Analysis of Iranian health workforce emigration based on a system dynamics approach: a study protocol.

BACKGROUND: Emigration of health workers has emerged as a significant obstacle in Iran, compelling policymakers to implement a diverse range of interventions and reforms to enhance healthcare services. It is imperative to comprehend the efficacy of emigration control interventions. To explore the intricate dynamics of elite emigration, this study employs a system dynamics modeling approach. The objective is to scrutinize Iranian health workers' emigration, examine the relationships, and evaluate the impact of various factors involved. OBJECTIVES: The general purpose of this study is to analyze the policy interventions affecting the emigration of human resources in the field of health in Iran based on the system's dynamic approach. METHOD: The research consists of four phases including analyzing the emigration status of health workers in developing countries, studying health personnel emigration in Iran, developing a System Dynamics (SD) model, and determining evidence-based policy interventions to address health worker emigration. These phases involve realist review, document analysis, qualitative interviews, data integration, and policy scenario planning. The primary objective is to gain a profound understanding of the underlying causes, mechanisms, and consequences of migration, as well as assess the impact of policies, in order to prioritize effective interventions. RESULTS: It seems that the SD model developed in this study can highlight the interconnectedness of various factors that influence health worker emigration, including demographic changes, economic conditions, and characteristics of healthcare systems. CONCLUSION: This study uses a systems dynamics approach to analyze health worker emigration from Iran, focusing on policies that promote retention and explore the implications of emigration on the healthcare system. By examining interrelationships and feedback loops within the healthcare system and socioeconomic factors, the study aims to identify effective policy interventions that can mitigate the negative effects of emigration.

Main findings: The study reveals a complex web of factors driving the emigration of Iranian health workers, and along with the Investigating the effectiveness of different interventions, the aim of this research is to develop sustainable solutions to deal with the emigration of health workers.Added knowledge: This research adds to the existing literature by employing a system dynamics approach to model the multifaceted nature of health workforce emigration in Iran, offering a novel perspective on policy intervention analysis.Global health impact for policy and action: The findings underscore the necessity for comprehensive policy strategies that address the root causes of health worker emigration and can inform global efforts to retain healthcare professionals and ensure sustainable healthcare systems.

Exploring nationwide policy interventions to control COVID-19 from the perspective of the rapid learning health system approach.

Introduction: The health systems needed to improve their learning capacities during the COVID-19 pandemic. Iran is one of the countries massively struck by the pandemic. This study aimed to explore whether and how the policy interventions made by Iran's policymakers at the national level to control COVID-19, could improve the rapid learning characteristics of the health system. Methods: A guide to clarify rapid learning health system (RLHS) characteristics was developed. The guide was used by two independent authors to select the policy interventions that could improve RLHS characteristics, then, to analyze the content of the selected policy interventions. In each stage, results were compared and discussed by all three authors. Final results were presented based on different RLHS characteristics and the potential mechanisms of contribution. Results: Five hundred policy interventions were developed during the first 7 months of the outbreak. Thirty-one policy interventions could potentially improve RLHS characteristics (6.2%). Two characteristics, such as the timely production of research evidence and the appropriate decision support were addressed by selected policy interventions. Policies, that could improve learning capacities, focused on decision-maker groups more than user groups or researcher groups. Conclusions: Most of the developed policy interventions during the first months of the epidemic did not address the learning capacities of the health system. To improve health system functions, improving RLHS characteristics of the health system, especially in patient-centered and data linkage characteristics, is recommended.

Key factors affecting health promoting behaviors among adolescents: a scoping review.

BACKGROUND: Health-promoting behaviors have been noticed recently as one of the most critical factors in raising life expectancy, which can be formed during adolescence. Thus, the current scoping review aimed to identify the key factors affecting health-promoting behaviors among adolescents. METHODS: In this scoping review, we searched multiple English online databases, including PubMed, Web of Science, Science Direct, ProQuest, and Scopus, for articles published between 1977 and 2020. All eligible studies describing health-promoting behaviors in adolescents were included. We followed the JBI guideline for conducting a scoping review and increasing the study's rigor. Extracted data were synthesized through inductive approaches. RESULTS: A total of 3199 articles were identified during the first phase. After the screening process, 20 articles were found eligible for final inclusion. Educational factors (individualized education and school health promotion programs), Economic factors (income, economic incentives and national health insurance), Social factors (support system, responsibility and peers), Spiritual, Psychological and Personal factors (gender, family structure, patterns of living, and medical problems) were found effective in health-promoting behaviors among adolescents. CONCLUSIONS: Health-promoting behaviors among adolescents require careful consideration. The current review identified some fundamental factors affecting health-promoting behaviors in adolescents. Based on the findings, it is recommended that policymakers and healthcare providers develop several interventions based on identified factors to increase adolescent's health-promoting behaviors among adolescents.

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.

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.

Factors Affecting Health Policies for Older People in Iran.

