Publications by authors named "Hasan Abolghasem Gorji"

33 Publications

Network governance theory as basic pattern for promoting financial support system of the poor in Iranian health system.

BMC Health Serv Res 2021 Jun 7;21(1):556. Epub 2021 Jun 7.

Department of Agriculture and Natural Resources, University of Hormozgan, Bandar Abbas, Iran.

Background: The share of out-of-pocket payments in Iranian families has the greatest burden on the poor and lead to an impoverishment caused by catastrophic health expenditures. In order to improve access of the poor to public resources, it is necessary to create a better governance system and effective policy-making. The purpose of this study is to improve network effectiveness of the Iranian health system and to design a financial protection network for the poor, based on the network governance theory.

Methods: We are using a quantitative method framework in conjunction with a Social network analysis (SNA) strategy. To draw an optimal network, we conducted interviews with experts by focusing on the arrangement and relationship among different institutions. The research sample was purposefully selected. We used UCINET software for data analysis and NetDraw software to draw networks.

Results: In this article, an optimal network was proposed with the following characteristics: First, the problem of the density of relationships among several central institutions and the isolation of the other institutions have been solved. Second, in our model, the relationships have been distributed in a balanced manner among all institutions in the network. Third, the number of participants has been reduced and consensus on poor people support policies has been achieved in this optimal network. Forth, executive organizations keep their central positions and upper institutions are not at the central position, so that the power is distributed in favor of more balanced governance. However, in order to increase efficiency and to have coherent decision-making, it is necessary to establish a "core" for this optimal network. The "core" has to include the organizations with the most relationship with others.

Conclusion: The result revealed that the usefulness of network analysis as a tool for proposing the effectiveness of governance. By strengthening the relationship among the main actors, an organized system of network management can be achieved. The network has to include all actors from different levels, from policy-making to implementation. The network also has to clarify the tasks from identifying the poor to covering costs. From an academic perspective, this study showed the adequacy of network analysis as a tool for policy sciences. Governance in our optimal health financial protection model follows the shared-governance pattern due to its high density, low centralization and low distance. The model of network governance can be the source of changes in the health governance system. It is a necessary structural condition to provide access to universal health coverage.
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http://dx.doi.org/10.1186/s12913-021-06581-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183031PMC
June 2021

Evaluation of social accountability in hospital managers.

J Educ Health Promot 2021 31;10:104. Epub 2021 Mar 31.

Tehran Emergency Center, Tehran, Iran.

Background: Today, hospitals need managers who, in addition to having the necessary skills for management and leadership, are accountable to stakeholders, especially the community. Accordingly, the purpose of this study was to evaluate the social accountability of managers of public and private hospitals in Tehran.

Materials And Methods: The present study is descriptive-analytical and cross-sectional and was performed on 155 managers of selected public and private hospitals in Tehran. The research tools included a demographic characteristic questionnaire and a researcher-made social accountability questionnaire for managers. Data analysis was performed using descriptive and inferential statistics in SPSS 22 software.

Results: The situation of social accountability in the managers of public hospitals was at a weak level and in the managers of private hospitals in Tehran was at a good level. In comparing the status of social accountability and its dimensions in the managers of public hospitals with the managers of private hospitals, the status of social accountability in the dimensions of human resource management, quality improvement, executive management, and overall social accountability were significantly different from each other ( ≤ 0.05). However, in terms of governance, the status of social accountability of public hospital managers was not significantly different from private hospitals ( ≥ 0.05). Overall, the results of social accountability in private hospitals were better than in public hospitals.

Conclusion: The social response status of managers in private hospitals was better than public ones. Lack of attention of managers to social accountability affects the quality of other educational, health, and medical services. This fact raises the need for managers to pay more attention to the issue of social accountability.
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http://dx.doi.org/10.4103/jehp.jehp_359_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150057PMC
March 2021

Assessing Iran's health system according to the COVID-19 strategic preparedness and response plan of the World Health Organization: health policy and historical implications.

J Prev Med Hyg 2020 Dec 14;61(4):E508-E519. Epub 2021 Jan 14.

Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Italy.

Background: The role of health systems in the management of disasters, including natural hazards like outbreaks and pandemics, is crucial and vital. Healthcare systems which are unprepared to properly deal with crises are much more likely to expose their public health workers and health personnel to harm and will not be able to deliver healthcare provisions in critical situations. This can lead to a drammatic toll of deaths, even in developed countries. The possible occurrence of global crises has prompted the World Health Organization (WHO) to devise instruments, guidelines and tools to assess the capacity of countries to deal with disasters. Iran's health system has been hit hardly by the COVID-19 pandemic. In this study, we aimed to assess its preparedness and response to the outbreak.

Methods: The present investigation was designed as a qualitative study. We utilized the "COVID-19 Strategic Preparedness and Response Plan" devised by WHO as a conceptual framework.

Results: The dimension/pillar which scored the highest was national laboratories, followed by surveillance, rapid response teams and case investigations. Risk communication and community engagement was another pillar receiving a high score, followed by infection prevention and control and by country-level coordination, planning and monitoring. The pillars/dimensions receiving the lowest scores were operational support and logistics; case management; and points of entry.

Discussion: The COVID-19 pandemic has represented an unprecedent event that has challenged healthcare systems and facilities worldwide, highlighting their weaknesses and the need for inter-sectoral cooperation and collaboration during the crisis. Analyzing these experiences and capitalizing on them, by strengthening them,will help countries to be more prepared to face possible future crises.
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http://dx.doi.org/10.15167/2421-4248/jpmh2020.61.4.1613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888405PMC
December 2020

The challenge of outsourcing of hospital services in Iran: A qualitative study.

J Educ Health Promot 2020 30;9:294. Epub 2020 Oct 30.

Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Outsourcing, as one of the important managerial strategies to improve performance, has become one of the main areas of research in hospital management studies. The aim of this study was to identify the challenges of outsourcing hospital services in Iran.

