Institutionalization for good governance to reach sustainable health development: a framework analysis.

BACKGROUND: This article explores the concept of institutionalization, which is the process of transforming ideas into programs and automating actions, in the context of health system governance and sustainable development. Institutionalization is a key mechanism for creating accountable and transparent institutions, which are essential for achieving health system resilience and sustainability. This study identifies the components and dimensions of institutionalization in the health system and its relationship with good governance and sustainable health development. MAIN TEXT: We applied a scoping review method in five steps. First, we formulated a question for our research. Then, we concluded a comprehensive literature search in five electronic databases for identifying relevant studies. This review has two phases: identifying the concept of institutional approach and its components in health system, and its relationship with good governance to reach Sustainable Health Development (SHD). The third step was study selection, and the 1st author performed data abstraction. The key issues which are identified in our review, related to the concepts of SDH, its goals, pillars and principles; positive peace; good governance; components of institutional approach components, and their relations. Finally, we summarized and organized our findings in a format of a proposed conceptual framework, to underpin the role of institutionalization in the health system to achieve sustainable development. CONCLUSION: Institutionalization is a key concept for achieving positive peace and good governance, which requires meaningful involvement of leaders, politicians, civil society, and public participation. It also depends on the conditions of justice, human rights, transparency, accountability and rule of law. In the wake of COVID-19, institutionalization is more crucial than ever for advancing sustainable development, especially in the context of low and middle-income countries (LMICs).

Response Time and Causes of Delay in Prehospital Emergency Missions in Mashhad, 2015.

Background: The response time is considered as one of the most important criteria for the quality of given care to the injured. This research aimed to investigate the frequency and causes of prehospital emergency delays in the 115 emergency center, in city of Mashhad, in 2015. Methods: In this cross-sectional study, 21,142 missions performed in 2015 were investigated, from among which 640 missions with delays in systematic sampling were recognized. For data analysis purposes, descriptive statistics (frequency, mean and SD) in Excel 2013 software was implemented. Results: Nearly 60% of the injured were men, 23% women, and the gender of 17% was not recorded in their profiles. The mean age of the injured was 29.8+15.9 years and 30% of the injured were in the age group of 16 to 25. The mean response time was 9:01+2:46. The most prevalent causes related to missions out of the operational zone (29.3%) and the second cause has been related to traffic groups (24.2%). Conclusion: Establishing new bases and completing the number of ambulances and human recourses, intervention in traffic causing factors, and training the public about emergency cases can be effective in reducing the number of missions and the pace and quality of services provided to the injured.

A Successful implementation of an idea to a nationally approved plan: Analyzing Iran's National Health Roadmap using the Kingdon model of policymaking.

Introduction: Hospital beds, human resources, and medical equipment are the costliest elements in the health system and play an essential role at the time of treatment. In this paper, different phases of the NEDA 2026 project and its methodological approach were presented and its formulation process was analysed using the Kingdon model of policymaking. Methods: Iran Health Roadmap (NEDA 2026) project started in March 2016 and ended in March 2017. The main components of this project were hospital beds, clinical human resources, specialist personnel, capital medical equipment, laboratory facilities, emergency services, and service delivery model. Kingdon model of policymaking was used to evaluate NEDA 2026 development and implementation. In this study, all activities to accomplish each step in the Kingdon model was described. Results: The followings were done to accomplish the goals of each step: collecting experts' viewpoint (problem identification and definition), systematic review of the literature, analysis of previous experiences, stakeholder analysis, economic analysis, and feasibility study (solution appropriateness analysis), three-round Delphi survey (policy survey and scrutinization), and intersectoral and interasectoral agreement (policy legislation). Conclusion: In the provision of an efficient health service, various components affect each other and the desired outcome, so they need to be considered as parts of an integrated system in developing a roadmap for the health system. Thus, this study demonstrated the cooperation process at different levels of Iran's health system to formulate a roadmap to provide the necessary resources for the health sector for the next 10 years and to ensure its feasibility using the Kingdon policy framework.

COVID-19 and Comparative Health Policy Learning; the Experience of 10 Countries.

BACKGROUND: Since December 2019, the world has been facing one of the most critical health threats of the last decades. In March 2021, the official number of deaths passed 2.6 million worldwide. Most countries have developed policies to control the disease. Nevertheless, countries have experienced different outcomes related to their various adapted policies. Complementing our first report, in this article, we report our findings of comparing the policies adopted to combat coronavirus disease 2019 (COVID-19) in Iran, with those from nine selected countries, including China, Japan, South Korea, Singapore, Germany, the United States, the United Kingdom, Spain, and Italy, to draw evidence-informed policy lessons. METHODS: This is a qualitative study conducted based on document analysis related to COVID-19 policies in Iran and nine selected countries. Using a deductive approach, data were extracted and analyzed based on the components of the WHO Building Blocks Framework. Finally, we compared the Iranian policies with the nine selected countries. RESULTS: Documents analysis revealed a spectrum of policies, which have led to a variety of outcomes. Based on our findings, three main strategies (widespread testing, comprehensive contact tracing, and timely measures) were the most effective directions to combat COVID-19. CONCLUSION: The experience of the first and second waves of COVID-19 showed that the risk of coronavirus is serious and will continue until a vaccine or decisive treatment is achieved. Therefore, countries are required to adopt appropriate and tailored policies to deal with this crisis effectively. Applying the experiences from the previous waves is essential for more efficient performance in the likely upcoming waves.

