Using Health in All Policies Approach for the Management of Non-Communicable Disease Risk Factors: A Developing Country Experience.

Background: Controlling and preventing non-communicable diseases and their risk factors through multisector collaboration and participation of other stakeholders requires structures that provide the necessary basis for sustainable interaction between stakeholders with legal support. The purpose of this study is to express the experience of the Islamic Republic of Iran in advancing the goals of the National Plan on Control and Prevention of Non-Communicable Diseases (NCD) through Health in All Policies (HiAP) approach and multisector collaboration. Methods: In this qualitative study, all documents related to the control and prevention of non-communicable diseases in the Secretariat of the Supreme Council for Health and Food Security(SCHFS) in the period 2013-2020 were reviewed. Data were thematically analyzed with the qualitative content analysis method; coding has done manually. Results: Multisector work group, which is one of work groups in the National Committee for control and prevention of NCD, applies its effect through SCHFS that proposed a four-level policy formulation and decision-making units for multisector collaboration based on political and administrative structure and HiAP approach at the national and provincial level. The Memorandum of Understanding (MOU) and health secretariats are used as tools for a multisector approach in non-communicable disease management. Conclusion: To draw up an appropriate structure for multisector collaboration for health, it is necessary to have a whole government-policy approach, through which all relevant organizations are appointed to engage and work together in a coherent framework since a sustainable framework based on shared trust and understanding for multisector decision-making and health action is a prerequisite for achieving health goals in NCD management.

Comparing selected countries using sin tax policy in sustainable health financing: Implications for developing countries.

BACKGROUND: Sustainable health financing is one of the main challenges of policy makers and planners. This study aimed at comparing the experiences of countries in using the sin tax policies for sustainable health financing resources. METHODS: This qualitative study was conducted in two phases. First, a comparative study was carried out by searching databases from 1990 to 2017, and six countries (Thailand, England, Australia, the Philippines, South Africa, and Vietnam) were selected. Second, the existing Iranian high policy documents from 2005 to 2017 were reviewed deeply by using the content analysis method. RESULTS: The sin tax, such as taxes on tobacco and alcohol, was one of the main policies to provide sustainable health financing in all selected countries. The Iranian health system had no significant-related legal and political gap, but there were limitations in enforcing and implementing them. Finally, it is necessary to evaluate the policy and follow its effects up. CONCLUSIONS: The main financial resources in the selected countries included health promotion funds with different names and goals which took taxes on harmful goods, tobacco, and alcohol. Weaknesses in implementing laws and monitoring them were the main reasons for the lack of sustainable financing.

Sustainable financing of health promotion services in selected countries: Best experience for developing countries.

Background: Sustainable health financing is one of the main challenges of policymakers in the health system. Thus, this study aimed to investigate the sustainable financing of health promotion services in 7 selected countries and to analyze the related documents in Iran in 2018. Methods: This was a comparative and qualitative study (document analysis). In the comparative phase, the studies related to the selected countries- Australia, England, Germany, Japan, Turkey, Sweden, and Denmark- were investigated. In the second phase of the study, through a qualitative method of content analysis, 60 related documents were examined from 2005 to 2018. The initial evaluation of the documents was done using the Scott method and data were analyzed using Nvivo 8 software. Results: Based on the main findings of the study, there were a variety of approaches to the sustainable financing of health promotion services: excise taxes on goods; health-related behaviors regarding tobacco and alcohol consumption and gambling; using the capacities of social insurance funds in Germany and Turkey; and relying on the government budget in all the studied countries. According to the results of documents analysis related to the sustainable financing of health promotion in Iran, 3 main issues and 11 sub issues were identified. Conclusion: Using any of these methods or a combination of them depends on the political, social, and cultural structure of each country. The provisions of the law seem to be almost comprehensive; however, implementation, operationalization and monitoring of these elements are of significant importance.

Environmental Scanning Model in Health System and Implementation Steps: A Scoping Review.

Background: Various studies have highlighted the usefulness of environmental scanning in assessing community needs and developing programs and policies. We aimed to find the most practical model of using such scanning in the healthcare literature. Methods: We conducted a scoping review based on the PRISMA guideline to ensure a comprehensive and systematic approach in 2023. To develop a comprehensive search strategy, we worked with experienced librarians and the research team. We then completed a search of five electronic databases, including Web of Science, PubMed, Scopus, Cochrane, and Embase databases. Two independent reviewers screened titles, abstracts, and full-text articles to select studies that met our inclusion criteria. The data was then analyzed and presented in a tabular format to facilitate easy interpretation and understanding. Results: We retrieved 7243 articles from various databases and sources. After removing 2755 articles due to duplication, we excluded 4380 more articles during the title and abstract screening phase. In the full-text review process, we ruled out an additional 103 articles. Finally, only 5 articles that were directly relevant to the study were included. The model that Bednar and colleagues have in their article is the latest model. Most studies propose six main steps to conduct an environmental survey in the healthcare system. Conclusion: Since the most important task of managers and policy makers of the health system is to make decisions, they can use our proposed model to collect, analyze and interpret data, identify important patterns and trends so that they can make evidence-based decisions.

