The experiences and perceptions of people with chronic and rare diseases during political-economic sanctions in Iran: a qualitative study

BACKGROUND

Economic sanctions aim to exert pressure on political and economic foundations. Hypothesizing that sanctions might affect various aspects of population health, this study, as a component of a broader investigation to ascertain the trend effects of sanctions on selected health outcomes in Iran, seeks to explore the experiences of Iranian citizens associated with the imposed sanctions.

METHODS

This is a qualitative study. We conducted 31 semi-structured interviews with randomly selected patients diagnosed with at least one chronic and rare disease from diverse backgrounds across four provinces in Iran. We analyzed data using an inductive content analysis approach, facilitated by the MAXQDA10 software.

RESULTS

We identified three primary themes: direct effects, side effects, and coping strategies. The immediate effects were perceived to be manifested through the restriction of healthcare service availability and affordability for citizens. The side effects included the economic hardships experienced in individuals' lives and the perceived devastation caused by these difficulties. Some coping mechanisms adopted by patients or their families/relatives included prioritizing comorbidities, prioritizing health needs within families with multiple ill members, and readjusting health/illness requirements in light of daily living needs.

CONCLUSION

In addition to the inherent burden of their illness, patients faced substantial healthcare costs as a result of sanctions, restricted access to medications, and availability of low-quality medications. We advocate considering these challenges within the healthcare system resilience framework as a crucial first step for policymakers, aiming to determine actionable measures and mitigate the adverse effects of sanctions on citizens, particularly the most vulnerable groups.

The Relationships between Social Capital, Metabolic, and Behavioral Risk Factors of Non-Communicable Diseases: A Systematic Review

Background

Contextual risk factors such as social capital have a vital role in affecting behavioral and biological risk factors of NCDs. We aimed to systematically identify the relationship between different aspects of social capital (SC) with metabolic, and behavioral risk factors of non-communicable diseases (NCDs).

Methods

This is a systematic review. The period of study was 2000-2021. We searched the English international databases, i.e. PubMed/Medline, Scopus, and Web of Science. Studies that reported NCDs' metabolic and behavioral risk factors as independent variables, were excluded. We also included studies if they analyzed the association between SC and metabolic and behavioral risk factors of NCDs.

Results

After the primary and quality appraisal process, 97 studies were entered in the final phase of the analysis. Five out of 18 studies reported an inverse association between SC and the level of alcohol drinking. Twenty-seven out of 32 studies reported a significant inverse association between SC and smoking and tobacco use, while only one study reported a significant positive association. Nine studies reported a significant inverse association between SC and high blood pressure. Three studies showed a significant inverse association between SC and diabetes. Seventeen studies indicated a significant positive association between SC and physical activity. Thirteen out of 17 studies reported a significant inverse association between SC, body mass index (BMI) and overweight.

Conclusion

High SC, people's participation and interaction are vital in tackling NCDs. Evidence shows positive effects of SC on prevention, control and improvement of NCDs' metabolic and behavioral risk factors.

The lessons of COVID-19 pandemic for communicable diseases surveillance system in Kurdistan Region of Iraq

Objectives

This study aimed to determine the opportunities of and barriers to communicable diseases surveillance system (CDSS) during the COVID-19 pandemic and the extent to which the disease integrated into the CDSS in the Kurdistan region of Iraq.

Study design

A descriptive qualitative approach was applied.

Methods

We conducted seven semi-structured interviews and seven interviewee in a focus group discussion (FGD) with purposefully identified Key Informants (KI) from June to December 2020. All interviews were digitally recorded and transcribed verbatim. We adopted a mixed deductive-inductive approach for thematic data analysis, facilitated by using MAXQDA20 software for data management.

Results

Although the CDSS was considered appropriate and flexible, the COVID-19 was interpreted not to be integrated into the system due to political influence. The main concerns regarding core and support activities were the lack of epidemic preparedness, timeliness, and partial cessation of training and supervision during the pandemic. The existence of reasonable surveillance infrastructure, i.e., trained staff, was identified as an opportunity for improvement. The main challenges include staff deficiency, absence of motivation and financial support for present staff, scarce logistics, managerial and administrative issues, and lack of cooperation, particularly among stakeholders and surveillance staff.

