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The aim of this study was to assess the appropriate use of diagnostic catheterizations (DC) for the patients with suspected coronary artery disease performed in Iran. The Electronic Health Record System database and manual review of files were utilised to collect data between 2012 and 2014. Patients were categorized in three groups as appropriate, uncertain, and inappropriate usage of DC and the logistic regression was used to investigate the relationships between variables. One-quarter of the 2458 angiographies were rated as inappropriate, out of which 99% had no previous stress test. The rate of inappropriate DC between various hospitals were approximately the same. The regression showed that some risk factors (Sex, high cholesterol, smoking, chronic heart failure, renal failure, diabetes) were significantly associated with inappropriate rate.

BACKGROUND: Professionalism, stress and demographic factors are the three key influences in nurses' intention to provide care. OBJECTIVES: This study examined the levels of work intention, stress and professionalism of nurses and determine the relationship between nursing work intention and factors in response to COVID-19. METHODS: This cross-sectional study was conducted on 362 nurses from COVID-19-devoted hospitals in Iran. A self-administered electronic-based questionnaire was developed and used to determine levels of stress, professionalism, and nursing intention. Multiple regression analysis was carried out to analyze the correlation between nursing intention with respect to stress and professionalism. RESULTS: The overall stress, professionalism, and nursing intention scores were 48.56, 21.46, and 17.83 respectively. There were significant differences in nursing intention scores between gender, marital status, and having training groups (p 

Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. Different frameworks for assessing of health financing systems have been developed. The purpose of this study is to review the current frameworks for understanding and assessing health financing and draw out the dimensions of conceptual frameworks and how different concepts are used in relation to the concept of health financing assessment. Lessons learned from different frameworks would guide the future use and formulation of such frameworks. Methods We carried out a systematic search strategy, using the PubMed database to find peer reviewed published literature. A search using generic search engines (Google Scholar and the Google) was also performed through a less structured search to find additional documents and reports published. To increase the comprehensiveness of search, Websites of World Health Organization (WHO) and World Bank were also searched. We included any type of report or peer reviewed journal article that reported frameworks to assess, review and map financing functions and sub-functions and highlight different factors that affect it. Results Fifteen frameworks/tools developed during 2001 until 2020 were found. We classified frameworks by grouping them into systems approach- analytical frameworks, indicator-based, and descriptive/ narrative categories. These frameworks vary in the concepts, functions and processes, dimensions, strategies and meet various international or country-specific challenges. Conclusion The process of framework development for health financing review is becoming more comprehensive with pushing universal health coverage to the international agenda. Despite being diverse, various health financing frameworks/ tools offer synergistic views to the health financing system and provide a comprehensive picture of the health financing system. While some frameworks covered the majority of the elements, not any of the frameworks on its own covered all the elements. Health financing review is a laborious endeavor, which usually needs diverse data and an expert team. It is sometimes infeasible to access ready and user-friendly information; therefore, it is important to apply them with some flexibility.

Background: In the health sector, competency-based education focuses on the desired performance characteristics of health professionals through designing and implementing the evidence-based standards, performance indicators and, quality outcomes. This paper aims to explore core competencies required for health policy graduates, aiming to prepare doctoral students for a spectrum of future roles, i.e. academic and non-academic.Methods: The databases including PubMed, Scopus, Google scholar, and SID were searched to identify the required competencies for health policy students worldwide. Students and well-known academics in the field of health policy (from Iran and other countries) were interviewed. This qualitative study was conducted in three phases: a critical review of literature; interviews; and validation of identified competencies through face to face consultations with experts complemented by a survey. We used three methods for data collection: 1) review of the literature; 2) 74 face to face and email-based semi-structured interviews and 3) validating the identified competencies through face to face consultations with qualified experts. Results: We identified five core competencies for health policy doctoral graduates without specific order including research, policy analysis, education, decision making, and communication.Conclusions: As countries are gearing up towards sustainable development goals (SDGs), the role of health policy graduates is crucial paving the pathway towards SDGs on health and well-being. Appropriate and contextually-tailored curriculum is pivotal, we envisage, to foster multi-dimensional competencies that are complementary to the specific disciplines of health policy scholars of future, those who can genuinely serve their health systems towards sustainable health development.

