Challenges in institutionalizing evidence-informed priority setting for health service packages: a qualitative document and interview analysis from Iran.

BACKGROUND: Setting and implementing evidence-informed health service packages (HSPs) is crucial for improving health and demonstrating the effective use of evidence in real-world settings. Despite extensive training for large groups on evidence generation and utilization and establishing structures such as evidence-generation entities in many countries, the institutionalization of setting and implementing evidence-informed HSPs remains unachieved. This study aims to review the actions taken to set the HSP in Iran and to identify the challenges of institutionalizing the evidence-informed priority-setting process. METHODS: Relevant documents were obtained through website search, Google queries, expert consultations and library manual search. Subsequently, we conducted nine qualitative semi-structured interviews with stakeholders. The participants were purposively sampled to represent diverse backgrounds relevant to health policymaking and financing. These interviews were meticulously audio-recorded, transcribed and reviewed. We employed the framework analysis approach, guided by the Kuchenmüller et al. framework, to interpret data. RESULTS: Efforts to incorporate evidence-informed process in setting HSP in Iran began in the 1970s in the pilot project of primary health care. These initiatives continued through the Health Transformation Plan in 2015 and targeted disease-specific efforts in 2019 in recent years. However, full institutionalization remains a challenge. The principal challenges encompass legal gaps, methodological diversity, fragile partnerships, leadership changeovers, inadequate financial backing of HSP and the dearth of an accountability culture. These factors impede the seamless integration and enduring sustainability of evidence-informed practices, hindering collaborative decision-making and optimal resource allocation. CONCLUSIONS: Technical aspects of using evidence for policymaking alone will not ensure sustainability unless it achieves the necessary requirements for institutionalization. While addressing all challenges is crucial, the primary focus should be on required transparency and accountability, public participation with an intersectionality lens and making this process resilience to shocks. It is imperative to establish a robust legal framework and a strong and sustainable political commitment to embrace and drive change, ensuring sustainable progress.

Sources of anxiety among health care workers in Tehran during the COVID-19 pandemic.

By applying multivariate regression to 2020 survey data from four Tehran hospitals, we measure eight recognized sources of Coronavirus disease 2019 (COVID-19) pandemic-related anxiety among 723 healthcare workers (HCWs) with diverse sociodemographic characteristics employed across different hospital areas and positions. The most prominent anxiety source identified is the risk of workplace COVID-19 contraction and transmission to family, followed by uncertainty about organizational support for personal and family needs in the event of worker infection. A supplemental qualitative analysis of 68 respondents in the largest hospital identifies four additional anxiety sources, namely, health, finances, workload, and leadership. This evidence of the multifaceted nature of anxiety sources among HCWs highlights the differentiated approaches that hospital policymakers must take to combat anxiety.

Administrative Process and Criteria Ranking for Drug Entering Health Insurance List in Iran-TOPSIS-Based Consensus Model.

The purposes of our study were to identify a drug entry process, collect, and prioritize criteria for selecting drugs for the list of basic health insurance commitments to prepare an "evidence based reimbursement eligibility plan" in Iran. The 128 noticeable criteria were found when studying the health insurance systems of developed countries. Four parts (involving criteria) formed the first questionnaire: evaluation of evidences quality, clinical evaluation, economic evaluation, and managerial appraisal. The 85 experts (purposed sampling) were asked to mark the importance of each criterion from 1 to 100 as 1 representing the least and 100 the most important criterion and 45 out of them replied completely. Then, in the next questionnaire, we evaluated the 48 remainder criteria by the same45 participants under four sub-criteria (Cost calculation simplicity, Interpretability, Precision, and Updating capability of a criterion). After collecting the replies, the remainder criteria were ranked by TOPSIS method. Softwares "SPSS" 17 and Excel 2007 were used. The ranks of the five most important criteria which were found for drug approval based on TOPSIS are as follows: 1-domestic production (0.556), 2-duration of using (0.399), 3-independence of the assessment group (0.363) 4-impact budgeting (0.362) 5-decisions of other countries about the same drug (0.358). The numbers in parenthesis are relative closeness alternatives in relation to the ideal solution. This model gave a scientific model for judging fairly on the acceptance of novelty medicines.