Globally, the number and proportion of people aged 60 years and older is growing fast. As people age, health needs become more complex, and the health system's responsiveness to older people's needs requires evidence-informed policies. Hence, this study explores the factors affecting the health policy development process for older people in Iran. We conducted 32 interviewers with people aged 60 years and older and 21 interviews with key informants involved in policy making related to older people. Qualitative data were analyzed using thematic analysis. Actors and stakeholders, policy structure, selected health policy processes, the health care service delivery system, government financial support, and community and culture building are the most influential factors in health policy making for older people. Government policies and health priority interventions are needed to address these influential factors for older people to ensure healthy aging over the life course.

A systematic synthesis of expert opinion on effective policies to tackle bacterial resistance worldwide.

Actions that are taken to preserve effective antibacterial agents and eliminate transmission of resistant organisms are crucial to prevent a catastrophic postantibiotic era. In this systematic review, we searched and appraised relevant texts and expert opinions to determine effective strategies to tackle bacterial resistance worldwide. We considered expert opinions, consensus, current discourses, comments, assumptions or assertions and discussion papers published in English. We searched following databases for expert opinion-based literature: MEDLINE, CINAHL, ISI Web of Knowledge, SCOPUS, Cochrane Central Register of Controlled Trials and World Health Organization (WHO). We extracted the textual data from texts using a standardised data extraction tool. Textual pooling was not possible, so the conclusions were presented in a narrative form. Eighteen texts were included in this review. The findings show that, the most repeated policies and strategies include implementing and strengthening bacterial resistance surveillance, developing national guidelines, improving public awareness; enhancing home and everyday life hygiene; improving prescribing patterns, improving laboratories capacity, promoting innovation and research in new drugs and technology and strengthening coordination. This review systematically gathered strategies that were recommended by textual publications. To our knowledge, this was the first systematic review of text and opinion in the field of bacterial resistance. These results can be used by policymakers, hospital managers, and governments, alongside the results of quantitative and qualitative systematic reviews.

Iranian primary health care network: challenges and ways forward.

AIM: This study aimed to explore the current challenges of Iran's Iranian Primary Health Care (PHC) network and possible ways forward. BACKGROUND: PHC network was established in 1985. It remains a core instrument of health care delivery. However, it faces several challenges that can threaten its effective functioning. METHODS: We conducted face-to-face semi-structured interviews with 26 key stakeholders. We used the deductive content analysis approach. World Health Organization's health system framework guided our analyses. Data were analysed using MAXQDA software. To enhance data triangulation, we reviewed PHC national related plans, bylaws, and national and international published reports. FINDINGS: PHC network experiences financial challenges and fails to respond fully to the emerging population's needs due to unfair distribution of resources and a lack of community health workers for PHC and a sustainable financing model for PHC. Furthermore, the insurance package is not well integrated into the PHC network system. Policy interests and resource commitments for innovative, preventive, and health promotion initiatives are lacking. Innovative, preventive, and health promotion initiatives should become the highest priority for policymakers. Well-trained community health professionals, active community participation, private sector engagements and active involvement of non-government organisations are fundamental for a well-functioning PHC network in Iran, especially to foster the delivery of evidence-based initiatives.

Road safety lead agency challenges of three decades of intervention for road safety in Iran: implications for policy-makers.

BACKGROUND: Road traffic crashes and associated injuries and mortalities are one of the big public health challenges, especially in low/middle-income countries. Road safety lead agency (RSLA) is a vital factor in the sustainable prevention and promotes road safety. In the recent decades, various policy interventions have been conducted for road safety in Iran. This study aimed at exploring the challenges of RSLA from the perspectives of stakeholders at various levels. METHODS: A qualitative study was conducted. In-depth interviews and document reviews were used for data collection. To conduct interviews, different stakeholders at various levels such as policy-makers, senior national authorities, researchers and faculty members were selected. Data collection was conducted between November 2019 and June 2020. Thematic content analysis approach was used for data analysis. RESULTS: The experts' perspectives were analysed and then categorised under five main themes including the role and position of the lead agency, the role and duties of the actors and players, translating policy into practice, intrasectoral and intersectoral cooperation and coordination and evidence production and application and a total of 22 subthemes were identified. The current structure of the RSLA is one of the main challenges emphasised by the research participants. CONCLUSION: To achieve significant improvements in road safety at the national level, a strong management system and leadership body is a critical issue. Organisational reform to establish an effective unique lead agency is proposed to cope with RSLA challenges.

Strategies to strengthen non-governmental organizations' participation in the Iranian health system.

Background: Non-governmental organizations (NGOs) added a new dimension to intersectoral action for health. Involving the NGOs in health system strengthening could lead to a more efficient, equitable, and better-governed healthcare system. This qualitative study explored effective strategies for NGO participation in the Iranian health system to achieve broader health system goals. Method: We conducted 33 semi-structured interviews with health policymakers and planners, NGO actors at the national and provincial levels, and other key informants. The qualitative data were analyzed through a thematic analysis approach. Trustworthiness in the study was observed at all stages of the study. Result: Four main themes- were identified: empowerment for learning leadership and management skills, creating active participation in policy-making, capacity building for participation, clarifying participation process, falling into 17 sub-themes. Along with the government and health sector policymakers, NGOs may have a significant role in improving health system goals and increasing equity, social responsiveness, financial risk protection, and efficiency. Conclusion: The participation of NGOs in the Iranian health system is a complex process. All elements and dimensions of this process need to be considered when developing a platform for the appropriate participation of NGOs in the health system functions. Evidence-informed strategies for strengthening the participation of NGOs in the health system should be used to utilize NGOs potential to the fullest.

