Challenges of Implementing an Effective Primary Health Care Accreditation Program: a qualitative study in Iran.

BACKGROUND: Accreditation is a prerequisite for scientific management of the health system, owing to its numerous benefits on health centres' performance. The current study examined Iran's primary healthcare accreditation program to ascertain the challenges to its successful implementation. METHODS: This qualitative study examined the perspectives of 32 managers and staff members in the pilot accreditation program (from the Ministry of Health and Medical Education, Semnan University of Medical Sciences, and Aradan District Health Network). Three in-depth group interviews were conducted using a semi-structured questionnaire, and the data obtained were assessed using thematic analysis. As a result of this investigation identified six themes, 29 sub-themes, and 218 codes as challenges to the successful accreditation of primary health care in Iran. RESULTS: Six main themes, including "organisational culture", "motivational mechanisms", "staff workload", "training system", "information systems", and "macro-executive infrastructure", were identified as the main domain of challenges, with seven, five, two, four, three, and eight sub-themes respectively. CONCLUSION: Accreditation of PHC in Iran faces significant challenges and obstacles that, if ignored, can jeopardise the program's success and effectiveness. By identifying challenges and obstacles and making practical suggestions for overcoming them, the findings of this study can aid in the program's successful implementation and achievement of desired outcomes.

Catastrophic health expenditures in hospitalized patients with delta variant of COVID-19: A cross-sectional study.

Background: Financial protection of populations against healthcare costs is one of the fundamental responsibilities of governments. This study aimed to investigate the incidence of catastrophic health expenditures (CHE) and it's affecting factors in hospitalized patients with delta variant of COVID-19. Methods: In this cross-sectional study, we included 400 hospitalized COVID-19 patients at Kosar Hospital of Semnan in 2022, using a researcher-made checklist. Based on qualitative nature of the variables, chi-square test was used to investigate the statistical associations between the demographic/background characteristics and the incidence of CHE. Results: On average, COVID-19 imposed 1833.43 USD direct medical costs per one hospitalized patient. The ratio of direct-medical costs to household's non-food expenses was 2.35, and 61% (CI:±4.78%) of the patients were subject to CHE. Besides, residence place, basic insurance type, benefitting from supplementary insurance, suffering from underlying diseases, hospitalization in ICU, falling into a coma, facing pulmonary failure, and performing hemoperfusion had significant associations with CHE (P<0.05). Conclusion: The incidence of CHE in hospitalized COVID-19 patients was undesirable, which may be due to geographical, economical, and occupational inequalities apart from the factors related to the severity of the disease. So, health policymakers should pay attention to the provision of proper financial risk protection policies to make the health insurance system more efficient and appropriate.

The roles and functions of future hospitals in health promotion: A systematic review in Iran.

As a main pillar of the health and social welfare system, hospitals affect the public health status in two ways: (1) Prevention, treatment, and rehabilitation services and (2) external effects on society and the environment. The present study aimed to identify the roles and functions of future hospitals in the world. The present study was a systematic review in which all studies about the roles and functions of future hospitals in different countries with a time limit of 2000 to August 2021 were extracted from foreign databases, including PubMed, Cochrane, Scopus, and Web of Science, and search engine, Google Scholar, as well as Persian databases, including Magiran, SID, and Iran Medex. We utilized the STROBE checklists for quantitative studies and SRQR checklists for qualitative studies to critique and evaluate the quality of qualitative studies. We then extracted their results and classified the content according to the main and subtopics. A total of 16 articles met the inclusion criteria of the present study. Hospitals can play four roles: stand-alone, dominant, collaborative, and partner. Findings were classified into six general groups: the role and mission of future hospitals, the way of providing care, funding, staff and patients, technology and information of future hospitals, and the challenges and barriers of current hospitals. Health service policy-makers need to pay special attention to technological innovations and advances as well as changes in the roles and functions of hospitals and seek to turn the threats arising from external changes into opportunities for better hospital performances.

Future Development Through the Past: Pathology of the Financing Dimension of Iran's Health Transformation Plan.