Conclusion

Our findings revealed that the CDSS in the Kurdistan region requires substantial enhancement in epidemic preparedness, strengthening human resources, and logistics. the system can be developed by fostering meaningful intersectoral collaboration. We advocate that the health authorities and policy-makers prioritise the surveillance and effective management of communicable diseases.

Two-Step Estimation of the Impact of Contextual Variables on Technical Efficiency of Hospitals: The Case Study of Public Hospitals in Iran

Background: Measuring the efficiency and productivity of hospitals is a key tool to cost contamination and management that is very important for any healthcare system for having an efficient system. Objective: The purpose of this study is to examine the effects of contextual factors on hospital efficiency in Iranian public hospitals. Methods: This was a quantitative and descriptive-analytical study conducted in two steps. First, we measured the efficiency score of teaching and non-teaching hospitals by using the Data Envelopment Analysis (DEA) method. Second, the relationship between efficiency score and contextual factors was analyzed. We used median statistics (first and third quarters) to describe the concentration and distribution of each variable in teaching and non-teaching hospitals, then the Wilcoxon test was used to compare them. The Spearman test was used to evaluate the correlation between the efficiency of hospitals and contextual variables (province area, province population, population density, and the number of beds per hospital). Results: On average, the efficiency score in non-teaching hospitals in 31 provinces was 0.67 and for teaching hospitals was 0.54. Results showed that there is no significant relationship between the efficiency score and the number of hospitals in the provinces (p = 0.1 and 0.15, respectively). The relationship between the number of hospitals and the population of the province was significant and positive. Also, there was a positive relationship between the number of beds and the area of the province in both types of teaching and non-teaching hospitals. Conclusion: Multilateral factors influence the efficiency of hospitals and to address hospital inefficiency multi-intervention packages focusing on the hospital and its context should be developed. It is necessary to pay attention to contextual factors and organizational architecture to improve efficiency.

Short and Long-term Impacts of COVID-19 Pandemic on Health Equity: A Comprehensive Review

Background: The impact of the COVID-19 pandemic on human life has led to profound consequences in almost all societies worldwide, and this includes its significant impact on all aspects of health. Health equity has been among the main challenges in any healthcare system. However, with the COVID-19 crisis worsening health inequalities, the need to prioritize health equity in upstream national and international plans must receive scholarly attention. Therefore, this paper reports the findings of a review of the current synthesized evidence about the impact of the COVID-19 pandemic on health equity. Methods: This is a comprehensive review in which we retrieved relevant studies during the period starting from 12/01/2019 to 01/15/2021 are retrieved from various databases. The PRISMA flow diagram and a narrative approach are used for synthesizing the evidence. Results: We initially retrieved 1173 studies, and after a primary quality appraisal process, 40 studies entered the final phase of analysis. The included studies were categorized into five main outcome variables: Accessibility (95%), Utilization (65.8%), Financial protection: 15 (36.5%), Poverty (31.7%), and Racism (21.9%) Conclusion: COVID-19 pandemic has been the most devastating global challenge in recent history. While the COVID-19 crisis is still unfolding, its multidimensional adverse effects are yet to be revealed. Nevertheless, some people, e.g., the elderly, minorities, as well as marginalized and poor persons, have suffered the COVID-19 consequences more than others. In line with the whole government/whole society approach, we advocate that governments need to strengthen their special efforts to reduce the extra burden of the pandemic on the most vulnerable populations.

Modeling organizational intelligence, learning, forgetting and agility using structural equation model approaches in Shiraz University of Medical Sciences Hospitals

Objectives

Strengthening the organizational agility of the hospital can lead to decreased production costs and increased market share, better serving to patients' needs, introduction of new services and increased competitiveness; therefore, this study aimed to investigate the agility of Shiraz public teaching hospitals.

Results

The results showed that organizational intelligence had a positive and significant effect on organizational agility with a path coefficient of 0.172. Organizational forgetting and organizational learning also played a mediating role between organizational intelligence and organizational agility. This means that organizational intelligence had positive effect on organizational forgetting with path coefficient of 0.482, organizational forgetting on organizational learning with path coefficient of 0.40 and subsequently organizational learning on organizational agility with path factor of 0.07. Organizational forgetting also played a mediating role between organizational intelligence and organizational learning.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-021-05682-w.