Methods: This research was conducted in a qualitative manner with the aim of determining the challenges of outsourcing hospital services in Iran. The research community consisted of managers and experts in the field of outsourcing. 21 managers and staff experts of the Ministry of Health, universities, and hospitals affiliated to Iran University of Medical Sciences, Tehran, and Shahid Beheshti, were selected as the target for the interview. Finally, the data were analyzed using content analysis method.

Results: Outsourcing challenges were extracted and reported in the form of 6 theme topics and 40 subthemes. The main issues included legal and political challenges, finance, human resources, organizational, managerial, and private sector.

Conclusion: Outsourcing hospital services in all six areas faced serious challenges. To this end, partnership between the private and government sectors through outsourcing requires the continuous development of effective political, organizational, and managerial capacity in order to guide and manage this process properly and efficiently to ensure that the goals and policies in the field of health. It is clearly understood and not forgotten or neglected.
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http://dx.doi.org/10.4103/jehp.jehp_132_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709742PMC
October 2020

Investigation of medical error-reporting system and reporting status in Iran in 2019.

J Educ Health Promot 2020 30;9:272. Epub 2020 Oct 30.

Department of Health Information Management, School of Health Management and Information Science, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Reporting medical errors is a major challenge in patient safety and improving service quality. The purpose of the present study is to investigate the status of error reporting and the challenges of developing an error-reporting system in Iran.

Methods: This study was designed with qualitative approach and grounded theory method in teaching hospitals affiliated to Iran University of Medical Sciences. The views of safety authorities at various levels of management, including those responsible for safety at the Ministry of Health, Vice Chancellor and Hospitals affiliated to Iran University of Medical Sciences, were investigated in 2019 regarding adverse events.

Results: Four major themes were identified included iceberg reporting and disclosure, weak reporting, underreporting, and non-error disclosure. The most common problems in reporting medical error were non-involvement of physicians in the error-reporting process, structural (human and information) bugs in root cause analysis sessions, and defective error prevention approaches designed based on the failure mode and effects analysis.

Discussion: Despite a large number of medical errors occurred in health-care settings, error reporting is still very low, with only a limited number of errors being reported routinely in hospitals and the rest are minor and occasional reports.

Conclusion: Creating a mandatory error-reporting system and requiring physicians to report and participate in error analysis sessions can create a safety culture and increase the error-reporting rate.
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http://dx.doi.org/10.4103/jehp.jehp_73_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709745PMC
October 2020

One health approach to tackle brucellosis: a systematic review.

Trop Med Health 2020 20;48:86. Epub 2020 Oct 20.

Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy.

Background: Brucellosis is the most significant and common bacterial zoonosis and is recognized as a re-emerging and neglected disease. Tackling zoonosis is very important for the health and the economy. One Health is an approach characterized by the integration of human and animal health, plants, and ecosystems and encourages joining local, national, and global multidisciplinary efforts to achieve optimal levels of health and collaboration among different disciplines to address complex health problems.

Objectives: The present study aimed to review published scientific literature related to the use of the One Health approach to tackle human brucellosis.

Methods: Web of Science (WoS), PubMed, Scopus, The Cochrane Library, and Embase databases were searched from inception until 30 January 2020. The reference lists of all relevant papers were hand-searched. Two authors extracted data from published studies independently. The Joanna Briggs Institute tool was used to assess the quality of studies.

Results: Of 2297 studies, 10 studies were deemed eligible, which were conducted between 2013 and 2019. Studies were performed in Uganda, Malta, Serbia, Greece, Mongolia, Azerbaijan, Israel, India, Ethiopia, and the USA. All studies suggested that brucellosis is still a major public health problem and that the most important aspect of the One Health approach is the interdependence of humans, ecosystems, and animals .Some studies have focused on livestock vaccination as the most effective way to prevent disease, and others have focused on the biology of infection and its transmission patterns. Some studies have pointed to the effectiveness of the One Health approach in all the phases of disease management as well as to its role in reducing health costs.

Conclusion: The success of the approach depends on the willingness of the decision-makers to implement the necessary policies. Due to the heterogeneity of current practices, and organizations involved in One Health approach-based programs, it will be incomplete without proper planning. To better implement the approach, strategies should be appraised and disseminated by experts and relevant stakeholders.
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http://dx.doi.org/10.1186/s41182-020-00272-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574566PMC
October 2020

Core competencies for health headquarters: a systematic review and meta-synthesis.

BMC Public Health 2020 Jun 9;20(1):891. Epub 2020 Jun 9.

Gerash University of Medical Sciences, Gerash, Iran.

Background: The availability of human resources for the health sector is not enough requirement for addressing health needs. Instead, it is necessary to take effective steps to meet the requirements of the health care system in case the system has the necessary competencies. This study was performed to identify the competencies of health headquarters in meeting the needs of the health system.

Methods: This thematic synthesis was performed to develop a set of central themes that summarize all the topics raised in the articles reviewed in this study. The quality of the articles was assessed by the Standards for Reporting Qualitative Research.

Results: We included 12 articles from seven countries. Seven central themes were inductively developed from the analysis: (1) Leadership and management, (2) Analyzing, interpreting, and reporting, (3) Public health knowledge, (4) Interpersonal relationship, (5) Personality competencies, (6) Cultural and community competencies, and (7) International/Global health competencies.

Conclusion: The findings of this review may help to address how to recruit and retain health headquarters, optimize the headquarters ability and expertise, and develop some approaches to promote their scientific, practical, and professional levels. These issues can drive the organization toward their visions, strategies, and great objectives.
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http://dx.doi.org/10.1186/s12889-020-08884-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285561PMC
June 2020

Prevalence of Psychiatric Disorders in Iran: A Systematic Review and Meta-analysis.

Int J Prev Med 2020 17;11:21. Epub 2020 Feb 17.