Background: This study aimed to provide tailored transferrable lessons for expanding population coverage through a descriptive lens by reviewing the population coverage policies, reforms and strategies in selected nations. Methods: In this comparative short communication, 14 countries with different status of population coverage and political economy that had successful experiences with coverage expansion were selected and categorized in four groups to study their approaches to reach Universal Health Coverage (UHC). Results: Although each country needs to tailor its policies and reforms based on its own contextual factors, the legal right of citizens to social security and health protection are enshrined in most countries' Constitution. Some countries adapted political and economic reforms to evolve their Social Health Insurance schemes. National laws to push governments to adapt UHC as a national strategy for ensuring that every resident is enrolled in health insurance schemes are key policies to reach UHC. Conclusion: A series of reforms are required to provide total population coverage through various approaches. To create an effective insurance coverage, physical merger of all insurance funds is not necessarily required. Further, the share of GDP for health is not a definite indicator to reach UHC. Finally, strong political commitment and citizens’ participation are the key issues in reaching UHC, while considering the poorest, remote and neglected population really matters.

Background: Mobile technologies are widely used in healthcare. The purpose of this study was to compare the effectiveness and cost-effectiveness of fixed computed tomography (CT) and magnetic resonance imaging (MRI) with the mobile ones. Methods: In this systematic review, PubMed, Cochrane Library, Scopus and CRD database were searched from 1995 to 2015. The data on safety and effectiveness of technologies were extracted from included studies. Because the review showed no significant differences in the performance of mobile CT and MRI compared to the fixed ones, then a cost minimization approach was used to explore the cost-effectiveness of three scenarios. Results: Twenty two articles were included in the review that showed no statistically significant differences in the performance of mobile MRI and CT scan compared to the fixed ones. The cost minimization approach showed that the third scenario based on purchasing a common mobile MRI and CT scan; and using it by two or more hospitals that are in rational distance from each other is associated with the lowest costs, so it is the most cost-effectiveness strategy. Conclusion: The performance of Mobile CT and mobile MRI is comparable to the fixed ones; and using a combined mobile CT and MRI by two or three hospitals is the most cost-effective approach.

Background: Healthcare systems are always facing increasing public demands to provide better services. Therefore, countries always need more resources and are constantly seeking more fiscal space for health. Freeing up resources through improving efficiency can be a practical option for all settings, particularly countries with low resources. This study aimed to identify feasible options for expanding fiscal space through efficiency within Iran’s healthcare system. Methods: This was a qualitative study. We conducted 29 semi-structured in-depth interviews with stakeholders at various levels of healthcare system in 2017 and 2018. We used mixed method (deductive and inductive) qualitative content analysis. Pre-defined themes extracted from literature and meanwhile new subthemes were developed and added to the initial framework. Results: We identified three main themes that affect the efficiency of healthcare system in Iran: administration, implementation, and monitoring. Problematic administration, inappropriate implementation and lack of good monitoring in healthcare initiatives may lead to inefficiencies and wasting resources. Recognizing these leakages in every healthcare system can free up some resources. Conclusion: Irrespective of their economic development, all countries may, to some extent, face limited resources to address ever-increasing needs in their healthcare systems. While generating new resources is not always possible, enhancing efficiency to expand fiscal space might be a feasible option. Healthcare systems should identify the leakages and respond to wastages with appropriate planning. Getting the most out of current resources is possible through proper administration, good implementation and a well-established monitoring system for healthcare initiatives.