BACKGROUND: In Iran, during the years, the budgeting model used for healthcare funding is affected by factors such as global oil prices and fluctuation in the exchange rates. So, developing or continuing to implement a plan in the health system depends on the current and future global and local economic trends. OBJECTIVE: To analyze the future of the recent significant reform called Health Transformation Plan (HTP), started on June 15, 2014, in the light of potential financial barriers and challenges. METHODS: Face-to-face interviews were conducted with health policymakers at different levels of the health system, health researchers, health insurance officers, and faculty members. Also, published and unpublished documents about HTP in the country and worldwide were reviewed. Data analysis was done using a qualitative inductive content analysis approach and assisted by qualitative data management software. RESULTS: Instability of financial resources and allocation of gross domestic product (GDP) to the HTP in the traditional way is a challenge in continuing this policy reform. Also, the bureaucratic procedures in allocation and distribution of funds, the discrepancy between health insurance funds and affiliated units of Ministry of Health and Medical Education (MoHME) especially Medical Sciences Universities (MSU), the lack of purchaser-provider split, inappropriate payments and compensation mechanisms, and dependence of MSU on especial revenues are the main challenges that threaten the future of HTP in Iran. CONCLUSION: Given the current situation, where the country's funding resources are often unpredictable, it seems that such funding challenges will lead to poor HTP results. Therefore, the continuance of such a high cost-based plan requires the strategies and policies to ensure raising additional funds through various types of innovative financing to overcome challenges.

Seven Decades of Primary Healthcare during Various Development Plans in Iran: A Historical Review.

OBJECTIVE: To explore historically primary healthcare (PHC) development in Iran in the light of development plans before and after the Islamic Revolution. The results of this study can be used to outline the future of PHC in the Iranian health system. METHODS: We conducted a retrospective analysis of the PHC development in the Iranian health system using data from relevant published and unpublished policy documents. The literature was retrieved and reviewed on the basis of predetermined inclusion criteria with no language or date restriction. The data were integrated and analyzed using content analysis. RESULTS: During various upstream development plans, the attitude of the policy makers to PHC has been very different, resulting in fundamental differences in addressing such an important issue and the consequent outcomes. In the aftermath of Iran's revolution, due to more understanding of PHC services importance and the principal slogans of the revolution to pay attention to villagers and vulnerable people, health policymakers paid more attention to PHC, which was not evident in previous periods. CONCLUSION: Despite considerable achievements in PHC, the history of PHC in Iran indicates frequent changes in planning and health provision structure. This suggests that the challenges facing the health sector today, the evolving needs and demands of the people, and population changes necessitate reinforcement and reform in the structure of the current PHC network as the main mission of Iran's Ministry of Health.

Policy analysis of the Iranian Health Transformation Plan in primary healthcare.

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.

Using an Analytical Framework to Explain the Formation of Primary Health Care in Rural Iran in the 1980s.

BACKGROUND: In the 1980s, PHC implementation promoted the health care delivery and overall health status of the population in Iran. Identifying the crucial design and implementation aspects of the PHC program can highlight the way it was implemented in a difficult sociopolitical environment. Using a policy analysis approach unfolds the details of implementation in a context which was not overtly convenient for a great health system reform. METHODS: We conducted semi-structured interviews with 35 key participants and collected relevant literature and documents. We used a policy triangle framework to conceptualize the study and used a thematic data analysis approach to analyze the verbatim transcribed texts and documents. Data were analyzed with regard to the context, content, process and actors of the policy. RESULTS: Proper use of the conditions and opportunities, during the first years after a revolutionary political change resulted in the establishment of a PHC network in Iran. Talented actors, clear content with agreed objectives and a top-down approach to the implementation in a special sociopolitical context were the main influential factors to fulfillment of the PHC policy in Iran. However, full implementation of the policy was hampered by the failure of some main components like referral system. CONCLUSION: The policy triangle framework helped us to separate the different components of the PHC policy denoting that successful implementation of a policy requires attention to all related elements. Policy actors should invest in the development of an effective advocacy coalition, while giving ample attention to the implementation concerns. National health policies can be materialized even during financial hardships, if they align with the wider expectations of the public and politicians.

Effects of Targeted Subsidies Policy on Health Behavior in Iranian Households: A Qualitative Study.

BACKGROUND: This study aimed to explore the effects of national targeted subsidies policy on health behavior of Iranian households. METHODS: In this qualitative study, data were collected between January 2012 and December 2013 through face-to-face interviews (23 experts in national and provincial levels of health system and 18 household heads) and through a comprehensive and purposive document analysis. The data was analyzed using a thematic analysis method (inductive-deductive) and assisted by Atlas-ti software. RESULTS: Rising health care costs, removing some food subsidies and the increase in price of most goods and services due to the implementation of economic policy of targeted subsidies have led to significant changes in the demand for health services, changes in the consumption trends of goods and services affecting health as well as changes in the health habits of households. CONCLUSION: Targeted subsidies and the cash subsidy policy have some negative effects on population health behavior especially among poor people. Hence, maintaining or increasing the cash subsidy is not an efficient allocation of resources toward health care system. So, it is necessary to identify appropriate strategies and policies and apply interventions in order to moderate negative effects and enhance positive effects resulted from implementing this economic reform on population health behavior.