The roles and functions of future hospitals in health promotion: A systematic review in Iran.

As a main pillar of the health and social welfare system, hospitals affect the public health status in two ways: (1) Prevention, treatment, and rehabilitation services and (2) external effects on society and the environment. The present study aimed to identify the roles and functions of future hospitals in the world. The present study was a systematic review in which all studies about the roles and functions of future hospitals in different countries with a time limit of 2000 to August 2021 were extracted from foreign databases, including PubMed, Cochrane, Scopus, and Web of Science, and search engine, Google Scholar, as well as Persian databases, including Magiran, SID, and Iran Medex. We utilized the STROBE checklists for quantitative studies and SRQR checklists for qualitative studies to critique and evaluate the quality of qualitative studies. We then extracted their results and classified the content according to the main and subtopics. A total of 16 articles met the inclusion criteria of the present study. Hospitals can play four roles: stand-alone, dominant, collaborative, and partner. Findings were classified into six general groups: the role and mission of future hospitals, the way of providing care, funding, staff and patients, technology and information of future hospitals, and the challenges and barriers of current hospitals. Health service policy-makers need to pay special attention to technological innovations and advances as well as changes in the roles and functions of hospitals and seek to turn the threats arising from external changes into opportunities for better hospital performances.

Establishing clinical governance model in primary health care: A systematic review.

Clinical governance is a systematic approach to enhancing the quality of primary health care and ensuring high clinical standards, responsiveness to performance, and continuous improvement in service quality. The objective of the current study was to investigate the global experiences of clinical governance in primary health care. In the present systematic review, relevant articles from different countries were searched in various databases such as MD PubMed from Medline portal, Emerald Springer link, ProQuest, Cochrane, Scopus, Web of Science, and Consult until April 2019. The searched articles were checked through CASP and PRISMA checklists, and their results were extracted. Of the 17 selected studies, 16 belonged to developed countries, including England (13), Australia, Italy, and New Zealand, and one was from Turkey. The findings were divided into three general categories: (1) principles of effectiveness and risk management, (2) deployment requirements such as structural and organizational needs, resource and communication, and information management, and (3) barriers of clinical governance toward providing primary health care. it is recommended that a suitable framework or model be developed and designed adapted to the local culture and taking into account all effective dimensions for a proper establishment and implementation of clinical governance in primary health care.

Dynamics of the COVID-19 Clinical Findings and the Serologic Response.

The factors affecting the dynamics of lengthening of symptoms and serologic responses are not well known. In order to see how the serologic responses change in relation to the clinical features, we selected a group of 472 adults with a positive IgM/IgG antibody test result from a baseline study of the anti-SARS-CoV-2 seropositivity, assessed their COVID-19 and past medical histories, and followed them up in about 3 months. Nearly one-fourth of the subjects were asymptomatic at the baseline; 12.8% subjects became symptomatic at the follow-up (FU) when 39.8% of the subjects had some persisting symptoms. At the baseline, 6.1% showed anti-SARS-CoV-2 IgM positive, 59.3% only for IgG, and 34.5% for both. At the FU, these figures declined to 0.6, 54.0, and 4.4%, respectively, with the mean IgM and IgG levels declining about 6.3 and 2.5 folds. Blood group A was consistently linked to both sustaining and flipping of the gastrointestinal (GI) and respiratory symptoms. The baseline IgM level was associated with GI symptoms and pre-existing cirrhosis in multivariate models. Both of the baseline and FU IgG levels were strongly associated with age, male, and lung involvement seen in chest computed tomography (CT)-scan. Finally, as compared with antibody decayers, IgM sustainers were found to be more anosmic [mean difference (MD): 11.5%; P = 0.047] with lower body mass index (BMI) (MD: 1.30 kg/m2; P = 0.002), while IgG sustainers were more commonly females (MD: 19.2%; P = 0.042) with shorter diarrhea duration in the FU (MD: 2.8 days; P = 0.027). Our findings indicate how the anti-SARS-CoV-2 serologic response and COVID-19 clinical presentations change in relation to each other and basic characteristics.

A policy brief on improving the finance of family physician program: An experience from urban areas of Iran.

In the current scenario, financing suffers from problems related to lack of specific line for UFFP, lack of resource pooling, delay in payment to physicians, and conflict of interests among family physician team. As a result, this policy brief was formulated based on the role of FPs in public access to general practitioner (GP) services in the referral system on one hand, followed by the impact of it on health costs reduction on the another hand, and further considering the necessity of financing system audit to find a sustainable resources for this program to be implemented at a national level in the country of Iran.

Implementing Health Impact Assessment at National Level: An Experience in Iran.