Background: The ultimate goal of health systems is creating a healthy community through the efficient and equitable provision of health services. The proportion of equity and efficiency of health systems indicates the quality of their practice. This systematic review aims to seek evidence that show any effect of resource allocation decisions on efficiency and equity in health worldwide. Methods: Five databases including PubMed, Scopus, Ovid, ProQuest, and EBSCOHOST were searched from 1992 to 2014. Based on the inclusion criteria, 527 papers were identified, of which 11 were assessed and analyzed. Results: The 11 included studies have been conducted in different countries including USA, North Africa, Greece, China, Australia, Taiwan, and South Africa. The main methods for resource allocation included: linear programming, Markov model, cost-effectiveness analysis, per capita resource allocation, modelling the resource allocation. Conclusion: Linear and mathematical programming methods, and economic models such as Markov models can lead to equity and efficiency to some extent. These models take into account the details of treatment methods, the population under treatment, and costs of health services. &nbsp

Background Iran’s Parliament passed a Law in 2010 to merge the existing health insurance schemes to boost risk pooling. Merging can be challenging as there are differences among health insurance schemes in various aspects. This qualitative prospective policy analysis aims to reveal key challenges and implementation barriers of the policy as introduced in Iran. Methods A qualitative study of key informants and documentary review was conducted. Sixty-seven semi-structured face-to-face interviews were conducted, with key informants from relevant stakeholders. Purposive and snowball sampling techniques were used for selecting the interviewees. The related policy documents were also reviewed and analyzed to supplement interviews. Data analysis was conducted through an existing health financing World Bank framework. Results This study demonstrated that for combining health insurance funds, operational challenges in the following areas should be taken into account: financing mechanisms, population coverage, benefits package, provider engagement, organizational structure, health service delivery and operational processes. It is also important to have adequate cogent reasons to “the justification of the consolidation process” in the given context. When moving towards combining health insurance funds, especially in countries with a purchaser-provider split, it is critical for policy makers to make sure that the health insurance system is aligned with the policies and Stewardship of the broader health care system. Conclusions Implementation of major reforms in a health system with fragmented insurance schemes with different target populations, prepayment structures, benefit packages and history of development is inherently difficult, especially when different stakeholders have vetoing powers over the proposed reforms. Solving the differences and operational challenges in the main areas of health insurance system generated in this study may provide a platform for the designing and implementing merging process of social health insurance schemes in Iran and other countries with similar situations.

Context: Increasing demand for medicines can influence the health system performance and impose a financial burden on individuals and society. Therefore, the current study aimed to investigate factors affecting the induced demand for medicines and provide strategies to address the issue. Evidence Acquisition: A scoping review was conducted using three databases including PubMed, Cochrane Library, and Embase from January 1990 until March 2017. By defining inclusion and exclusion criteria, 33 papers that considered the factors affecting the induced demand for medicines and the strategies to reduce the demand were included in the study. The papers were used to extract common themes. Results: The final factors were categorized into eight groups, including monitoring mechanisms, demand-side factors, supply-side factors, structural factors, legal-political factors, insurance coverage and subsidies, commercial interactions and advertisements, and educational factors. In addition, strategies to address them were extracted. Conclusions: Since in developing countries the most important factors are the lack of a comprehensive monitoring system and supply-side factors, it seems that monitoring mechanisms such as performance audit and guideline development can reduce the induced demand for medicines.

Background Health systems reform is inevitable due to the never-ending changing nature of societal health needs and policy dynamism. Today, the Health Transformation Plan (HTP) remains the major tool to facilitate the achievements of universal health coverage (UHC) in Iran. It was initially implemented in hospital-based setting and later expanded to primary health care (PHC). This study aimed to analyze the HTP at the PHC level in Iran. Methods Qualitative data were collected through document analysis, round-table discussion, and semi-structured interviews with stakeholders at the micro, meso and macro levels of the health system. A tailored version of Walt & Gilson’s policy triangle model incorporating the stages heuristic model was used to guide data analysis. Results The HTP emerged through a political process. Although the initiative aimed to facilitate the achievements of UHC by improving the entire health system of Iran, little attention was given to PHC especially during the first phases of policy development – a gap that occurred because politicians were in a great haste to fulfil a campaign promise. Conclusions Health reforms targeting UHC and the health-related Sustainable Development Goals require the political will to improve PHC through engagements of all stakeholders of the health system, plus improved fiscal capacity of the country and financial commitments to implement evidence-informed initiatives.