Department of Medical library and Information Science, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

The prevalence of mental disorders in Iran is rising for many reasons including the population growth and its problems, the collapse of the family foundation, the economic problems, etc. Epidemiological studies of psychiatric disorders play an important role in determining the general mental health of the population and policy-making and future planning of service delivery. To identify the relevant studies, two authors independently searched different scholarly databases including Embase, PubMed/MEDLINE, ISI/Web of Science (WOS), Scopus, Psych INFO, and Iranian databases such as MagIran, SID, IranPsych, and Irandoc from 1 January 2007 up to 1 July 2018. The gray literature (through Google Scholar) was also mined. Studies written in English or in the Persian language were searched. After searching the databases and removing duplicates cases, a total of 10 studies were selected and included in the study, which reported a total of 14 prevalence rates. There were a total of 72,262 participants, of whom 32,925 were male and 39,337 were female. The prevalence of psychiatric disorders in studies which used screening tool was 31.03% (95% confidence interval: 25.99-36.07). The prevalence was 25.42% in studies which used clinical interviews (95% CI: 15.96-34.88). There is an undeniable fact that the prevalence of mental disorders in Iran has been increasing, and this could be a warning to policy-makers and health system managers. Hence, it is necessary to pay attention to this issue to maintain social capital, vitality, and efficiency of individuals and society as a whole.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_510_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050223PMC
February 2020

How Cancer Supportive and Palliative Care is Developed: Comparing the Policy-Making Process in Three Countries from Three Continents.

Indian J Palliat Care 2020 Jan-Mar;26(1):72-79. Epub 2020 Jan 28.

Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Supportive and palliative care worldwide is recognized as one of the six main cancer control bases and plays an important role in managing the complications of cancer. Limited studies have been published in the field of this policy analysis in the world.

Aim: This study aimed to analysis the policy-making process of supportive and palliative cancer care in three countries.

Methodology: This qualitative study is a part of a comparative study. The data were collected through reviewing scientific and administrative documents, the World Health Organization website and reports, government websites, and other authoritative websites. Searches were done through texts in English and valid databases, in the period between 2000 and 2018. To investigate the policy process, heuristic stages model is implemented consisting of the four stages: agenda setting, policy formulation, policy implementation, and policy evaluation.

Results: The findings of the study were categorized based on the conceptual model used in four areas related to the policy process, including agenda setting, policy formulation, policy implementation, and evaluation of cancer palliative care policies.

Conclusion: Several factors are involved in how cancer palliative care policy is included in policy-makers' agenda, understanding a necessity, raising public awareness, and acceptance as a result of sensing the physical and nonphysical care outcomes. The stages of development, implementation, and evaluation of palliative care in countries regardless of existing differences are a function of the health system and context of each country.
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http://dx.doi.org/10.4103/IJPC.IJPC_55_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017679PMC
January 2020

Developing a Model for Accreditation of Iranian Teaching Hospitals: A Qualitative Study.

Ethiop J Health Sci 2019 Nov;29(6):657-668

Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Among different factors, accreditation is being widely used across the world to improve quality and safety in hospitals. Therefore, the purpose of the present study was to develop an accreditation model for teaching hospitals in Iran.

Methods: This qualitative study was conducted in four phases from January, 2017 to March, 2018. To this end; firstly, existing accreditation models were extracted and reviewed comparatively. Within the second stage, dimensions and components of the accreditation model were extracted through semi-structured interviews. In the third stage, a new instruction was developed via integrating the findings from the first and the second stages. Finally, the model was validated in two phases of Delphi method and a specialized forum in the fourth step. Qualitative findings were then analyzed using content analysis method.

Results: Models of Joint Commission International (JCI) and Word Federation for Medical Education (WFME) in other 6 countries were reviewed and compared with the current Iranian model. Extracted dimensions discovered to complement the present model included learner assessment, continuous reviews and revisions, and educational productivity. The final model was also developed with 12 dimensions and 94 standards. Content validity ratio (CVR) and content validity index (CVI) were also estimated to be 0.40 and 0.80, respectively. As well, the second round of Delphi method could increase the number of model standards to 97. Moreover, Cohen's kappa coefficient was calculated to be at least 0.71.

Conclusion: This study led to the development of a comprehensive model for scientific accreditation of teaching hospitals through reviewing documentation, combining and comparing global approaches, as well as integrating them with the views of domestic experts.
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http://dx.doi.org/10.4314/ejhs.v29i6.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842710PMC
November 2019

The challenges of hepatitis C management in Iran: A qualitative study with patients.

Int J Health Plann Manage 2020 Jan 3;35(1):e56-e65. Epub 2019 Nov 3.

Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

Background: The patient's perspective concerning the treatment process and the knowledge of the challenges and problems that they encounter can help to improve their treatment conditions.

Aim: The present study aimed at analyzing the experiences of hepatitis C virus (HCV) patients in Iran and the challenges encountered during the management and treatment process.

Methods: Semi-structured in-depth and face-to-face interviews were conducted. The criteria for selecting patients were as follows: HCV-positive subjects, with confirmed diagnosis of HCV, and under treatment. Content analysis was used to analyze the data. MAXQDA Ver11 software was used to better manage data. This study is based on the "Consolidated Criteria for Reporting Qualitative Research" (COREQ) checklist.

Results: Twenty-one HCV patients were interviewed. The mean age of participants was 36.14 ± 11.29 years. Seven themes with 20 subthemes emerged from the content analysis of the interviews, namely, (a) disease-related stigma, (b) lack of knowledge, (c) psychological problems, (d) financial problems, (e) complications of treatment, (f) lack of family and community support, and (g) health-care system.

Conclusion: The findings of this study showed that a range of economic, social, and cultural problems could affect the treatment of HCV patients. Health policy and decision makers should try to provide them with a better management.
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http://dx.doi.org/10.1002/hpm.2927DOI Listing
January 2020

Comparison of prevention, screening and treatment of hepatitis C in Iran, Egypt and Georgia.

J Virus Erad 2019 Apr 1;5(2):116-121. Epub 2019 Apr 1.

School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Italy.

