Sustainable political commitment is necessary for institutionalizing community participation in health policy-making: Insights from Iran.

BACKGROUND: Community participation is currently utilized as a national strategy to promote public health and mitigate health inequalities across the world. While community participation is acknowledged as a civic right in the Constitution of Iran and other related upstream documents, the government has typically failed in translating, integrating and implementing community participation in health system policy. The present study was conducted to determine the level of public voice consideration within the health policy in Iran and address fundamental interventions required to promote the public voice in the context of Islamic Republic of Iran (IRI). This study has originality because there is no study that addresses the requirements of institutionalizing community participation especially in low-middle-income countries, so Iran's experience can be useful for other countries. METHODS: Methodologically, this study utilized a multi-method and multi-strand sequential research design, including qualitative, comparative and documentary studies. In the first phase, the current level of community participation in the health policy cycle of Iran was identified using the International Association for Public Participation (IAP2) spectrum. In the second phase, a comparative study was designed to identify relevant interventions to promote the community participation level in the selected countries under study. In the third phase, a qualitative study was conducted to address the barriers, facilitators and strategies for improving the level of public participation. Accordingly, appropriate interventions and policy options were recommended. Interventions were reviewed in a policy dialogue with policy-makers and community representatives, and their effectiveness, applicability and practical feasibility were evaluated. RESULTS: Based on the IAP2 spectrum, the level of community participation in the health policy-making process is non-participation, while empowerment is set at the highest level in the upstream documents. Moreover, capacity-building, demand, mobilization of the local population, provision of resources and setting a specific structure were found to be among the key interventions to improve the level of community participation in Iran's health sector. More importantly, "political will for action" was identified as the driving force for implementing the necessary health interventions. CONCLUSIONS: To sum up, a paradigm shift in the governing social, economic and political philosophy; establishing a real-world and moral dialogue and communication between the government and the society; identifying and managing the conflicts of interest in the leading stockholders of the healthcare system; and, more importantly, maintaining a stable political will for action are integral to promote and institutionalize participatory governance in the health sector of Iran. All of the above will lead us to scheme, implement and institutionalize suitable interventions for participatory governance in health and medicine.

Barriers and Facilitators to Participatory Governance in Iran Health Policymaking: A Qualitative Study.

Background: Community participation has been accepted as a promising approach to promoting health and health equality. Based on Iran's constitution and the general health policies, community participation in health is addressed as a right, and during recent decades, some measures have been put in place. However, it is critical to improve public participation in Iran's health system and institutionalize community participation in health policymaking. This study aimed to identify barriers and facilities affecting public participation in Iran's health policymaking. Methods: Semi-structured qualitative interviews with health policymakers, health managers and planners, and other stakeholders were conducted to collect data. The conventional content analysis approach was used to analyze the data. Results: Two themes-including community level and government level-and 10 categories were identified through the qualitative analysis. Cultural and motivational factors, lack of awareness of the right to participate, and lack of sufficient knowledge and skills are among the identified barriers in the process of establishing effective interaction. From the health governance perspective, a lack of political will is identified as one of the obstacles. Conclusion: A culture of community involvement and political will are pivotal in the sustainability of community participation in health policymaking. The provision of a suitable context for participatory processes and capacity building on the community and government levels can be useful in institutionalizing community participation in the health system.

Designing a toolkit for the assessment of Health in All Policies at a national scale in Iran.

Background: Equitable promotion of health indicators requires cooperation among different sectors more than ever. The "Health in All Policies" (HiAP) approach contributes to this process through strengthening intersectoral collaboration. To implement this approach at a national scale, indicators of health-oriented performance from various organizations, and their measurement methods, need to be precisely defined. The aim of present study was to design a toolkit for implementing HiAP in Iran. Methods: A review of literature and documents, as well as conducting semi-structured interviews and focus group discussions were undertaken to collect data for this qualitative study. Content analysis was applied to the collected data and the results were placed in three categories: criteria, sub-criteria and indicators; implementation processes; and implementation requirements. Results: The toolkit aims to achieve various objectives, including intersectoral excellence and the systematic development of intersectoral collaboration. In the process section, reports on measures taken by organizations are assessed by a three-member audit committee. The top three organizations, in terms of intersectoral cooperation in achieving public health goals, are introduced in a Health Week. Requirements for success in achieving the HiAP approach include financial resources to implement the HiAP, a database, an electronic method for submitting reports, training courses, monitoring and annual reporting of relevant indicators, and formulating regulations in order to assess organizations. Conclusion: Justification and training in various organizations to support the implementation of health-oriented measures, providing an annual ranking of organizations, and encouraging the organizations can contribute to the institutionalization of the toolkit through the SupremeCouncil for Health and Food Security. It is recommended that a Secretariat of sustainable development to be established under the Plan and Budget Organization (PBO) of the Islamic republic of Iran to monitor portfolio indicators.

The Association Between Management of the Board of Trustees and Its Effectiveness at Hospitals in Tabriz; 2011 to 2013.

BACKGROUND: Reforming the structure and improving care and service system, particularly at hospitals, are the main priorities of the health system. The board of trustees of the hospitals is the main proposed strategy in this field. Hospitals with board of trustees were created with the aim of improving accountability to the community and guaranteeing efficient management and attracting public support in running the hospital. OBJECTIVES: The aim of this study was to investigate the association between hospital effectiveness and the board of trustee's management method. MATERIALS AND METHODS: This cross-sectional study was conducted in Tabriz City, Iran, during the years 2011 to 2013. To assess the effectiveness of board of trustees' management, two hospitals in Tabriz City were compared. Hospitals selected through purposive typical case sampling method. Two hospitals had equal structure, same doctors, and both were gynecology hospitals of Tabriz City, but one of them was a gynecology hospital managed by the board of trustees and the other was managed by the chairman. The information about the five variables of hospital effectiveness was collected during the years 2011 to 2013 using standard lists and questionnaires, which were available in the hospitals; these variables included quality management, safety, medical equipment management, and patients and staff satisfaction. Then, each variable was weighted through the technique of hierarchical analysis and finally they were analyzed using SPSS 17 and Expert Choice 11. RESULTS: Among the five variables related to the effectiveness, safety showed to have the highest weight and medical equipment management had the lowest weight. According to the statistical analyses, the score of the effectiveness of the hospital with the board of trustees was 33.08 (on the scale of 0 - 100) and the score of the hospital with the chairperson was 29.52. No significant association was found between the effectiveness of hospital and the board of trustees management (P = 0.81). CONCLUSIONS: Because there was no significant difference in the effectiveness between hospitals with and without board of trustees, decision-makers must monitor how the commands are carried out to make board of trustees for hospitals and make sure its success in achieving its objectives.