BACKGROUND: The objective of this study was to shed light on the challenges and successes of HIV/AIDS services delivery as perceived by Sex workers. METHODS: Face-to-face semi-structured interviews were conducted with 20 IDUs and Sex workers in drop-in centers in Shiraz. A thematic analysis of these qualitative data was conducted by the authors. RESULTS: Participants identified major challenges and successes of HIV/AIDS services delivery. Access services, services delivery in terms of challenges and the successes concept were classified. CONCLUSIONS: Our study demonstrates that while there is greater availability of HIV/AIDS services, this does not equate with greater accessibility because multiple, complex and interrelated barriers to HIV/AIDS service utilization at the service delivery level such as Stigma, discrimination, violence, harassment and social equity issues are critical concerns of FSW. Language: en

In recent decades, the rate of caesarian section (C-section) has increased in the Islamic Republic of Iran. A reform in the Iranian health system - the Health Transformation Plan (HTP) - was launched in 2014 in which one of the objectives of HTP is decreasing the rate of C-section.This study aimed to assess the effects of the Health Transformation Plan (HTP) on the C-section rate in the Islamic Republic of Iran.This study was an interrupted time series analysis that used segmented regression analysis to assess the immediate and long-term effects of the HTP on C-section rate in two groups of hospitals affiliated and not affiliated to the Ministry of Health and Medical Education (MoHME) in Kurdistan province. Study samples were selected using the data on monthly C-section rate collected over a period of four years.We observed significant decreases in C-section rate immediately after the HTP in both groups of hospitals by 0.0629 and 0.0013, respectively (P0.05). In the long run, we observed no significant decrease in the regression slope of C-section rate in both groups.The implementation of HTP decreased the C-section rate. However, the reduction does not meet expectations.آثار خطة التحوُّل الصحي على معدل الجراحات القيصرية في جمهورية إيران الإسلامية: سلسلة زمنية متقطعة.آرش رشيديان، قباد مرادي، أمير حسين تكيان، مينو علي بوري سخا، صديقه صلواتي، عبيد الله فرجي، بختيار بيروزي.في العقود الأخيرة، ارتفع معدل الجراحات القيصرية في جمهورية إيران الإسلامية. وبدأ إصلاح نظام الصحة الإيراني -خطة التحوُّل الصحي - في عام 2014 ، وكانت أحد أهداف الخطة تخفيض معدل الجراحات القيصرية.هدفت هذه الدراسة إلى تقييم آثار خطة التحوُّل الصحي على معدل الجراحات القيصرية في جمهورية إيران الإسلامية.استخدمت هذه الدراسة طريقة “تحليل سلسلة زمنية متقطعة”، حيث استُخدم التحليل الانحداري المجزأ في تقييم الآثار الفورية وعلى المدى الطويل لخطة التحوُّل الصحي على معدل الجراحات القيصرية في مجموعتين من المستشفيات التابعة لوزارة الصحة والتعليم الصحي في محافظة كردستان، ومستشفيات أخرى غير تابعة لها. وتم اختيار عينات الدراسة باستخدام البيانات المُجمَّعة عن المعدل الشهري للجراحات القيصرية على مدار أربع سنوات.لاحظنا انخفاضات جوهرية فورية في معدل الجراحات القيصرية بعد تنفيذ خطة التحوُّل الصحي في مجموعتي المستشفيات بمقدار 0.0629 و 0.0013 على التوالي (P0.05). وعلى المدى البعيد، لاحظنا عدم وجود أي انخفاض جوهري في ميل خط الانحدار لمعدل الجراحات القيصرية في كلا المجموعتين.أدى تنفيذ خطة التحوُّل الصحي إلى تخفيض معدل الجراحات القيصرية. ومع ذلك، لم يحقّق الانخفاض التوقعات المأمولة.Effets du plan national de transformation du secteur de la santé sur le taux de césarienne en République islamique d’Iran : série chronologique interrompue.Au cours des dernières décennies, on a observé une augmentation du taux de césarienne en République islamique d’Iran. Une réforme du système de santé iranien – le plan national de transformation du secteur de la santé – a été lancée en 2014. L’un des objectifs de ce plan vise à réduire le taux de césarienne.La présente étude vise à évaluer les effets du plan national de transformation du secteur de la santé sur le taux de césarienne en République islamique d’Iran.La présente étude constitue une analyse d’une série chronologique interrompue basée sur une analyse de régression segmentée afin d’évaluer les effets immédiats et à long terme du plan de transformation du secteur de la santé sur le taux de césarienne dans deux groupes d’hôpitaux affiliés et non affiliés au ministère de la Santé et de l’Éducation médicale dans la province du Kurdistan. Les échantillons de l’étude ont été choisis en utilisant les données relatives au taux mensuel de césariennes, collectées sur une période de quatre ans.Nous avons observé une diminution sensible du taux de césarienne immédiatement après la mise en place du plan de transformation du secteur de la santé dans les deux groupes d'hôpitaux, s’élevant respectivement à 0,0629 et 0,0013, (p0,05). À long terme, nous n’avons observé aucune diminution importante de la pente de régression du taux de césarienne dans les deux groupes.La mise en oeuvre de ce plan de transformation du secteur de la santé a permis de diminuer le taux de césarienne. Cependant, cette réduction est en deçà des attentes.