Hepatitis C virus (HCV) infection represents one of the major public health challenges worldwide. HCV is a blood-borne pathogen associated with a high rate of mortality and imposes a dramatic societal and economic burden on health systems. Untreated chronic HCV infection can progress to liver cirrhosis and cancer. Lessons can be learned from countries such as Egypt and Georgia that are considered to be 'on-track' for the World Health Organization HCV elimination targets, as well as countries such as Iran that are 'working towards elimination'. This article compares HCV-related policies and strategies in Iran, Egypt and Georgia to identify programme strengths and limitations that could inform policy and decision makers in Iran. Controlling and eliminating HCV remain a serious public health challenge. The rising HCV incidence could generate a dramatic economic burden in the coming years. Therefore, Iran requires a strategic plan to fight HCV. Adequate cultural and social infrastructures are needed. Centres specifically devoted to the diagnosis and management of this infection should be used for screening and delivery of inexpensive and high-quality testing. Quick initiation of treatment should take place at lower costs to facilitate access to treatment.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543481PMC
April 2019

Nongovernmental organizations coordination models in natural hazards: A systematic review.

J Educ Health Promot 2019 15;8:44. Epub 2019 Feb 15.

Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Nongovernmental organizations (NGOs) play a significant role to provide humanitarian services in natural hazards. However, few studies have been conducted on the coordination models of NGOs. Using these models, NGOs are expected to act along with other agencies to provide unified and effective humanitarian's services. The present study aimed to identify the published coordination models of NGOs.

Materials And Methods: This systematic review was conducted from October to November 2017. Electronic source, including PubMed, Web of Science, ProQuest Research Library, and Scopus were examined. All English articles published in journals or presented at conferences were included in the study. Nonjournal and irrelevant articles were excluded from the study. Furthermore, papers which were not available as a full text and published in languages other than English were also excluded. Thematic analysis technique was used to analyze the articles.

Results: From 871 documents which captured in initial search, only 7 studies identified as eligible articles for extract 8 coordination models of NGOs in disasters and emergencies including: (1) Sphere project, (2) Cluster approach, (3) Code of conduct, (4) Decentralized approach, (5) National Disaster Response Framework, (6) Conceptual integrated NGO collaboration framework for community postdisaster reconstruction, (7) Model of temporal coordination of disaster response activities, and (8) Collabit application.

Conclusions: This systematic review identified eight proposed coordination models that have been implemented internationally, nationally, and locally in natural hazards. However, these models are not enough, and there are some gaps between what is it and what should be. More effective and efficient models and strategies are needed to increase the effectiveness of coordination activities at all levels of community. These results should serve policy-makers and administrators of NGOs delivering humanitarian services during and postnatural hazards to choose from a number of options on how to coordinate their efforts.
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http://dx.doi.org/10.4103/jehp.jehp_201_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6432838PMC
February 2019

Hepatitis C virus-related policy-making in Iran: a stakeholder and social network analysis.

Health Res Policy Syst 2019 Apr 16;17(1):42. Epub 2019 Apr 16.

Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Hepatitis C virus (HCV) infection is a major public health challenge worldwide. Implementing policies to cope with this challenge requires commitment from all stakeholders at various levels, and all necessary resources should be mobilised. Support for various HCV-related stakeholders can reduce the challenges and obstacles that can be encountered during the programme implementation. The present study aims to identify all stakeholders involved with HCV-related policy-making in Iran at different steps (policy development, implementation and evaluation) and to characterise them in terms of interest, position, power and influence, in order to provide valuable information for appropriate decision-making and design. The present study can also serve as a case study for healthcare systems in other countries.

Method: An approach based on social network analysis was utilised. Data collected included relevant document searches and in-depth interviews to a sample of 18 key informants.

Results: Various stakeholders were found to be involved with HCV-related policies in Iran. The extent of their participation and support in policy-making varied. Specifically, international agencies had a high interest for HCV-related policy-making, whereas media and members of the private sector were characterised by a medium interest and governmental and non-governmental bodies by a highly variable interest, ranging from low to high, depending on the specific organism. Moreover, media and members of the private sector, non-governmental institutions and international agencies were rated low in terms of position, whereas governmental actors were rated low to high. Media were rated medium in terms of power, whereas international agencies and members of the private sector were respectively rated low to medium and low. Non-governmental actors were rated low, whilst governmental bodies were rated low to high. Finally, media, members of the private sector and international agencies were rated medium in terms of influence, whereas non-governmental and governmental actors were respectively rated low to medium and low to high.

Conclusion: Policy-making involves trust, negotiation and integration of the different views of all stakeholders. Social network analysis was critical for identifying stakeholders and showing that, in Iran, involvement in HCV-related policy-making is generally low. This information is of practical implication for policy- and decision-makers regarding the adoption of more favourable and effective strategies.
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http://dx.doi.org/10.1186/s12961-019-0442-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469134PMC
April 2019

The hepatitis C infection in Iran: a policy analysis of agenda-setting using Kingdon's multiple streams framework.

Health Res Policy Syst 2019 Mar 27;17(1):30. Epub 2019 Mar 27.

School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

Background: Hepatitis C virus (HCV) infection causes a large number of deaths annually worldwide. Policies play an important role in regulating healthcare agendas and prioritising of health-related issues. Understanding these priorities is very important in health. The objective of this study was to investigate HCV-related issues and their influence on agenda-setting in Iran.

Methods: A qualitative design was used. Data were collected by carrying out a review of documents and interviews. A comprehensive search was conducted to identify documents related to HCV-related policies in Iran. Semi-structured interviews were conducted with both purposive and snowball sampling of 14 interviewees related to the HCV programme in Iran, including government officials, civil society, development partnership members and academicians. Documents and interview data were analysed manually and using MAXQDA Version 10 software. Kingdon's multiple streams framework was used to guide data analysis.

Results: The factors which influenced HCV-related agenda-setting were lack of proper information of the HCV epidemiology before the 1990s, lack of diagnostic facilities, neighbouring countries with high HCV prevalence, the stigma of HCV, high prevalence in prisoners, international evidence and high costs generated by HCV. The factors related to policy were effective treatment methods, drug production inside Iran, Iran Hepatitis Network, support outside government group elites and academicians. The factors related to political will were international influence, changes in the government and parliament support.

