed at provincial and national levels. Policy documentation on health issues included the consultation of guidelines, rules and regulations, websites, reports, books, guides, and conferences. These documents were collected by referring to specialized centers, institutions, and organizations. In the second step, semi-structured interviews were conducted to determine the burden of disease with actors and stakeholders involved with the brucellosis program in the Lorestan province. More in detail, physicians, healthcare workers, managers, policy- and decision-makers were selected for interviews. Results The problem stream was characterized by: 1) high prevalence of the disease, 2) traditional livestock production, 3) unsafe animal slaughtering, 4) centers for the sale and distribution of non-authorized dairy products, 5) raw milk and 6) traditional unsafe dairy products consumption, 7) incomplete livestock vaccination, 8) lack of knowledge of Brucellosis, 9) neighboring countries with high prevalence of Brucellosis, 10) lack of livestock quarantine, and 10) nomadic immigration. The policy stream was characterized by 1) primary healthcare networks, 2) guidelines, 3) medicines, insurance, and 4) diagnostic services. Finally, the political stream was characterized by: 1) support of the University of Medical Sciences, 2) sponsorship by the Ministry of Health and Medical Education, 3) Health transformation plan, and 4) Working Group on Health and Food Security in Lorestan. Conclusion This study examined the brucellosis-related agenda setting: if different issues are taken into consideration, it can be perceived as a health priority.
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Affiliation(s)
- MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
- Correspondence: Masoud Behzadifar, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran - E-mail: /
| | - SAEED SHAHABI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - MOHAMMAD ZEINALI
- Zoonoses Control Unit, Center of Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - MAHBOUBEH KHATON GHANBARI
- Zoonoses Control Unit, Center of Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - MARIANO MARTINI
- Department of Health Sciences, Section of Medical History and Ethics, University of Genoa, Italy
| | - NICOLA LUIGI BRAGAZZI
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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SHAHABI SAEED, MARTINI MARIANO, BEHZADIFAR MASOUD, KALATEH SADATI AHMAD, ZAREI LEILA, NOROOZI MASOOME, TABRIZI REZA, HEYDARI SEYEDTAGHI, BAGHERI LANKARANI KAMRAN. How Iranian people perceived the COVID-19 crisis? Explored findings from a qualitative study: current concerns, ethics and global solidarity. J Prev Med Hyg 2021; 62:E53-E60. [PMID: 34622085 PMCID: PMC8452290 DOI: 10.15167/2421-4248/jpmh2021.62.1s3.2117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022]
Abstract
Objectives This nation-wide project aimed to investigate the common perceptions and concerns regarding COVID-19 outbreak in Iran. Methods This qualitative study was conducted in Iran from February to March 2020 via an online open-ended questionnaire. The participants were also selected using convenience and snowball sampling methods. As well, the data collection process continued until data saturation was achieved. Thematic content analysis was utilized to analysis the transcribed texts. Results The statements retrieved also represented the most challenging psychological stress experienced by the participants. Four themes were accordingly recognized based on the content analysis including stressful conditions, health concerns, social and political concerns, and economic concerns. Throughout the study, a major proportion of the participants commented that psychological disorders such as fear, anxiety, stress, and ennui were their main challenges regarding this pandemic. Furthermore, lack of social responsibility, worries about high-risk and susceptible groups, decreased economic power of the public, financial hardships for low-income groups, shortage of healthcare facilities, and adverse effects of disinfectants were expressed as the main concerns. Conclusions As a whole, it is evident that people have confronted with several challenges and need help together with effective policies and strategies during and after COVID-19 pandemic to reduce their current concerns. The study findings provided a favorable ground to develop and adopt the required policies in Iran and other countries. It was concluded that creating local, national, and global solidarity in such outbreaks is an inevitable necessity.
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Affiliation(s)
- SAEED SHAHABI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - MARIANO MARTINI
- Section of History of Medicine and Ethics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | - LEILA ZAREI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | | | - REZA TABRIZI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - SEYED TAGHI HEYDARI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
- Correspondence: Seyed Taghi Heydari, Health Policy Research Center, Building No. 2, 8th Floor School of Medicine Zand Avenue, Shiraz, Iran- Tel.: +989173034420 - Fax: +98-711-2309615 - E-mail:
| | - KAMRAN BAGHERI LANKARANI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
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GHANBARI MAHBOUBEHKHATON, BEHZADIFAR MASOUD, BAKHTIARI AHAD, BEHZADIFAR MEYSAM, AZARI SAMAD, ABOLGHASEM GORJI HASAN, SHAHABI SAEED, MARTINI MARIANO, BRAGAZZI NICOLALUIGI. Assessing Iran's health system according to the COVID-19 strategic preparedness and response plan of the World Health Organization: health policy and historical implications. J Prev Med Hyg 2021; 61:E508-E519. [PMID: 33628954 PMCID: PMC7888405 DOI: 10.15167/2421-4248/jpmh2020.61.4.1613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/30/2020] [Indexed: 01/10/2023]
Abstract
Background The role of health systems in the management of disasters, including natural hazards like outbreaks and pandemics, is crucial and vital. Healthcare systems which are unprepared to properly deal with crises are much more likely to expose their public health workers and health personnel to harm and will not be able to deliver healthcare provisions in critical situations. This can lead to a drammatic toll of deaths, even in developed countries. The possible occurrence of global crises has prompted the World Health Organization (WHO) to devise instruments, guidelines and tools to assess the capacity of countries to deal with disasters. Iran's health system has been hit hardly by the COVID-19 pandemic. In this study, we aimed to assess its preparedness and response to the outbreak. Methods The present investigation was designed as a qualitative study. We utilized the "COVID-19 Strategic Preparedness and Response Plan" devised by WHO as a conceptual framework. Results The dimension/pillar which scored the highest was national laboratories, followed by surveillance, rapid response teams and case investigations. Risk communication and community engagement was another pillar receiving a high score, followed by infection prevention and control and by country-level coordination, planning and monitoring. The pillars/dimensions receiving the lowest scores were operational support and logistics; case management; and points of entry. Discussion The COVID-19 pandemic has represented an unprecedent event that has challenged healthcare systems and facilities worldwide, highlighting their weaknesses and the need for inter-sectoral cooperation and collaboration during the crisis. Analyzing these experiences and capitalizing on them, by strengthening them,will help countries to be more prepared to face possible future crises.
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Affiliation(s)
- MAHBOUBEH KHATON GHANBARI
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Zoonoses Control Unit, Center of Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - AHAD BAKHTIARI
- National Center for Health Insurance Research, Iran Health Insurance Organization, Tehran, Iran
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Correspondence: Ahad Bakhtiari, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran - E-mail:
| | - MEYSAM BEHZADIFAR
- Department of Epidemiology and Biostatistics, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - SAMAD AZARI
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - HASAN ABOLGHASEM GORJI
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - SAEED SHAHABI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - NICOLA LUIGI BRAGAZZI
- Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Italy
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
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