Role of non-governmental organizations in moving toward universal health coverage: A case study in Iran.

Background: Delivering essential health services through non-governmental organizations (NGOs) could facilitate moving toward universal health coverage (UHC), especially in low- and middle-income countries. This study investigates the viewpoints of Iranian health system experts and executive stakeholders on the role of NGOs in moving toward UHC. Method: We conducted 33 semi-structured interviews with health policymakers, NGO representatives at the national and provincial level, and other key informants and analyzed using content analyses methods, using MAXQDA 12. The inductive-deductive approach was used for qualitative data analyses. Result: Based on the thematic analysis of interviews and document reviews, nine main themes and one hundred and five sub-themes were identified. Each theme was categorized based on NGO-, society-, and government-related factors. Conclusion: Recognizing the critical role of NGOs and their contribution in moving toward UHC is essential, particularly in the local context. Collaboration between NGO stakeholders and the government could facilitate moving toward UHC.

Developing inpatient suicide prevention strategies in medical settings: Integrating literature review with expert testimony.

OBJECTIVE: According to some recent evidence, suicide rate is higher in inpatients than in the general population around the world. However, suicide prevention strategies (SPS) are poorly focused and understood in medical settings. This study aimed to develop effective SPS and interventions in medical settings of Iran and provide evaluation checklists/procedures for them. METHODS: The study was performed in two steps, including literature review and expert opinions panel. In the first stage, we conducted a comprehensive literature review to find relevant suicide prevention programs, strategies, interventions, or any efforts to prevent suicide in the medical settings. In the second stage, an expert panel was arranged for developing effective and feasible SPS in medical settings. Data were analyzed through content analysis approach. RESULTS: Overall, 11 records were included in the literature review. SPS varied from staff training, safety plan and quality improvements, and prevention programs to therapy methods. Finally, in the second stage, the following seven major SPS were recommended by the expert panel: 1) Integration and application of obtained suicidal behavior data through evaluating medical records, 2) Screening and suicide risk assessment, 3) Staff training, 4) Quality improvement, 5) Follow-up of inpatients with high-risk behaviors, 6) Reducing stigma and improving public awareness, and 7) Follow-up of discharged high-risk inpatients. Also, 23 interventions within the strategies were presented. CONCLUSION: Given that SPS are poorly focused in medical settings, the practical framework that emerged in this study could be used to develop or advance SPS in various medical settings.

Factors affecting hospital services overutilization and reductive strategies in Iran: a qualitative study to explore experts' views.

OBJECTIVES: This study aimed to investigate the viewpoints of the main stakeholders of the Iranian healthcare system about the overutilization of hospital services and strategies to eliminate or reduce it in Iran. METHODS: This is a qualitative study and thematic data analysis using face-to-face semi-structured interviews and Focus Group Discussions (FGDs). We conducted eight interviewers and two FGDs with hospital stakeholders including faculty members, insurance organizations' authorities, experienced hospital administrative staff, hospital managers, and health-care providers. RESULTS: The factors leading to the overutilization of hospital services were categorized into four main themes including site of service, quality, supplier push, and demand pull. Strategies for eliminating or reducing the overutilization of hospital services are also identified based on the influential factors. CONCLUSION: Addressing overutilization of hospital services in the health system and adherence to policies for reducing or eliminating overutilization is a way to make preventive strategies to overcome overutilization. Developing a national plan to integrate utilization management into health system programs is a strategy to combat overutilization in various levels of the health system including hospital setting.

Interventions to reduce the incidence of medical error and its financial burden in health care systems: A systematic review of systematic reviews.

Background and aim: Improving health care quality and ensuring patient safety is impossible without addressing medical errors that adversely affect patient outcomes. Therefore, it is essential to correctly estimate the incidence rates and implement the most appropriate solutions to control and reduce medical errors. We identified such interventions. Methods: We conducted a systematic review of systematic reviews by searching four databases (PubMed, Scopus, Ovid Medline, and Embase) until January 2021 to elicit interventions that have the potential to decrease medical errors. Two reviewers independently conducted data extraction and analyses. Results: Seventysix systematic review papers were included in the study. We identified eight types of interventions based on medical error type classification: overall medical error, medication error, diagnostic error, patients fall, healthcare-associated infections, transfusion and testing errors, surgical error, and patient suicide. Most studies focused on medication error (66%) and were conducted in hospital settings (74%). Conclusions: Despite a plethora of suggested interventions, patient safety has not significantly improved. Therefore, policymakers need to focus more on the implementation considerations of selected interventions.

Health policy analysis in Eastern Mediterranean region using a health policy triangle framework: Historical and ethical insights from a systematic review.

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.