Conclusion: The findings of this study showed that there are various national and international factors that play a role in shaping HCV-related policies. It seems that, if HCV is put into the agenda, it can be eliminated in Iran by 2030 by supporting and implementing appropriate programmes from decision- and policy-makers.
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http://dx.doi.org/10.1186/s12961-019-0436-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6438031PMC
March 2019

Comparison of invasive and noninvasive blood hemoglobin measurement in the operating room: a systematic review and meta-analysis.

J Anesth 2019 06 20;33(3):441-453. Epub 2019 Mar 20.

Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Noninvasive hemoglobin (Hb)-monitoring devices are new inventions in pulse oximeter systems that show hemoglobin levels continuously. The aim of this systematic review and meta-analysis was to evaluate the accuracy and precision of noninvasive versus standard central laboratory Hb measurements in the operating room. We systematically searched multiple databases. Then, for the quality assessment of studies, we modified QUADAS-2 in the Revman 5.3 software. The GRADE approach was used to measure the quality of evidence (Grading of Recommendations Assessment, Development, and Evaluation). Data were analyzed using the meta-analysis method (random effect model) using STATA 11 software. A total of 28 studies on 2000 participants were included in the meta-analysis. Meta-analysis results of mean differences between noninvasive and the central laboratory Hb measurements in overall pooled random effects were - 0.27 (95% LoA (0.44, - 0.10); P value < 0.05). According to this meta-analysis, noninvasive hemoglobin measurement has acceptable accuracy in comparison with the standard invasive method.
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http://dx.doi.org/10.1007/s00540-019-02629-1DOI Listing
June 2019

Emergency health evaluation of affected population during disasters: Are there new approaches?

J Educ Health Promot 2019 29;8. Epub 2019 Jan 29.

Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Introduction: Disasters are inescapable phenomena. Once they occur, reliable and objective information becomes vital in sound decision-making to respond. Emergency health evaluation of affected population can be used to gather information about the patterns of access to medical care, basic household needs, and other health needs. The objective of this review was to summarize evidence from scientific studies on the various methods of emergency health evaluation following disasters.

Materials And Methods: A comprehensive list of studies was provided in May 2017 by an extensive search using PubMed, Web of Sciences, Ovid Medline, ProQuest Research Library, and World Health Organization Library.

Results: Of the 1592 retrieved articles, 21 articles were included in this review. In a majority of the studies ( = 18), a questionnaire was used and an interview was conducted to collect information, but in three studies, smartphone-based methods were used. Sampling method in most of the studies was cluster sampling in Community Assessment for Public Health Emergency Response method. But in eight studies, random sampling method was used. In a majority of the studies, the demographic status of samples and in 18 studies, the condition of diseases, water, shelters, health, food, mortality rate, and existing medical services were investigated.

Conclusions: Although new methods such as social media and smartphones were already investigated in some articles, but these approaches require further investigation since there is a growing need for new methods.
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http://dx.doi.org/10.4103/jehp.jehp_115_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378814PMC
January 2019

Which groups of the poor are supported more by the law? Pro-poor health policy network in Iran.

Int J Health Plann Manage 2019 Apr 22;34(2):e1074-e1086. Epub 2019 Feb 22.

Department of Agriculture and Natural Resources, University of Hormozgan, Bandar Abbas, Iran.

Background: Considering the challenges of health services utilization of the poor in Iran, it is necessary to examine the supportive policy documents about the poor in order to identify such challenges.

Methods: This study is a policy documents analysis that has evaluated the legal documents in the health financial support to the poor. The researchers looked in the websites for documents and referred to related organizations. Social network analysis approach and UCINET software were chosen for data analysis.

Results: Twenty-seven different disadvantaged groups were identified for financial support in the legal documents. The main focus was on "poor people," "unsupported women and children," and "disabled and elderly poor people." There is a bundle of confusion about the number of supporting institutions for different groups and the amount of support in the network.

Conclusion: The coverage of the poor in Iran has been impaired by a lack of clear boundary in their support. Because of the interorganizational partnership challenges, much more promising results would have been achieved if there was only one administrative institution for the Iranian poor. Given the inconsistencies seen in the support types and levels for the poor to access health services, it is inevitable to amend the laws.
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http://dx.doi.org/10.1002/hpm.2744DOI Listing
April 2019

The role of insurance providers in supporting treatment and management of hepatitis C patients.

BMC Health Serv Res 2019 Jan 10;19(1):25. Epub 2019 Jan 10.

School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

Today, one of the most important global public health challenges is represented by hepatitis C virus (HCV), which imposes relevant costs. Globally speaking, the median cost of HCV-related complications ranges from $280 for an uncomplicated hepatitis to $139,070 for a liver transplantation. There are effective therapies for HCV patients worldwide, which has increased the hope of improving the process of managing and curing these patients. The adherence of patients to the pharmacological treatment and the use of effective drugs in the management of HCV disease are of crucial importance for health policy- and decision-makers. Studies show that, globally, insurance coverage for patients with HCV is not adequate in that still many patients are not covered by insurance programs. This issue as well as the economic conditions of countries are very serious challenges for ensuring an effective treatment. The most important and greatest help currently available to ensure HCV treatment is to implement plans to reduce costs and support patients. Some studies have shown that the expansion of coverage by private payers seems able to generate positive spillover benefits to public insures. Insurers, in addition to maintaining and increasing their own interests, are trying to increase their social status as a sponsor of patients. In conclusion, HCV disease requires serious policies and affordable insurance coverage.
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http://dx.doi.org/10.1186/s12913-019-3869-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6329117PMC
January 2019

The challenges of implementation of clinical governance in Iran: a meta-synthesis of qualitative studies.

Health Res Policy Syst 2019 Jan 9;17(1). Epub 2019 Jan 9.

Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Policy- and decision-makers seek to improve the quality of care in the health sector and therefore aim to improve quality through appropriate policies. Higher quality of care will satisfy service providers and the public, reduce costs, increase productivity, and lead to better organisational performance. Clinical governance is a method through which management can be improved and made more accountable, and leads to the provision of better quality of care. In November 2009, the Iranian Ministry of Health and Medical Education implemented new clinical guidelines to standardise and improve clinical services as well as to increase efficiency and reduce costs. The purpose of this study was to assess the challenges of implementing clinical governance through a meta-synthesis of qualitative studies published in Iran.

Methods: Ten databases, including ISI/Web of Sciences, PubMed/MEDLINE, Embase, PsycINFO, the Cochrane Library, CINAHL, Scopus, Barakatns, MagIran and the Scientific Information Database, were searched between January 2009 and May 2018. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool. This study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines. Thematic synthesis was used to analyse the data.

Results: Ten studies were selected and included based on the inclusion/exclusion criteria. In the first stage, 75 items emerged and were coded, and, following comparison and combination of the codes, 32 codes and 8 themes were finally extracted. These themes included health system structure, management, person-power, cultural factors, information and data, resources, education and evaluation.

Conclusion: The findings of the study showed that there exist a variety of challenges for the implementation of clinical governance in Iran. To successfully implement a health policy, its infrastructure needs to be created. Using the views and support of stakeholders can ensure that a policy is well implemented.

Trial Registration: CRD42017079077 . Dated October 10, 2017.
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http://dx.doi.org/10.1186/s12961-018-0399-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327528PMC
January 2019

A Comparative Study on Different Pharmaceutical Industries and Proposing a Model for the Context of Iran.

Iran J Pharm Res 2018 ;17(4):1593-1603

Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Medication is known as the main and the most effective factor in improving public health. On the other hand, having a strong and effective pharmaceutical industry will, to a very large extent, guarantee people's health. Therefore, this study was prospected to review the different pharmaceutical industries around the world and propose a model for the context of Iran. This is a qualitative as well as a comparative study which was carried out in 2015. At the first stage, using the World Bank website, countries were divided into four groups of low-income, lower-middle-income, upper-middle-income, and high-income economies. Then, four countries of Afghanistan, India, Brazil, and Canada were chosen from these four groups, respectively. Secondly, data gathered from these countries were given to two 12-member expert panels. Finally, using the articles and the results of expert panel groups, useful and effective policies were extracted for the growth and development of Iran's pharmaceutical industry. Findings of the study indicated that the following seven items are the essential policies for the context of Iran: establishment of high academic centers as well as research institutes, using weak patent law, supporting research and development centers at universities and pharmaceutical companies, backing national pharmaceutical companies up, implementing generic rules, gradual economic liberalization, and membership in world trade organization. Since, pharmaceutical industry is an effective and inseparable part of every health system, proper and evidence-based policies should be taken into account in order to develop this industry and, ultimately, meet the public needs.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6269560PMC
January 2018

Cancer Patients During and after Natural and Man-Made Disasters: A Systematic Review

Asian Pac J Cancer Prev 2018 Oct 26;19(10):2695-2700. Epub 2018 Oct 26.

School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. Email:

Background: Disasters affect all social functions. In particular, hospitals must mobilize their resources for response to mass injuries. This process can affected treatment of cancer patients and may resulted in delayed care. Considering the importance of continuity of care for cancer patients, the aim of this systematic review was to identify challenges and preparedness measures for cancer patients during and after disasters. Materials and Methods: This systematic review that was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines between January 2000 to December 2017. The keywords searched included: “disaster,” “emergency,” “crisis,” “disruptive event,” “technological disaster,” “natural disaster,” “cancer,” “cancer patient,” “chronic disease,” “continuity of care,” and “patient with chronic disease. “The Google Scholar, ISI Web of Science, Science Direct, PubMed and Scopus databases were searched. Results: After screening and review of article eligibility, seven were included in the study. The selected articles were compared from several aspects. The results showed that most publications concerned all of the chronic diseases or all types of cancers. In addition breast cancer appeared a field of interest in disaster studies. Cancer studies in disaster management usually concentrated less on technological disasters. Conclusion: In aftermath of disasters, the concentration on measures to provide services for injuries and food, water and shelter, results in many challenges for cancer patients. Thus the health system must prepare cancer patients and caregivers for better responses to disasters. In addition, surge capacity must be considered in hospitals and other medical facilities to guarantee continuity of care.
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http://dx.doi.org/10.22034/APJCP.2018.19.10.2695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291047PMC
October 2018

Prevalence of hepatitis C virus among street children in Iran.

Infect Dis Poverty 2018 Oct 1;7(1):88. Epub 2018 Oct 1.

School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

Background: Street children are forced to spend a lot of time away from their homes and some of them do not have homes at all, due to economic and family problems, which makes them exposed to many health problems, such as the hepatitis C virus (HCV) infection. Iran, like many other countries in the world, experiences the burden of street children, however, the rate of HCV among street children is virtually unknown. This study aimed to determine the prevalence of HCV among street children in Iran.

Main Body: This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study protocol of this review was registered in PROSPERO under identification term CRD42018082336. A comprehensive literature search was conducted to identify published studies reporting on the prevalence of HCV among street children in Iran. Several international scholarly databases, including Web of Science, PubMed®/MEDLINE®, Embase, Scopus®, Google Scholar and Directory of Open Access Journals, as well as Iranian databases such as MagIran and Barakathns were searched. Studies published between 1988 and December 2017 with any of the following keywords were selected: (street OR homeless OR labour) AND (children OR child OR infant) AND (hepatitis C OR hepatitis C virus OR HCV OR viral hepatitis OR hepatitis OR hepacivirus) AND Iran. Moreover, a grey literature search was performed in order to obtain other potentially relevant studies. The search was carried out without any language restrictions. Four studies, surveying a total of 1691 street children, conducted between 2006 and 2017 were found to be eligible for inclusion in the review and therefore analysed. Three studies were conducted in Tehran and one in Isfahan. The prevalence of HCV among street children in Iran was found to be high, at 2.4% (95% CI: 1.8-3.3).

