Translating political commitments into actions to enhance Universal Health Coverage in the Eastern Mediterranean Region

Background:Many countries in the Eastern Mediterranean Region (EMR) have developed packages of services for achieving Universal Health Coverage (UHC), however, policymakers, especially in resource-constrained countries, still face challenges in delivering equitable, efficient and sustainable health services.Aims:To provide guidance for EMR countries and develop packages of services for UHC.Methods:We used information gathered from narrative reviews, national experiences and expert consultations to develop step-by-step guidance for the development of national packages of services for the achievement of UHC by countries in the EMR.Results:The processes used to develop packages of services varied between EMR countries and these processes may not have involved all relevant stakeholders. We highlight in this paper the iterative processes, including several phases and steps, to be used by EMR countries for developing packages of services for UHC. These processes also make provision for continuous monitoring and revision to make necessary improvements as morbidity patterns evolveConclusion:Developing a package of services for the achievement of UHC is a significant milestone for EMR countries and it is central to shaping the healthcare system for effective delivery of services.

Developing a framework for the monitoring and evaluation of the Health Transformation Plan in the Islamic Republic of Iran: lessons learned

Background: Monitoring and evaluation of health system reforms are essential to ensure the achievement of their objec-tives. The latest heath sector reform in the Islamic Republic of Iran, namely, the Health Transformation Plan (HTP), was launched in 2014 and the country is embarking on the HTP to achieve universal health coverage (UHC). Aims: The study aimed to develop the most appropriate monitoring and evaluation framework for the HTP in accordance with national and global goals and priorities, and to identify data gaps in its monitoring and evaluation. Method: A case study and evidence-based approach was applied to develop the monitoring and evaluation framework. The model that was proposed jointly by the World Bank and the World Health Organization for monitoring and eval-uation of UHC was used as the basis for the potential list of the indicators and key policy documents were reviewed, accordingly. The framework formulation process was carried out through a series of meetings with experts and senior managers working at the Ministry of Health and Medical Education, whose perspectives on the frameworks functionality and usage were regarded as valuable. The final draft was presented to policy-makers for input and approval.Results: A data mapping revealed that at least nine national surveys were required to obtain the indicators for effective monitoring. At the time of framework designing, many indicators were not available or had not been updated for several years due to lack of available and appropriate data sources.Conclusions: Results indicated that the country’s health information system had many information gaps that should be filled to enable the tracking of UHC goals and measuring the success of the plan. Applying the proposed framework would increase the comparability of the country’s health indicators at the global level and specify a path to successfully achieve the objectives of the reform.

Contexte : Le suivi et l’évaluation des réformes des systèmes de santé sont essentiels pour garantir la bonne réalisation des objectifs que celles-ci se sont fixés. La dernière réforme du système de santé en République islamique d’Iran, appelée Plan de transformation sanitaire, a été lancée en 2014. La République islamique d’Iran a commencé à mettre en œuvre ce plan en vue de réaliser la couverture sanitaire universelle (CSU).Objectifs : La présente étude avait pour objectif d’élaborer un plan d’action de suivi et d’évaluation du Plan de transformation sanitaire le plus approprié qui soit, conformément aux priorités et aux objectifs mondiaux et nationaux, ainsi que d’identifier les lacunes à combler en matière de données concernant ce processus de suivi et d’évaluation.Méthodes : Une étude de cas et une approche reposant sur des bases factuelles ont été appliquées pour le cadre susmentionné. Le modèle proposé par la Banque mondiale et l’Organisation mondiale de la Santé (OMS) pour le suivi et l’évaluation de la couverture sanitaire universelle (CSU) a été utilisé pour servir de base à une liste possible d’indicateurs. Des documents d’orientation clés ont ainsi été passés en revue. Le processus de formulation du cadre d’action a été mené au moyen d’une série de réunions entre experts et hauts responsables travaillant dans différents départements du ministère de la Santé et de l’Éducation médicale dont les perspectives sur la fonctionnalité et l’utilisation du cadre d’action étaient considérées comme utiles. Le projet final a été présenté aux responsables de l’élaboration des politiques en vue d’obtenir leurs contributions et leur approbation.Résultats : Une cartographie des données a révélé qu’au moins neuf études nationales étaient requises pour obtenir les indicateurs permettant un suivi efficace. À l’étape de la conception du cadre d’action, de nombreux indicateurs n’étaient pas disponibles ou n’avaient pas été mis à jour depuis plusieurs années du fait de l’absence de source de données fiables.Conclusions : Les résultats ont indiqué que le système d’information sanitaire du pays comportait de nombreuses lacunes nécessitant d’être comblées afin de permettre d’évaluer les progrès effectués sur la voie de la réalisation des objectifs de la CSU et d’appréhender la réussite du plan. La mise en œuvre du cadre d’action proposé permettrait d’augmenter la comparabilité des indicateurs sanitaires du pays au niveau mondial et de préciser la voie à emprunter pour atteindre les objectifs annoncés dans la réforme.

Barriers to Health Service Utilization Among Iranian Female Sex Workers: A Qualitative Study / 예방의학회지

OBJECTIVES: In most countries around the world, sex work is an illegal activity. Female sex workers (FSWs) in Iran hide their identities, and they are known to be a hard-to-reach population. Despite free access to HIV testing, fewer than half of FSWs receive HIV testing. The purpose of this study was to characterize the reasons for which FSWs do not seek testing at drop-in centers (DICs) and voluntary counseling and testing (VCT) centers in Iran. METHODS: A qualitative study was conducted in 2016. The participants were 24 FSWs who received services at VCT centers and DICs for vulnerable females in the north of Iran and 9 males who were the clients of FSWs. In this study, we made use of purposive sampling and carried out a thematic analysis. RESULTS: We found 4 major and 6 minor themes. The major themes were: fear of being infected (with HIV), stigma, indifference, and knowledge. CONCLUSIONS: Despite the significant efforts made by the government of Iran to establish and expand DICs for vulnerable females, the number of FSWs receiving services at these centers has not been very considerable. Consequently, by introducing and implementing training programs for peer groups, it may be possible to take steps toward establishing strategic programs for the control and prevention of HIV/AIDS.

Healthy and Unhealthy Dietary Patterns Are Related to Depression: A Case-Control Study

OBJECTIVE: Major depressive disorder is the leading cause of disability around the world. The relationship between depression and dietary patterns has been reported in a few studies but with controversial results. This study aimed to investigate this relationship in an Iranian population. METHODS: In our study, 330 depressed patients (cases) and healthy people (controls) (1:2) were individually matched according to age, sex and area of residence. New cases of depression were recruited from two psychiatric clinics in Tehran. Interviewers went to each patient's residential area, and invited qualified individuals to participate in the study as controls. Food intake over the past year was collected using a validated semi quantitative food frequency questionnaire. Dietary patterns were determined by the principal components method. Binary logistic regression was used to test the effect of dietary patterns on depression. RESULTS: We identified two major dietary patterns by using factor analysis: the healthy and unhealthy dietary patterns. We categorized the scores of these patterns to quartiles. After adjusting for non-depression drug use, job, marital status, children number, and body mass index, the relations of depression and quartiles of two dietary patterns are significant (p=0.04 & p=0.01, respectively). Compared with participants in the lowest quartile, those in the highest quartile had significantly lower odds ratio (OR) for depression in healthy dietary pattern, and higher OR for depression in unhealthy dietary pattern. CONCLUSION: This study indicates that healthy and unhealthy dietary patterns may be associated with the risk of depression. The results can be used for developing interventions that aim to promote healthy eating for the prevention of depression.