Mental Health Services Integration in Primary Health Care in Iran: A Policy Analysis.

Objective: The National Mental Health Services (N-MHSs) in Iran was integrated with Primary Health Care (PHC) in 1988. This study aimeds to analyze the policy of integrating N-MHSs in PHC, focusing on the analysis of the current situation, pathology, and the existing challenge. Method : This qualitative research was conducted in 2020 using a case study approach. This study used the policy triangle model to analyze the policy. The required data were collected via interviews, literature review, and document analysis. The interviews were conducted with 23 experts, stakeholders across the country who were selected through purposive sampling, and the data were analyzed using the content-analysis method. Results: The main goals of this policy were to raise mental health literacy among the people and eliminate its stigma in the society, while implementing the referral system for N-MHSs. Twenty weaknesses were extracted in eight areas, including negative views of mental health, weaknesses in human resource training, compensation for the service of psychologists, unfavorable working conditions of the workforce, inappropriate service delivery facilities, lack of meaningful communication between different levels of service delivery, poor inter-sectorial communication, and the challenging nature of mental health care. De-stigmatizing psychological disorders in the society and identifying hidden patients are some of the most significant achievements of this policy. Conclusion: Despite the successful implementation and significant achievements in integrating N-MHSs in PHC, the results of the present study indicate that there are many challenges in this field that require serious planning and attention from relevant authorities.

Public-private partnership in primary health care: an experience from Iran.

AIM: The aim of this paper is to introduce the experience of applying public-private partnership (PPP) in providing primary health care (PHC) in East Azerbaijan Province (EAP), Iran. BACKGROUND: Moving toward the Universal Health Coverage (UHC) involves using of all health-related resources. Certainly, one of the key strategies for achieving UHC is PPP. Since 2015, a PPP in PHC policy has begun in EAP as a major strategy for strengthening the health system and achieving UHC. METHODS: In this case study, data were collected through interviews with stakeholders, document analysis, reviewing of health indexes and published studies. The data were analyzed using content analysis. FINDING: PPP in PHC policy was designed and implemented in EAP with the aim of social justice, strengthening the health system and achieving UHC in the framework of health complexes (HCs). HCs provide a defined service package according to the contract. The reimbursement method is a combination of per capita, fee for services and bonus methods. Part of the payments is fixed and the other part is based on the pay for quality system and paid according to the results of monitoring and evaluation. According to the study results, the most important strength of the plan is to improve access to services, especially in marginalized areas. The main weakness is not providing infrastructures before the implementation of the plan, and the most important challenges are financial, political and organizational unsustainability and, sometimes, poor cooperation by the other organizations. The findings show that PPP in PHC in EAP is an effective strategy to provide social justice, implement family practice and achieve UHC.

Analysis of Public-Private Partnership in Providing Primary Health Care Policy: An Experience From Iran.

Background: This study aims to analyze the public-private partnership (PPP) policy in primary health care (PHC), focusing on the experience of the East Azerbaijan Province (EAP) of Iran. Methods: This research is a qualitative study. Data were gathered using interviews with stakeholders and document analysis and analyzed through content analysis. Results: Participants considered political and economic support as the most important underlying factors. Improving system efficiency was the main goal of this policy. Most stakeholders were supporters of the plan, and there was no major opponent. Implementing the health evolution plan (HEP) was an opportunity to design this policy. Participants considered the lack of provision of infrastructure as the main weakness, changing the role of the public sector as the main strength, and promoting social justice as the main achievement of policy. The results of the quantitative data review showed that following the implementation of this policy, health indicators have been improved. Conclusions: Based on the results of this study, the PPP model in EAP is a new and successful experience in PHC in Iran. Supporting and developing this policy may improve the quality and quantity of providing care.

Health Complex Model as the Start of a New Primary Healthcare Reform in Iran: Part B: The Intervention Protocol.