Conclusions: Since the prevalence of HCV among street children in Iran is quite high, health decision- and policy-makers should pay more attention to street children and widen support channels, both social and economic. Further studies should be conducted among street children in different cities of Iran to add to the knowledge base of HCV among street children in the country. The health system should provide facilities for street children to be screened to quickly diagnose illnesses and prevent them from developing complications.
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http://dx.doi.org/10.1186/s40249-018-0469-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166285PMC
October 2018

Average medical visit time in Iran: A systematic review and meta-analysis.

Med J Islam Repub Iran 2018 8;32:58. Epub 2018 Jul 8.

School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

Visit length is an indicator that can be used to assess patients' satisfaction of the health care services. In recent years, some studies have focused on the mean visit time in Iran. This study aimed at determining the average visit time in Iran by performing a systematic review and meta-analysis. In this study, Embase, PubMed/MEDLINE, Scopus, ISI/Web of Science databases, and Google Scholar search engine, as well as Iranian national databases/thesauri, such as MagIran, SID, and Irandoc were used. These databases were searched from their inception until September 2017. The quality of retained studies was assessed using the STROBE checklist. Average visit length was reported using stochastic model with 95% confidence interval (CI). I2 and Q tests were used to assess the heterogeneity of the studies. A sensitivity analysis was conducted to ensure the stability of the results. After searching the scholarly databases and reviewing the articles based on inclusion and exclusion criteria, 6 studies were finally selected. Based on the random model, the mean visit time was 4.89 minutes in Iran, ranging from 4.66 to 5.12 minutes (p=0.82). The most time visit in specialists belonged to psychiatrists with 9.12 (7.28 to 10.96) minutes (p=0.19) and the lowest belonged to internists with 3.59 (2.24 to 4.95) minutes (p=0.00), respectively. The average visit time in Iran was estimated to be 4.89 minutes. To increase patients' satisfaction and provide a better disease treatment and management in Iran, the following suggestions could be helpful: properly distributing physicians across the country, reducing waiting lists, and implementing the use of guidelines to standardize the visit time.
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http://dx.doi.org/10.14196/mjiri.32.58DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6113590PMC
July 2018

Factors affecting emergency medical dispatchers' decision-making: a qualitative study.

J Multidiscip Healthc 2018 22;11:391-398. Epub 2018 Aug 22.

Antimicrobial Resistance Research Center, Rasoul-e-Akram Hospital, Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Prehospital emergency medical service dispatchers should make prompt and appropriate decisions to save the life of victims. The complexity of timely and reasonable decision-making in life-threatening conditions has driven researchers to investigate varying aspects of the emergency medical dispatch (EMD) process. The purpose of this study was to explore the contributors to appropriate and prompt decision-making among dispatchers.

Methods: A qualitative study through thematic analysis was designed. Data were collected using observation and semistructured interviews with 16 authorities and dispatchers in seven EMDs across Iran.

Results: The study found "responsiveness" as the main category contributing to improved decision-making in EMD. The components introduced in this study for dispatchers' responsiveness consisted of two categories. The first was "personal values" including faith and belief, eagerness to help, service excellence, altruism, respect, and impartiality in clinical judgment. The second was "professional attitudes" resulting from education and experience, including the recognition of emergency as a threat to health, sensitivity in triage, response to all requests for help, care for early warnings, commitment to organizational goals and standards, attention to the emergency medical service social support responsibility, and professional temperance.

Conclusion: In this study, responsiveness was identified as a main category in improving the decision-making process among dispatchers. To attain responsiveness, institutionalization of its values and establishment of EMD-specific professional attitudes in dispatchers should be taken into consideration.
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http://dx.doi.org/10.2147/JMDH.S159593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110286PMC
August 2018

The role of the Primary Healthcare Network in Iran in hepatitis C virus elimination by 2030.

J Virus Erad 2018 Jul 1;4(3):186-188. Epub 2018 Jul 1.

Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran.

The World Health Organization (WHO) has estimated that about 71 million people in the world have chronic hepatitis C virus (HCV) and 399,000 die every year due to cirrhosis and cancer caused by HCV. Despite efforts to prevent and control hepatitis, there are still many barriers. In September 2000, during a summit in New York organised by the United Nations, world leaders agreed on a set of achievable targets within a limited timeframe, with the goal of combating poverty, hunger, disease, illiteracy, destruction of the environment and of improving the status of women by 2015; these were known as the Millennium Development Goals. The Primary Health Care Network (PHCN) in Iran has played a very important role in health promotion but its achievements could be enhanced further by improving performance and implementing further changes. The WHO strives to achieve goals of sustainable development by 2030 in many countries, thereby raising awareness, encouraging greater community participation, mobilising resources, using evidence-based policies, and increasing screening services, care and treatment. The concept of the PHCN has been very successful in health promotion in Iran, and has provided a basis for accessible and high-quality services for all. Achieving HCV elimination by 2030 could be achieved with the support of the PHCN, and changes in management with regard to screening, prevention and treatment practices.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038132PMC
July 2018

The challenges of the family physician policy in Iran: a systematic review and meta-synthesis of qualitative researches.

Fam Pract 2018 12;35(6):652-660

Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy.

Background: A good level of health requires the establishment of primary health care. Family physician policy (FPP) is probably one of such initiatives, which enables societies attaining the universal health coverage.

Objective: The present study is the first systematic review and meta-synthesis that seeks to provide a more comprehensive understanding of the challenges for FPP in Iran.

Method: Several international scholarly databases (namely, ISI/Web of Sciences, PubMed/MEDLINE via Ovid, Embase, PsycINFO, Scopus and CINAHL via EBSCO), as well as three Iranian databases [MagIran, Irandoc and Scientific Information Database (SID) databases], were mined from January 2006 to December 2017. The Noblit & Hare approach was used to analyse the selected studies.

Results: Based on the study inclusion criteria, seven studies were retained. Initially, 133 codes were identified. In the second step, two of the authors examined the codes and merged themes based on their similarities and shared meaning. New codes were created through discussion. In the next and final step, eight themes emerged, namely, (i) financing; (ii) motivational factors; (iii) education; (iv) referral system; (v) performance evaluation; (vi) problems with health policy; (vii) health information system; and (viii) culture-building for proper policy implementation.

