How to improve Iranians� vision health: On the national policy of preventing iranians� blindness

� AIM: To review vision health situation of Iranian community, analyze its determinants, and discuss the adopted improvement strategies by the Iran Ministry of Health and Medical Education (MOHME). � METHODS: This was a rapid situation analysis with a qualitative approach in three parts of recognition, orientation and implementation. The data were gathered via review of upstream documents, national and international experiences, and experts and stakeholders� opinions. � RESULTS: Eradicating trachoma, increasing human resources, increasing educational and research centers and promotion of ophthalmic technologies were important achievements in the field of vision health in Iran. Through these achievements, it seemed that the pattern of causes of blindness and low vision was similar to that of the developed countries. However, the review of Iranians� vision health indicators showed that a considerable percent of the blindness and low vision was avoidable through a national program demanding 3 types of interventions in social determinants of health (SDH), community education, and increasing the access to health care services by integrating the necessary services in primary health care system. � CONCLUSION: Managing the issue requires attentions from a national committee for preventing blindness with participation of all stakeholders, implementing a national survey on vision health, preparation of the primary level health centers including employment and education of community health workers (Behvarzes), optometrists and general practitioners, fair distribution of specialized human resources and establishing at least one specialized center in each province for referring patients from the primary levels. © 2019, International Journal of Ophthalmology (c/o Editorial Office). All rights reserved

Interventions for decreasing drug abuse and social problem in Iran's mental and social health services model (SERAJ program)

Objective: Social problems and drug abuse, especially addiction, divorce, poverty, crime, violence, alcohol consumption, and substance abuse, have increased in Iran over the past two decades. The present study aims to determine an approach to decrease drug abuse and social problems in the Islamic Republic of Iran. Method: A national program on providing comprehensive social and mental health services, entitled "SERAJ", was developed and piloted in three districts of Iran. To compile this study, three types of data collection have been used: (1) review of the literature, (2) an in-depth interview with experts and stakeholders, (3) focused group discussions. Results: In our proposed model for decreasing drug abuse and social problems, comprehensive mental and social health service are provided. Social care is integrated into the primary health care and six types of services, including social health education, screening for risk factors of social problems, and drug abuse, identifying underlying psychiatric, psychological, or social causes, short consultations, referral to social workers, and follow-up. Conclusion: Theoretically, if mental disorders are reduced, social harm and addiction will also be reduced because it is one of the important risk factors for divorce, violence, crime, drug abuse, and alcohol consumption. SERAJ reduces mental disorders; therefore, it can reduce social problems and addiction. Copyright © 2021 Tehran University of Medical Sciences

How much should we pay to deliver comprehensive mental and social health services? Experiences from Iran

Objective: Comprehensive mental and social health services is the new benefit package which had been aimed to provide mental health services to people who suffer from mental disorders. The aim of this study was to estimate the cost of plan and its drivers to provide evidence for decision-making by national policymakers. Method: We used the bottom-up costing approach to estimate the cost of plan. We identified the cost centers, services delivery process, and facilities. Data were collected via different sources and tools such as the new financial system, registration forms, and performance reporting forms. We categorized the cost into 4 groups and selected appropriate measures to estimate the cost. We estimate the total and unit cost for 3 levels in 2 scenarios by considering the 2017 prices. Results: Screening resulted in 8.9 new detection with a different incidence in urban and rural areas (urban: 16.5; rural: 2.7). Also, 61 842 million IRR was spent for the screening, diagnose, treatment, and rehabilitation of detected people in 2017. Personal cost is responsible for 90.6 and primary screening for 66.4 of the total cost. Conclusion: For the development of the program (from screening to rehabilitation) 530 513 IRR should be spent per capita. The cost of detection per client can vary due to differences in disease prevalence, especially treatment and rehabilitation costs. It is suggested to consider the variation of the prevalence in expanding the plan to the whole country. Integrating the services in primary health care lead to huge cost saving. Copyright © 2021 Tehran University of Medical Sciences