Informal payment is a major barrier to universal health coverage, particularly in low and middle-income countries.The aim of this study was to determine appropriate methods to reduce informal payments in health care via a systematic review.For this systematic review, we searched the Cochrane Library, PubMed and SCOPUS covering the period 2000-2014: 10 papers which considered reduction strategies for IP were finally included in the review. Three of the authors independently extracted data and assessed the papers against inclusion and exclusion criteria.Improving public awareness and measures towards changing the culture were the main policies to combat informal payment. In addition, providing additional financial support to motivate physicians and other health service providers, appropriate monitoring of legislation, and converting informal to formal payment through tailored new policies were other solutions mentioned towards reducing or removing informal payments.No unique strategy exists for reducing informal payments in any health system. Choosing an appropriate strategy depends on the context and financing structure of the health system in any particular setting.استراتيجيات لتقليل المدفوعات غير الرسمية في النظم الصحية: استعراض منهجي.حامد زنديان، عاطفة اسفندياري، مينوعلي بوري سخا، أمير حسين تقيان.يُعدّ دفع مبالغ مالية بصفة غير رسمية عائقاً كبيراً أمام التغطية الصحية الشاملة، لا سيما في البلدان ذات الدخل المنخفض والمتوسط.هدفت هذه الدراسة إلى تحديد طرق مناسبة لتقليل المدفوعات غير الرسمية في نظام الرعاية الصحية من خلال استعراض منهجي.في هذا الاستعراض المنهجي، بحثنا في "مكتبة كوكرين" ومحرك بحث PubMed وقاعدة بيانات SCOPUS عن بحوث ودراسات تغطي الفترة من 2000 إلى 2014: وفي نهاية المطاف، اشتمل الاستعراض على 10 بحوث تناولت استراتيجيات لتقليل المدفوعات غير الرسمية. وقام ثلاثة من المؤلفين على نحو مستقل بتقييم البحوث من حيث الشمول والجودة، واستخراج البيانات، وتقييم خطر التحيز.كانت السياسات الرئيسية لمكافحة المدفوعات غير الرسمية تتمثل في إذكاء الوعي العام واتخاذ تدابير تهدف إلى تغيير الثقافة. وإضافة إلى ذلك، ذُكرت حلول أخرى من أجل تقليل المدفوعات غير الرسمية أو القضاء عليها، ألا وهي تقديم دعم مالي إضافي لتحفيز الأطباء وغيرهم من مُقدمي الخدمات الصحية، والرصد المناسب للتشريعات، وتحويل المدفوعات غير الرسمية إلى مدفوعات رسمية من خلال سياسات جديدة مُعدة خصوصاً لذلك.لا توجد استراتيجية وحيدة لتقليل المدفوعات غير الرسمية في أي نظام صحي. بل يعتمد اختيار الاستراتيجية المناسبة على ظروف النظام الصحي وهيكله المالي في أي بيئة معينة.Stratégies visant à réduire les paiements informels dans les systèmes de santé : analyse systématique.Les paiements informels représentent un obstacle majeur à la couverture sanitaire universelle, en particulier dans les pays à revenu faible et intermédiaire.L’objectif de la présente étude était de déterminer des méthodes appropriées pour réduire les paiements informels dans les soins de santé par le biais d’une analyse systématique.Pour la présente analyse systématique, nous avons fait des recherches dans la Cochrane Library, PubMed et SCOPUS couvrant la période 2000-2014 : 10 articles de recherche qui envisageaient des stratégies de réduction des paiements informels ont finalement été inclus dans l’analyse. Trois des auteurs ont extrait les données et ont évalué ces articles de façon indépendante par rapport aux critères d’inclusion et d’exclusion.L’amélioration de la sensibilisation du public et les mesures visant à changer la culture ont été les principales politiques de lutte contre les paiements informels. En outre, la fourniture d’un soutien financier supplémentaire pour motiver les médecins et les autres prestataires de services de santé, un suivi approprié de la législation et la conversion des paiements informels en paiements formels par le biais de nouvelles politiques adaptées sont d’autres solutions mentionnées pour réduire ou supprimer ce type de paiements.Il n’y a pas de stratégie unique pour réduire les paiements informels dans quelque système de santé que ce soit. Le choix d’une stratégie appropriée dépend du contexte et de la structure de financement du système de santé dans un contexte particulier.