COVID-19 Pandemic and Comparative Health Policy Learning in Iran.

BACKGROUND: On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus disease (COVID-19) a global pandemic. Starting in December 2019 from China, the first cases were officially announced on February 19 in Qom city, Iran. As of April 3, 2020, 206 countries have reported a total of 932166 cases with 46764 deaths. Along with China, USA, Italy, Spain, and Germany, Iran has been suffering the hardest burden of COVID-19 outbreak. Worse still, countries like Iran are struggling with the double burden of political sanctions to provide lifesaving medical equipment and medicines to combat the emergency. METHODS: Using systematic document content analysis and through the lenses of health policy triangle, this article aims to compare the policies and strategies that Iran is adopting, with the experience and recommendations of China and WHO to combat COVID-19. RESULTS: Iran has formulated contextual-based policies to combat COVID-19 outbreak before and after virus entrance. Insufficient whole-government, whole-society approach in managing the outbreak, inadequate lifesaving and protective equipment, and delayed decisive governance are the biggest challenges in policy making to combat COVID-19. COVID-19 policies are a public health concern and require professional advocacy attempts through appropriate inter-sectoral collaboration and whole-government coalitions. CONCLUSION: COVID-19 is an unfolding outbreak; hence, policy learning is crucial to formulate appropriate policies and implement them accordingly. Iran has made many efforts to defeat the outbreak, but more coherent, timely and efficient action is required, now, more than ever, to save lives and slow the spread of this pandemic.

The Factors Associated With Direct Medical Costs in Patients With Gastric Cancer: Quantile Regression Approach Compared With Gamma Regression.

OBJECTIVES: Evaluating the costs of illness can provide evidence to improve performance at all levels of health organizations. This study aimed to identify the relationship between the costs of diagnosing and treating patients with gastric cancer and their explanatory variables, using quantile and gamma regressions and comparing the results of the two models. METHODS: This was a cross-sectional and descriptive-analytic study carried out in 2016. In total, 449 patients with gastric cancer were selected at a hospital affiliated with Mashhad University of Medical Sciences. Direct costs and other variables were collected from medical documents. Data were analyzed using the STATA 12 software, using quantile and gamma regression analysis, and the results were compared. RESULTS: The highest average cost per patient was related to hospitalization costs in both metastatic (20 911 034 Iranian Rials) and nonmetastatic patients (20 738 062 Iranian Rials). The lowest average cost was related to biopsy services in nonmetastatic patients. The results of the study also showed that quantile regression is an appropriate substitute for gamma regression and, in some cases, can provide more information for the analysis of disease costs. Based on the results of the quantile regression, being a male and having a shorter stay had a positive effect on cost and the age of the patient had a significantly negative effect. CONCLUSIONS: Examining the cost of a common illness, such as gastric cancer, is an important economic tool for policy makers and decision makers. It provides evidence-based decision making about resource allocation that they can use for future planning and cost control.

The District Health Information System (DHIS2): A literature review and meta-synthesis of its strengths and operational challenges based on the experiences of 11 countries.

BACKGROUND: Health information systems offer many potential benefits for healthcare, including financial benefits and for improving the quality of patient care. The purpose of District Health Information Systems (DHIS) is to document data that are routinely collected in all public health facilities in a country using the system. OBJECTIVE: The aim of this study was to examine the strengths and operational challenges of DHIS2, with a goal to enable decision makers in different counties to more accurately evaluate the outcomes of introducing DHIS2 into their particular country. METHOD: A review of the literature combined with the method of meta-synthesis was used to source information and interpret results relating to the strengths and operational challenges of DHIS2. Databases (Embase, PubMed, Scopus and Google Scholar) were searched for documents related to strengths and operational challenges of DHIS2, with no time limit up to 8 April 2017. The review and evaluation of selected studies was conducted in three stages: title, abstract and full text. Each of the selected studies was reviewed carefully and key concepts extracted. These key concepts were divided into two categories of strengths and operational challenges of DHIS2. Then, each category was grouped based on conceptual similarity to achieve the main themes and sub-themes. Content analysis was used to analyse extracted data. RESULTS: Of 766 identified citations, 20 studies from 11 countries were included and analysed in this study. Identified strengths in the DHIS were represented in seven themes (with 21 categories): technical features of software, proper management of data, application flexibility, networking and increasing the satisfaction of stakeholders, development of data management, increasing access to information and economic benefits. Operational challenges were identified and captured in 11 themes (with 18 categories): funds; appropriate communication infrastructure; the need for the existence of appropriate data; political, cultural, social and structural infrastructure; manpower; senior managers; training; using academic potentials; definition and standardising the deployment processes; neglect to application of criteria and clinical guidelines in the use of system; data security; stakeholder communications challenges and the necessity to establish a pilot system. CONCLUSION: This study highlighted specific strengths in the technical and functional aspects of DHIS2 and also drew attention to particular challenges and concerns. These results provide a sound evidence base for decision makers and policymakers to enable them to make more accurate decisions about whether or not to use the DHIS2 in the health system of their country.