The effectiveness of the pilot implementation of iran's comprehensive mental and social health services (the SERAJ Program): A controlled community trial

Objective: A national program on providing comprehensive social and mental health services, entitled "SERAJ"was developed and piloted in three districts of Iran. The present study aimed to evaluate the effectiveness of SERAJ by conducting assessments before and after the implementation in the intervention and the control areas. Method: This was a controlled community trial that was assessed by conducting repeated surveys in the intervention and the control areas. In total, 2952 and 2874 individuals were assessed in the intervention and the control areas, respectively. The change in prevalence of mental disorders (using the Composite International Diagnostic Interview; CIDI), service utilization, mental health literacy, happiness, and perceived social support were measured over 18 months in three districts of Osko, Bardsir, and Quchan as the intervention areas, which were compared with three matched districts as the control areas. Results: No significant difference was found in the mean score of happiness between the intervention and the control areas throughout the study period. Most aspects of mental health literacy were improved in the intervention areas after implementing the intervention. The mean score of social support decreased after implementing the intervention in all areas. The prevalence of mental disorders in the intervention districts was significantly reduced after 18 months. The rate of using any mental health services after the intervention was not statistically different between the intervention and the control areas. Conclusion: There was no significant change in some indicators in the intervention compared with the control areas. We suggest evaluating SERAJ's achievements and challenges in the three intervention districts before expanding the implementation of this pilot experience into other districts. Copyright © 2021 Tehran University of Medical Sciences

Basic Criteria, Models, and Indicators of Intersectoral Collaboration in Health Promotion: A Scoping Review

Background: In this study, the basic criteria, models, and indicators of intersectoral collaboration in health promotion were investigated to facilitate the implementation of collaboration.&#x0D; Methods: This scoping review was conducted using datasets of Embase, Web of Science, Scopus, and PubMed, and search engines of Google, Google Scholar, and ProQuest.&#x0D; Results: 52 studies were included, and 32 codes in Micro, Meso, and Macro level, were obtained. Micro-level criteria had the highest frequency. Among the models used in the reviewed studies, social network analysis, Diagnosis of Sustainable Collaboration, Bergen, and logic models had the highest frequency. Among the indicators studied, the number of participants and the level of collaboration as well as its sustainability were the most frequent indicators.&#x0D; Conclusion: The findings identified the most important and widely used criteria, models, and indicators of intersectoral collaboration in health promotion which can be useful for decision-makers and planners in the domain of health promotion, in designing, implementing, and evaluating collaborative programs.</jats:p

Scaling-up a new socio-mental health service model in Iran to reduce burden of neuropsychiatric disorders: an economic evaluation study

Background: The integration of core packages of mental health care into routine primary health care has been introduced as an effective way to achieve universal health coverage in mental health care. Based on the transition of mental health care in Iran, from introducing basic mental health care in PHC to the experience of community-based mental health centers for urban areas, a new socio-mental health service model has been so far proposed. This study aimed to estimate the impact of scaling-up the new socio-mental health model at the national level as well as its associated costs. Methods: This study was a cost-consequence analysis following One Health Tool methodology. The data required for the study were collected in the first quarter of the year 2020 with a time horizon from 2020 to 2030. The selected metric for summarizing health effects is healthy life years gained. Resources used in terms of drug and supply, staff salaries and outpatient visits were documented and associated costs were subsequently estimated in order to estimate the average cost of each intervention per case. Results: The health impacts are calculated in terms of healthy life years gained for 2020�2030, after adjusting the prevalence and incidence rates for each disorder. In total, 1,702,755 healthy life years were expected to be gained. Considering total 1,363,581,654 US dollars cost in base case scenario, each healthy life years gained will cost around 801 US dollars. Based on the WHO criteria for cost-effectiveness threshold, all of the values ranged from 724 to 1119 US dollars obtained through eight different scenarios were considered as cost-effective given the GDP per capita of 5550 US dollars for Iran in 2018. Conclusions: Mental health budget in Iran equals to about three percent of total health expenditure while the mental health cost per capita is estimated to be 1.73 US dollar which are relatively low considering the share of the MNS disorders in the national burden of diseases. The results of current study showing the cost of 16.4 US dollar per capita for scaling up this comprehensive mental health service model can convince high-level policy-makers to increase the share of mental health budget accordingly. The present study demonstrated that the cost in this new socio-mental services model is not substantial compared with GDP per capita of Iran. © 2021, The Author(s)