BACKGROUND: For overcoming the existing problems and finding a pathway for realization of universal health care, health complexes were implemented in the form of a pilot project in Tabriz suburban area. METHODS: Tabriz Health Complex Project was designed in 2013 in the provincial health center of East Azerbaijan. In terms of execution schedule, this intervention had 4 phases including 1) study phase, 2) planning phase, 3) pilot phase, and 4) implementation phase. Each health complex covers a population of 40,000 to 120,000 in a defined geographic area and consists of a Comprehensive Health Center (CHC) including health centers and a management center, which usually located in CHC. The important features of this project are as follows: people-centered primary health care, special attention to health promotion and prevention and establishment of a referral system within the region (organic connection between the first and second levels). RESULTS: An accountable and responsive health care system has been established to deliver integrated care services to people in a defined catchment area against identified per capita payment, under district health centre policies and regulations. Each health team consisted of a general practitioner and a family health nurse who covered around 4000 people to deliver prevention, promotion, and treatment services especially in and NCDs field. CONCLUSION: Health complex as a model of public-private participation and practical solution to address many of the problems in the primary care system of the country. The project can organize the PHC system and family medicine program.

Reliability and validity of the March of dimes preconception/prenatal family health history questionnaire: The Persian version.

In recent years, there has been a remarkable gap between rapid advancements in genetic technology and public health practice. Looking at the familial health history may bridge this gap for easier and cheaper diagnosis and prevention of congenital anomalies. The aim of this study was to validate and culturally adapt the March of Dimes Preconception/Prenatal Family Health History Questionnaire for the Iranian population. After obtaining written permission from March of Dimes, the translation-back translation of the original questionnaire was performed. The content validity was assessed by a team of 12 experts. Based on a sample of 50 general practitioners and 100 subjects referred to health centers from September to November 2014 in Tabriz, Iran, test-retest reliability and inter-rater reliability were evaluated by Kappa and Intra-class Correlation Coefficient (ICC). Content validity of the Persian version of the questionnaire was confirmed according to the modified kappa value above 0.76 for all the items included in this tool. Inter-rater reliability assessment yielded a kappa value between 0.62 and 0.92 for variables with dichotomous measurement scales and ICC ranged from 0.6 to 0.9 for variables with numeric scales. Test-retest re-administration produced kappa ranging from 0.62 to 0.92 for variables with dichotomous measurement scales and ICC from 0.6 to 0.9 for variables with numeric scales. The Persian version of the March of Dimes preconception/prenatal family health history questionnaire showed acceptable reliability and validity and may be used as a simple tool for the detection of risk factors of birth defects in Iranian population.

How accurate is diagnosis of congenital anomalies made by family physicians?

BACKGROUND: Although family physicians have a key role in clinical management of many diseases and in community health, the accuracy of the diagnosis for congenital anomalies by family physicians still needs more investigations. The aim of this study was to assess the accuracy of family physicians in case detection and diagnosis of congenital anomalies in rural areas, northwest of Iran. METHODS: In a community-based study of 22500 children born between 2004 and 2012, all 172 cases of congenital anomalies diagnosed by family physicians were assessed by a qualified pediatrician in 47 health houses in rural areas of Tabriz District, northwest Iran. A group of 531 children was compared as control subjects. RESULTS: The overall sensitivity and specificity of family physicians? diagnosis for congenital anomalies were estimated 98% (95% Confidence Interval (CI): 95.9 to 100) and 100% (95% CI: 99.3 to 100), respectively. Sensitivity for diagnosis of congenital heart diseases was 97% (95% CI: 93 to 100), and for genitourinary tract, it was 86% (95% CI: 59 to 100). Specificity was estimated 100% for both groups of heart and genitourinary tract anomalies. CONCLUSION: The performance of family physicians was found accurate enough in the diagnosis of congenital anomalies. Health care system may consider family physician program as an effective approach to detect and clinical management of congenital anomalies.