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Objectives To achieve sustainable health development, health systems need to constantly enhance their efficiency, through for instance reducing waste of resources. This study aimed to measure the efficiency in producing health in Upper Middle-Income Countries (UMICs) with a focus on Iran. Method A modified data envelopment analysis (DEA)-based Malmquist Productivity Index (MPI) was used to assess the changes in health productivity. Panel data was extracted from databases of the World Health Organization and the World Bank for the period of 2009–2015. Results The efficiency score of 13% of countries was higher than 0.8, while the score of all countries was above 0.5. The average score of Iran performance was 0.791 during the period. On average, performance improved in 15 countries, while it declined in 20 countries during the study period. Conclusion Different countries have implemented various health reforms to improve efficiency. We envisage, policy makers in the UMICs locate their health system performance and plan to improve it in line with the local specifications, along with the global pathway towards universal health coverage and sustainable health development ultimately.

Background: Aiming to enhance quality of care and increase efficiency, public hospitals have undergone several reforms in the course of last two decades in Iran. This paper reports the result of a national research that aimed to measure the technical efficiency and productivity change of public hospitals during 2012-2016 in Iran. Methods: We used Extended Data Envelopment Analysis (Extended-DEA) (an innovative modification to conventional DEA) to measure technical efficiency and productivity of 568 public hospitals. Nationally representative data were extracted from the official annual health reports. Data were analysed using GAMS software 24.3. Results: The average efficiency score of all hospitals was 0.733. 10.1% of all hospitals were efficient while 2.68% of them were under 0.2. The Malmquist Productivity Index (MPI) progressed in 49.3% of hospitals, remained constant in 2.3%, while 48.2% of hospitals regressed during 2015-2016. The average of MPI was 1.07 over the period of analysis. Conclusions: Extra efforts seem to be essential to enhance the efficient use of resources and develop appropriate policy solutions and tools. In particular, to increase the return to scale, we advocate the merger of small-size district hospitals towards establishing bigger efficient hospitals in various geographical regions across the country.

Background: Various pay for performance (PFP) models have been used for different purposes in many countries. The present study aimed to investigate the general framework and feasibility of the PFP program that was implemented in Iran (IR-PFP). Methods: In 2016, a document analysis was performed to achieve the original framework, and to evaluate its validity with the help of 2 expert panels, and both phases were managed using a four-stage Hermeneutic cycle. Results: The results of reviewing the documentation revealed that the framework required some prerequisites and determining the PFP of the department and individuals. The expert panels confirmed these 3 components, however, a fourth component namely determining the payment time was added to the model. In addition, the status of the key factors in the design and implementation of the program was reported. Conclusions: The model prerequisites proved helpful in considering the work diversity in hospitals. Furthermore, determining the PFP in 2 stages allowed the inclusion of more indicators in the structure of the program, however, it seems that determining the payment time in 3 months has not been practical for the Iranian health system. The framework has some instruments to strengthen teamwork and decentralize the human resources control and performance measurement in hospitals, however, hospital managers should always be careful about the unwanted side effects.

Background: During the last decade, the rapid expansion of universal neonatal hearing screening (UNHS) has brought into focus questions about the most appropriate screening technology for this indication. Objectives: The main aim of this study was to examine the cost-effectiveness of automated auditory brainstem response (AABR) and otoacoustic emissions (OAE) in universal neonatal hearing screening programs. Methods: This economic study was performed in Iran. A decision tree model was applied for economic evaluation of the AABR and OAE devices used in UNHS. The main inputs of our model included the prevalence of hearing loss in Iran, device sensitivity, specificity and cost per case, as well as definite diagnosis of each newborn. Upon collection, these inputs were analyzed with TreeAge economic analysis software. Sensitivity analysis was conducted upon examining the probability of uncertainty concerning the inputs. Results: For a one-year period and a one-million population of newborns, the UNHS entails a cost of $3,310,700 and detects 4,650 newborns with hearing loss, using the AABR device. However, if the OAE device is used, the cost will be expanded to $3,414,100 and 3,850 newborns with hearing loss will be detected. Consequently, the AABR device costs $103,400 less than the OAE device, and detects 800 more cases than the OAE device. Sensitivity analysis results revealed that the prevalence rate or costs of the gold standard had no effect on displacing the dominant technology. Conclusions: In this study, it was found that the AABR is the cost-effective alternative compared to OAE. AABR dominates OAE, because it has lower expected costs and higher effectiveness.