A policy analysis of the national phenylketonuria screening program in Iran

Background: Phenylketonuria (PKU) screening is a public health measure taken to diagnose and treat the patients with PKU to prevent severe neurological disorders in them. The present study was aimed at analyzing the policies of the national PKU screening (NaPS) program in Iran. Methods: PKU screening program policies were analyzed in compliance with the policy triangle model. Document review and 38 semi-structured interviews were used for data collection. Document review data were analyzed using content analysis, and interview data were analyzed using framework analysis. Results: The national PKU screening (NaPS) program was a decision made at the genetics department of Ministry of Health and Medical Education (MOHME) in Iran. Many internal and external stakeholders were involved in it and valid evidence was used to formulate the policies. Despite some opposition and insufficient support, the program was implemented due to the continuous persistence of parents, interested executives, formulated valid content and a top-down approach. The main barriers included rapid substitution of managers, shortage of Phe-free milk, little awareness of patients� families, social stigma, and inadequate co-operation of some hospital administrators. Conclusions: The policy triangle framework contributed to explaining the different components of the PKU screening program. A successful PKU screening program requires more stability of senior managers in MOHME, enough human resources and Phe-free milk, educating patients� families, and commitment of hospitals administrators. Meanwhile, all the stakeholders need to be involved in the program effectively. © 2021, The Author(s)

Lifetime cost effectiveness of phenylketonuria screening national program in iran

Background: Phenylketonuria (PKU) is an autosomal recessive disorder that screening and timely control of this disorder can prevent the adverse effects. Regarding the high prevalence of PKU in Iran, the PKU screening program was started in Iran in 2006. This study was conducted to determine the cost-effectiveness of PKU screening in Iran. Methods: An economic evaluation was performed among screened and treated individuals compared to no screening in 2013. The study population included 1356132 newborns that screened for PKU diagnosis. Lifetime costs, quality-adjusted life year (QALY) gains and incremental cost-effectiveness ratio (ICER) were calculated from the perspective of government. A discount rate of 3 was considered for both QALYs and costs. A one-way sensitivity analysis was used for assessing the robustness of the results. Results: The discounted lifetime cost of intervention and non-intervention were 59528953.8 and 85295501.6 re-spectively. Therefore, the total estimated cost saving was 25766547.84. PKU screening produces an ICER of 1844420 per QALY gained. Conclusion: Screening and early treatment for PKU is highly cost-effective. Therefore, the screening can improve quality of life of the patients and increase financial saving in health system. © 2021 Heidari et al. Published by Tehran University of Medical Sciences

A study of Happiness in the Islamic Republic of Iran�s work communities

Background: Happiness, a factor in social, political, and economic development, leads to higher performance, increase in production, and great efficiency. The goal of this study was to assess the level of happiness in Iran�s work communities. Methods: In this cross-sectional survey study, we randomly selected 13842 people from 380 workplaces in 31 provinces of Iran. Trained interviewers based on structured questionnaires collected data. Reliability of the questionnaire determined by using internal consistency. Collected data were analyzed through SPSS 16 software (SPSS Inc., Chicago, IL) and the charts and tables were prepared to indicate each province�s happiness level and the national mean. Results: Average age of employees was 35.4±7.78 years. The majority of the respondents were male(n=11835, 85.5), had finished middle/secondary school (n=7142, 51.6) and were married (n=11323, 81.8). The level of happiness varied from the highest value 148.97±21.49 in Boushehr Province and the lowest 130.39± 25.28 in Hormozgan Province. The mean ± SD value of happiness in the work communities of Iran was 141.22±22.89. Copyright© Iran University of Medical Science