Health equity in Iran: A systematic review

Background: Health inequities are among debatable and challenging aspects of health systems. Achieving equity through social determinants of health approach has been mentioned in most upstream national plans and acts in Iran. This paper reports the findings of a systematic review of the current synthesized evidence on health equity in Iran.

Methods: This is a narrative systematic review. The relevant concepts and terminology in health equity was found through MeSH. We retrieved the relevant studies from PubMed/MedLine, Social Sciences Database, and Google Scholar in English, plus the Jihad University Database (SID), and Google Scholar in Farsi databases from 1979 until the end of January 2018. The retrieved evidence has been assessed primarily based on PICOS criteria and then Ottawa-Newcastle Scale, and CASP for qualitative studies. We used PRISMA flow diagram and a narrative approach for synthesizing the evidence.

Results: We retrieved 172 455 studies. Following the primary and quality appraisal process, 114 studies were entered in the final phase of the analysis. The main part (approximately 95%) of the final phase included cross-sectional studies that had been analyzed through current descriptive inequality analysis indicators, analytical regression, or decomposition-based approaches. The studies were categorized within 3 main groups: health outcomes (40.3%), health utilization (32%), and health expenditures (27%).

Conclusion: As a part of understanding the current situation of health equity in the policymakers’ need to refer the retrieved evidence in this study, they need more inputs specially regarding the social determinants of health approach. It seems that health equity research plan in Iran needs to be redirected in new paths that give appropriate weights to biological, gene-based, environmental and contextbased, economic, social, and political aspects of health as well. We advocate addressing the aspects of Social Determinant of Health (SDH) in analyzing health inequalities.

Socioeconomic determinants of unmet need for outpatient healthcare services in Iran: a national cross-sectional study

BACKGROUND

Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran's health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran.

METHODS

We used the data of 13,005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariable logistic regression was used to determine significant predictors of SUN and associated major reasons.

RESULTS

About 17% of the respondents (N = 2217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Higher outpatient needs was the only factor that significantly increased SUN, responsibility-related SUN and acceptability-related SUN. Low education was associated with higher SUN and responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The people with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Although the middle-aged group had higher odds to experience SUN, the responsibility-related SUN were prevalent among elderly, while higher age groups had significant chance to be exposed to acceptability-related SUN.

CONCLUSION

It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status.

Refugees and Sustainable Health Development in Iran

BACKGROUND

Refugees' access to quality healthcare services might be compromised, which can in turn hinder universal health coverage (UHC), and achieving Sustainable Development Goal (SDG), ultimately. Objective: This article aims to illustrate the status of refugees' access to healthcare and main initiatives to improve their health status in Iran.

METHODS

This is a mixed-method study with two consecutive phases: qualitative and quantitative. In the qualitative phase, through a review of documents and semi-structured interviews with 40 purposively-selected healthcare providers, the right of refugees to access healthcare services in the Iranian health system was examined. In the quantitative phase, data on refugees' insurance coverage and their utilization from community-based rehabilitation (CBR) projects were collected and analyzed.

RESULTS

There are international and upstream policies, laws and practical projects that support refugees' health in Iran. Refugees and immigrants have free access to most healthcare services provided in the PHC network in Iran. They can also access curative and rehabilitation services, the costs of which depend on their health insurance status. In 2015, the government allowed the inclusion of all registered refugees in the Universal Public Health Insurance (UPHI) scheme. Moreover, the mean number of disabled refugees using CBR services was 786 (±389.7). The mean number of refugees covered by the UPHI scheme was 112,000 (±30404.9).

CONCLUSION

The United Nations' SDGs ask to strive for peace and reducing inequity. Along its pathway towards UHC, despite limited resources received from the international society, the government of Iran has taken some fundamental steps to serve refugees similar to citizens of Iran. Although the initiative looks promising, more is still required to bring NGOs on board and fulfill the vision of leaving no one behind.