BACKGROUND: According to the general health policies issued in 2014, Health Impact Assessment (HIA) or Health Annex should be implemented in Iran. The present study provided a model for executing HIA in the Iranian context as a developing country. METHODS: This is a system design study with the qualitative approach. The data on the system components were gathered via reviews of the literature, in-depth interviews and focused group discussions (FGDs) with experts. The information were contently analyzed in order to draft the model and a consensus was reached on by the steering committee. RESULTS: Fifteen in-depth interviews and six FGD meeting were conducted. The equity-based approach in assessing the health impacts of policies, programs and projects were chosen as the most practical tool. Experts believe that for the next five years, HIA should be used just for the "national projects" so that the ministries and national agencies could be empowered. Components of the model including structure, procedures, and standards, management style, mission and resources were prepared. The national regulations and protocols were sent to the SCHFS Secretariat for final revision and the council approval. CONCLUSION: The hasty implementation of HIA will face serious resistances as the health-oriented attitude and behavior in both government and non-governmental sectors will gradually form. Also, the overlapping of the contents of HIA with other tools such as Environmental, Cultural and Social Impact Assessments, currently used by other sectors, causes difficulties in implementing the HIA by the Ministry of Health and Medical Education.

Burden of Malaria in Iran, 1990-2010: Findings from the Global Burden of Disease Study 2010.

BACKGROUND: Malaria is a major public health challenge in tropical and semi-tropical countries in terms of high morbidity and mortality. The present study aimed to report the burden of malaria in Iran, extracted from the global burden of disease 2010 study (GBD 2010) covering the period 1990 to 2010, to compare these findings with similar results, and to present some recommendations as potential solutions for gaining more accurate estimations regarding the burden of the disease in Iran. METHODS: Data covering the period from 1990 to 2010 were derived from the GBD 2010, which is published by the Institute for Health Metrics and Evaluation (IHME). The findings were used to estimate the years lived with disability (YLDs), the years of life lost (YLLs), the disability-adjusted life-years (DALYs), and the death rate of malaria in Iran. RESULTS: The GBD 2010 estimated that there was a sharp declining death trend with regard to DALYs and death rate, showing that 4,647.63 DALYs were due to malaria in Iranian people of all ages and both genders, and that DALYs per 100,000 individuals declined from 37.15 in 1990 to 5.87 in 2010. The total number of malaria deaths over the 20 years was 73.37. CONCLUSION: The findings revealed that the burden of malaria decreased remarkably between 1990 and 2010. The explanation for this decrease is the establishment of a malaria surveillance system in various parts of Iran, and utilization of proper intervention and the improvement of infrastructures, which play a role in disease transmission, especially in endemic areas.

Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns.

In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016). It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP) payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs) of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers' concerns (as powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes) should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting interests) must be responded through clarification and providing transparent information. The requirements of HSEP and especially the key element of progressive tax should be considered properly in the coming sixth national development plan (2016-2021).

National health guidelines in I.R of iran, an innovative approach for developing countries.

BACKGROUND: Guidelines have produced and used in complex environment of health care system with its ethical, economical, legal and other aspects; that should be taken into account in any country. Modifying the format and content of guidelines might facilitate their usage and lead to improved quality of care and cost containment. We have produced this tool for explained above purpose. METHODS: A coordinating national team has settled at the office of minster of health and medical education, supported by a guideline review committee. An innovative and appropriate approach for adapting national health guidelines has consisted of eight steps, have defined For preparing the draft of each guideline a technical team which, including main author, her/his co-workers have nominated. The authors of each topic have systematically searched databases of the proposed Twenty-two International Sites, and then have selected at least five sources of them that were more relevant. The final recommendations have proposed by agreement of technical team and Guideline Review Committee. RESULTS: In less than 5 months, more than 500 authors in whole country have selected to prepare guidelines and, approximately 150 guidelines have provided in three volumes of the published and distributed book. Each guideline had a national ID number, constant forever; all topics should be reviewed every 3-5 years. CONCLUSION: National health guideline(s) would be essential means for policy making in health system and increased the cost containment and quality of care. Ministry of Health and Medical Education should provide and distribute the guidelines based on its accountability to legal responsibility.

Fairness of Financial Contribution in Iranian Health System: Trend Analysis of National Household Income and Expenditure, 2003-2010.

BACKGROUND: Social systems are dealing with the challenge of achieving fairness in the distribution of financial burden and protecting the risk of financial loss. The purpose of this paper is to present a trend analysis for the indicators related to fairness in healthcare's financial burden in rural and urban population of Iran during the eight years period of 2003 to 2010. METHODS: We used the information gathered by statistical center of Iran through sampling processes for the household income and expenditures. The indicators of fairness in financial contribution of healthcare were calculated based on the WHO recommended methodology. The indices trend analysis of eight-year period for the rural, urban areas and the country level were computed. RESULTS: This study shows that in Iran the fairness of financial contribution index during the eight-year period has been decreased from 0.841 in 2003 to above 0.827 in 2010 and The percentage of people with catastrophic health expenditures has been increased from 2.3% to above 3.1%. The ratio of total treatment costs to the household overall capacity to pay has been increased from 0.055 to 0.068 and from 0.072 to 0.0818 in urban and rural areas respectively. CONCLUSION: There is a decline in fairness of financial contribution index during the study period. While, a trend stability of the proportion of households who suffered catastrophic health expenditures was found.