Evaluation of workplace health promotion model: A communality trial study in Abyek district

Introduction: Workers are considered the productive force (power) of the society who besides their families account for about one-third of the population. One of the most important factors in increasing productivity and sustainability depends on improving the quality of workforce achieved by raising the level of workforces� health and hygiene. Proper health services would promote public health and increase the potential and actual capabilities of the workforce, and a healthier workforce will contribute more to increased production and economic growth. Workers' health house for workplaces of 50 to 500 people provide an opportunity to promote health in the workplaces. The designed model includes three packages of healthy lifestyle training, evaluation of working lifestyle, management of results and employer's health-centered initiatives, provided by a person called Behban (means health- keeper) at workplace. The purpose of this study is to evaluate the pattern of health promotion in the workplace in order to improve the lifestyle and health of workers and increase productivity Methods: The study is carried out in Qazvin province through a case-control method. The effectiveness of workers' health promotion model was evaluated for three intervention packages before and after their implementation in selected workplaces from Abyek (as case) and selected workplaces from Alborz city (as control). At first, 15 work environments were randomly selected from each city for the study. However, workplaces with a small number of workers (less than 50 people), and those which their employers or workers were not satisfied to participate in the study, as well as the workplaces with economic problems were excluded from the study. Having said that, 11 industrial workplaces from Abyek and 10 workplaces from Alborz were included in the study. In order to carry out the intervention, a responsible person named Behban was selected from each of the industrial units of the case city. A training and orientation workshop was held for the Behbans on how to implement the three service packages of healthy lifestyle training, evaluation of workers' lifestyle and management of results and health-oriented actions of the employer. In addition, educational resources including booklets, brochures and educational slides were provided to them after the workshop. In fact, Behban was tasked with educating each staff member about a healthy lifestyle for 20 hours, evaluating and recording each person's health status, and helping the employer create a healthier environment. For the control city, only health interventions continued as usual through the Occupational Health House. Information about the health literacy of workers in industrial environments, access to and use of existing services, satisfaction with services as well as social support (employer performance related to employees� health), was collected before and after the intervention, using a questionnaire designed by researchers. Findings: Access to health house after the intervention increased significantly compared to before the intervention (63.6 vs. 50.7, P = 0.001), while this index did not show a significant difference in the control group before and after the intervention (55.1 vs. 62, p = 0.7). Satisfaction with occupational health house, health education services in the intervention group increased significantly after the intervention compared to before the intervention (86.8 vs. 63.3, P = 0.001), but there was no significant difference in the size of this index in the control group (65.6 vs. 70, P = 0.5). Satisfaction with the service of referral to a physician and its follow-up by the health house in the intervention group after the intervention increased significantly (78.2 vs. 66.4, p = 0.01). This index in the control group, had no significant change (84.6 vs. 79, p = 0.2). The mean score of social support in the intervention group increased significantly after the intervention compared to before (13.4 vs. 12.2, p = 0.03), while there was no significant change in this index in the control group. (11.9 vs. 12.6, p = 0.08). Therefore, the results show that this model has been able to significantly improve health literacy, satisfaction with basic services including health screening, and feeling of social support in workers (resulting from employer-centered health measures). Conclusion: The results of this project can be applied to a national model by the Ministry of Labor and Social Welfare and the Ministry of Health and Medical Education. Implementation challenges of this model need to address the low motivation of employers in adverse economic conditions, Behbans' part-time employment, as well as the number of counseling and health units in workplaces with stewardship of different systems (parallel working). Given the undeniable impact of the six macro factors include; political, economic, social, technological, environmental and international on the situation of economic enterprises and consequently the health of workers, it is necessary to simultaneously seek support for priority issues such as improving economic conditions and social capital in the country's highest institutions. © 2020 Iran University of Medical Sciences. All rights reserved