Background: In Iran, the most common mode of HIV transmission among male intravenous drug users is sharing injection needles and syringes.Harm reduction initiatives, as a way of reducing the burden of this problem , are a set of policies and programs which attempt primarily to reduce the adverse health, social, and economic consequences of substances to drug users, their families, and communities. Objectives: The objective of this study was to elucidate the challenges and successes of HIV/AIDS services delivery as perceived by senior officials and service providers. Patients and Methods: Face-to-face, semi-structured interviews were conducted in Shiraz, Iran with a purposive sample of sub-national service providers. A thematic analysis of these qualitative data was conducted by the authors. Results: Participants identified major challenges and successes of HIV/AIDS services delivery. Service delivery and accessibility, in terms of challenges and successes, were classified. Conclusions: Our study demonstrates that, despite greater availability of HIV/AIDS services, this availability is not associated with greater accessibility and utilization because of multiple, complex, and interrelated barriers to HIV/AIDS service provision at the service delivery level.

Background: Providing healthcare for mothers and children is one of the major health duties in any community and is considered as a health index. Regarding the analysis of healthcare services, Anderson's behavioral model has received great attention. According to this model, social factors play a determining role in consumption of healthcare services. Objectives: The present study aimed to determine social factors affecting healthcare consumption. Patients and Methods: This descriptive, cross-sectional, population-based study was conducted on 735 women who were mothers and were aged between 15 and 49 years old. These subjects were selected through multi-stage cluster random sampling. The study data were collected using a researcher-made data gathering form. The data were entered into the SPSS software and analyzed using descriptive statistics and multiple logistic regression tests with the enter method. The significance level was set at < 0.05. Results: The mean age of the studied women was 30.6 ± 5.7 years. Most of them (628 cases, 85.4%) were housewives and 317 (43.1%) had high school education. Besides, 570 women (77.6%) had no incomes and 94 (12.8%) mentioned that they had received no services during pregnancy. Nevertheless, 74 (56.1%), 248 (33.8%) and 74 (10.1%) had received services from governmental, private, or both centers, respectively. Women's and husbands' education levels as well as women's occupation affected reception of services. Conclusions: According to the results, a large number of the subjects had not received services and in case they had, it was from the private sector. Moreover, social factors, such as education level, income and occupation, were influential factors regarding received services.