Conclusion: Although more than 10 years have passed since the implementation of FPP in Iran, and despite its positive effects on health, there are still challenges in implementing this policy, which makes it difficult to achieve its objectives. Health decision- and policy-makers in Iran should address these challenges and use all available capacities to face them.
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http://dx.doi.org/10.1093/fampra/cmy035DOI Listing
December 2018

Prevalence of hepatitis C virus infection among prisoners in Iran: a systematic review and meta-analysis.

Harm Reduct J 2018 05 9;15(1):24. Epub 2018 May 9.

Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy.

Background: Hepatitis C virus (HCV) is one of the major public health problems both in developed and developing countries. Prison represents a high-risk environment for prisoners, in that it is characterized by high-risk behaviors such as injecting drug use (IDU), tattooing, unprotected sexual intercourses, or sharing syringes. The aim of this study was to quantitatively evaluate the prevalence of HCV among Iranian prisoners conducting a systematic review and meta-analysis.

Methods: We searched different scholarly databases including Embase, PubMed/MEDLINE, ISI/Web of Sciences, the Cochrane library, Scopus, CINAHL, and PsycINFO as well as Iranian bibliographic thesauri (namely, Barakatns, MagIran, and SID) up to December 2017. The Newcastle Ottawa Scale (NOS) was used to assess the quality of the studies included. HCV prevalence rate with its 95% confidence interval (CI) was estimated using the DerSimonian-Laird random-effects model, with Freeman-Tukey double arcsine transformation. Egger's regression test was used to evaluate publication bias.

Results: Finally, 17 articles were selected based on inclusion and exclusion criteria. Overall, 18,693 prisoners were tested. Based on the random-effects model, the prevalence of HCV among Iranian prisoners was 28% (CI 95% 21-36) with heterogeneity of I = 99.3% (p = 0.00). All studies used an ELISA test for the evaluation of HCV antibodies. The findings of this study showed that the highest prevalence rate (53%) was among prisoners who inject drugs.

Conclusion: The findings of our study showed that the prevalence of HCV among Iranian prisoners is dramatically high. Managing this issue in Iran's prisons requires careful attention to the availability of health facilities and instruments, such as screening, and harm reduction policies, such as giving sterile syringes and needles to prisoners. An integrated program of training for prisoners, prison personnel and medical staff is also needed to improve the level of health condition in prisons.
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http://dx.doi.org/10.1186/s12954-018-0231-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5941323PMC
May 2018

The challenges of strategic purchasing of healthcare services in Iran Health Insurance Organization: a qualitative study.

Electron Physician 2018 Feb 25;10(2):6299-6306. Epub 2018 Feb 25.

RN, PhD, Post-Doc, Assistant Professor, Department of Health Management and Policy, University of Maryland, United States of America.

Background: Strategic purchasing in healthcare services is a key component in improving health system performance, and it has been one of the most important issues in health system reform around the world, especially Europe in the last decade. Iran health system and insurance, although sometimes considered the issue of strategic purchasing goals, has not been made possible to achieve or even to implement, due to the associated problems.

Objective: To determine the associated problems of strategic purchasing in the Iran Health Insurance Organization (IHIO).

Methods: This study is a qualitative study, and framework analysis which was conducted in Iran in 2014-15. The participants in this study were 34 individuals from decision-makers and executives in the IHIO purchasing process, and university experts who have been chosen purposefully. This study conducted frame analysis, by using MAXQDA 10.

Results: The findings included associated problems of IHIO strategic purchasing in 12 themes and 65 subthemes. The themes included: Laws and regulations for purchasing, Organization of purchasing, Qualified and authorized providers, Right type of services, Right type of contracts, Target groups for purchasing, Resources allocation, financing and pricing system, Purchasing as improving performance and quality, Purchasing as shaping the market and competition, Purchasing as health progress state of people and society, Guided purchasing and stewardship of government, Structure of decision-making process in the health and welfare ministries.

Conclusion: The findings of this study showed associated problems in IHIO strategic purchasing. To achieve strategic purchasing goals in Iran, identification of all issues and factors of the total insurers and health system sets which affect strategic purchasing is essential.
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http://dx.doi.org/10.19082/6299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878022PMC
February 2018

Power structure among the actors of financial support to the poor to access health services: Social network analysis approach.

Soc Sci Med 2017 12 31;195:1-11. Epub 2017 Oct 31.

Department of Public Policy, University of Tehran, Tehran, Iran.

The extent of universal health coverage in terms of financial protection is worrisome in Iran. There are challenges in health policies to guarantee financial accessibility to health services, especially for poor people. Various institutions offer support to ensure that the poor have financial access to health services. The aim of this study is to investigate the relationship network among the institutions active in this field. This study is a policy document analysis. It evaluates the country's legal documents in the field of financial support to the poor for healthcare after the Islamic Revolution in Iran. The researchers looked for the documents on the related websites and referred to the related organizations. The social network analysis approach was chosen for the analysis of the documents. Block-modelling and multi-dimensional scaling (MDS) was used to determine the network structures. The UCINET software was employed to analyse the data. Most the main actors of this network are chosen from the government budget. There is no legal communication and cooperation among some of the actors because of their improper position in the network. Seven blocks have been clustered by CONCOR in terms of the actor's degree of similarity. The social distance among the actors of the seven blocks is very short. Power distribution in the field of financial support to the poor has a fragmented structure; however, it is mainly run by a dominant block consisting of The Supreme Council of Welfare and Social Security, Health Insurance Organization, and the Ministry of Health and Medical Education. The financial support for the poor network involves multiple actors. This variety has created a series of confusions in terms of the type, level, and scope of responsibilities among the actors. The weak presence legislative and regulatory institutions and also non-governmental institutions are the main weak points of this network.
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http://dx.doi.org/10.1016/j.socscimed.2017.10.026DOI Listing
December 2017
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