The Demographic and Health Surveys (DHSs) have been used throughout the developing world for the last 20 years to provide data on the distribution of disease in order to inform planning. Data on child illness and death are reported by mothers and are susceptible to error.We conducted an in-depth study of the Iranian DHS carried out in 2000-2001 and reviewed 110 DHS carried out around the world to check for bias by assessing the social gradient in reported child morbidity and mortality.We found that the reported under-5 child morbidity and mortality rates for the 28 Iranian provinces were inversely correlated (r = -0.592, P0.001) and that the adjusted social gradient of child morbidity implied increased illness in those who had literate vs illiterate mothers (OR = 1.26, 95% CI 1.20-1.32) compared with a decrease in mortality with increased literacy (OR = 0.52, 95% CI 0.46-0.59). Many of the other DHSs also show increased rates of reported child diarrhoea in households with higher levels of maternal education, access to piped water and urban (vs rural) dwellings, the reverse of what is found with mortality rates.This suggests that there may be significant recall and reporting bias in under-5 childhood morbidity in DHSs. Caution should be used in the interpretation and use of data from DHSs and the survey methods should be reviewed.

Background and Aim: Otoacoustic emissions (OAE) and automated auditory brainstem response (AABR) are the most commonly-used methods for universal neonatal hearing screening (UNHS). Various sensitivity and specificity rates have been reported for the OAE and AABR tests as tools for screening newborn hearing. The main objective of this review was to determine the pooled sensitivity and pooled specificity of each of the two devices in comparison with ABR as the gold standard. Methods: A systematic review was performed to evaluate the diagnostic accuracy of the OAE and AABR tests. Research was conducted in the relevant domestic and international databases. There were no time restrictions. The quality of included studies was evaluated with Quality Assessment of Diagnostic Accuracy Study (QUADAS) checklist using the software RevMan 5.1 and results were extracted. After organizing and extracting data, the pooled sensitivity and specificity of OAE and AABR tests were calculated with Meta-Disc software. Results: A total of 5154 articles were found; 57 articles were investigated in full and 17 articles possessed the inclusion criteria. Analysis was performed on the basis of these results. the quality of the studies was weak (7 cases) to moderate (10 cases). Results of the meta-analysis showed that the pooled sensitivity and specificity of the OAE were 0.77 and 0.93 respectively, and for AABR they were 0.93 and 0.97 respectively. Conclusion: The single stage screening protocol using AABR is an effective alternative to the single stage screening protocol using OAE, which is less accurate.

Background: To reduce the health inequity, it is necessary to measure and monitor these inequalities. In this regard, in Iran a plan was developed and accordingly 52 indicators to measure equity in health were developed and announced by the Ministry of Health in collaboration with other sectors. This study aims to obtain a deeper understanding of the development of health equity indicators and identify their implementation challenges and proposed solutions from the perspective of policy makers and executives responsible for the indicators development and implementation. Methods: In this qualitative study, data were gathered using semi-structured interviews with 15 Stakeholders involved in the development and implementation of these health equity indicators (at national and provincial levels), and the review and analysis of relevant documents including meeting minutes, working plans and working progress reports. Data were analyzed using a framework analysis approach. Results: Four main themes were identified, including the concept of equity in health and its importance, the use of health equity indicators and process of indicators development, challenges of development and implementation of the indicators and laying the groundwork for the establishment of indicators. The findings showed that policy makers' viewpoint on concepts and indicators is different from those of executives and their perceptions have little in common. The establishment of indicators requires accurate stakeholders' understanding and accurate insight into the issue of equity in health, political will, financing, training and empowerment of organization's employees, legal requirements, and finally a clear action plan. Conclusion: The development of the indicators requires a shared understanding among policy makers and executives. As the attention has been focused recently on the issue, in addition to knowledge improvement, proper solutions with an intersect oral collaboration approach in order to tackle challenges should be considered.

Pressure ulcers (also called bed sores, decubitus ulcers or pressure sores) are sores on the skin caused by pressure or rubbing. They usually affect immobile people on the bony parts of their bodies such as hips, heels and elbows, and take a long time to heal. Electromagnetic therapy is not a form of radiation or heating, but uses an electromagnetic field with the aim of stimulating healing. However, the review of trials concluded that there is no strong evidence that electromagnetic therapy helps or hinders healing of pressure ulcers.