The Effective Coverage of Maternal and Child Primary Health-Care-Services and its Relationship with Health-Expenditures: An Analysis at Sub-National-Level in Iran

Introduction: The primary health care (PHC) approach is widely acknowledged as a fundamental element in achieving universal health coverage (UHC) goals. Consequently, numerous countries have undertaken efforts to restructure their health systems based on PHC principles. This study aims to evaluate geographic disparities in essential maternal and child indicators provided at the PHC level, focusing on both crude and effective coverage. Additionally, it seeks to explore the association between effective coverage and health expenditures within the national and sub-national contexts of Iran. Methods: This research employed a secondary analysis approach to investigate the spatial distribution of maternal and child health (MCH) indicators in Iran's provinces, utilizing the latest available data from the 2010 Demographic Health Survey (DHS). To provide a comprehensive understanding of MCH indicators, the study calculated composite indicators, crude, and effective coverage. The provinces' situations were compared using the median cut-off method. Additionally, the study examined the association between coverage indicators and total health expenditure per-capita. Results: At the national level, the crude and the effective composite coverage were 89.56% and 77.22%, respectively. Also, the medians of composite crude and effective service coverage in the provinces were 90.25% and 77.62%, respectively. There was no significant difference between urban and rural areas. Conclusion: This study has revealed a notable difference between the crude and effective service coverage of the selected MCH indicators. While the coverage of maternal services was generally higher than that of child services, there were significant geographic disparities in the coverage of key indicators of MCH services across provinces. Despite the provision of free services in rural areas, their coverage was not higher than that of urban areas. These findings suggest that PHC services in Iran are still far from achieving the desired coverage and UHC goals. Policymakers and stakeholders need to focus on addressing the gaps in effective coverage and geographic disparities to improve access to essential maternal and child health services and achieve UHC in Iran

How to develop strategic and operational plan for research institute; a qualitative approach

Background: Spiritual health is recognized as one of the dimensions of health in Iran and in recent years many studies are conducted in this field in the country. This study aimed to review the experience of developing a five-year strategic plan and a one-year operational plan for the Spiritual Health Research Center (SHRC) of Iran University of Medical Sciences. Methods: The study was conducted in three phases in a qualitative approach. first, researches on spiritual health in Iran, upstream documents, and stakeholders in this area were reviewed. Then the situation of SHRC was analyzed. Based on the information obtained in the previous phases, the center’s strategic plan was developed including vision, mission, and values ​​of the SHRC along with strategic objectives until 2023. The plan was presented during a focused group discussion meeting to the members of the research council of SHRC and finalized after receiving feedback. Results: Totally, 23 strategic five-year objectives were set for the SHRC to be archived by 2023. Then, the specific goals, activities, outcomes and indicators for the evaluation for the first year were determined. Conclusions: This study proposed a methodology for developing strategic and operational plan for research institutes. The methodology presented here can be applied to other national and international bodies and institutions

National and sub-national environmental burden of disease in Iran from 1990 to 2013-study profile

Development of national evidence-based public health strategies requires a deep understanding of the role of major risk factors (RFs) and the burden of disease (BOD). In this article, we explain the framework for studying the national and sub-national Environmental Burden of Disease (EBD) in Iran as a part of the National and Sub-national Burden of Disease (NASBOD) study.; The distribution of exposures to environmental RFs and their attributable effect size over 1990-2013 will be estimated through comprehensive reviews of either published or unpublished sources. Statistical modeling will be used to impute missing data in the distribution of RFs exposures for each district-year. National and sub-national BOD attributable to these RFs will be estimated in the following metrics: Prevalence, death, years of life lost due to premature death (YLL), years of life lost due to disability (YLD), and disability-adjusted life years lost (DALYs). The BOD attributable to the current distribution of exposures will be compared with a counterfactual exposure distribution scenario-here, the theoretical-minimum-risk exposure distribution. Inequalities in the distribution of exposure to RFs will be analyzed and manifested nationwide using geographic information systems.; The EBD study aims to provide an official report to Iranian Ministry of Health and Medical Education, to publish a series of articles on the exposure trends of the selected environmental RFs, to estimate the BOD attributable to these RFs, and to assess inequalities and its determinants in the distribution of exposure to RFs. Iran's territory is large with diverse population, socioeconomic, and geographic areas. Results of this comparative risk assessment study may pave the way for health policy makers to plan more comprehensive and cost-effective evidence-based strategies

The vaccination coverage rate in under-5 children in Nasiriyah, Iraq before and during the COVID-19 pandemic

OBJECTIVES This study compared the vaccination coverage rate (VCR) in children under 5 years old in Nasiriyah, Iraq before and during the coronavirus disease 2019 (COVID-19) pandemic. METHODS This cross-sectional study was conducted in the city of Nasiriyah in southeastern Iraq, with data collected from 79 primary healthcare facilities. This study evaluated the VCR in 3 periods (2018, 2019, and 2020) using multi-level random sampling. Pertinent data were extracted from the vaccination records of 598 children for Bacillus Calmette-Guérin (BCG); pentavalent 1, 2, and 3; measles; and activated oral poliovirus vaccine 1 and 2. Missing data were completed by telephone calls to participants’ parents. Logistic regression was applied to compare and estimate the odds ratios (ORs) with 95% confidence intervals (CIs) for the association between VCR and related factors. RESULTS The data showed the greatest decline in the studied vaccines in 2020. Among the vaccines studied, BCG had the highest rate in all 3 periods (100% VCR) and measles had the lowest rate (83.7%), reaching 63.6% in 2020 (p<0.001). The highest OR among all types of vaccine were found for the pentavalent-3 vaccine among city dwellers and those born in 2020 (OR, 2.67; 95% CI, 1.39 to 5.10 and OR, 2.34; 95% CI, 1.28 to 4.28, respectively). CONCLUSIONS The VCR for children decreased during the COVID-19 pandemic in Iraq, and new health policies are needed to increase the coverage rate. Improving the knowledge and attitudes of parents, as well as removing barriers or risk factors, can also be effective in improving the VCR

Prevalence of anemia and correlated factors in the reproductive age women in rural areas of tabas.

Objective: To find out the prevalence and relationship of anemia in reproductive age women in rural area of Tabas, center of Iran. Iron deficiency anemia is the most common nutritional problem, affecting about 41.8% of pregnant and 30.2% of non-pregnant women worldwide. Materials and methods: A cross-sectional study was conducted on the random sample of 382 reproductive age women in rural areas of Tabas in March 2010. Independent sample t-test, one way analysis of variance (ANOVA) and logistic regression were applied for the data analysis. Results: The obtained data revealed a total response rate of 13.8% for prevalence of anemia, while 14.5% and 5.9% belonged to non-pregnant and pregnant participants, respectively. Low socioeconomic status (odds ratio 3.35) and high parity index (odds ratio 2.31) were associated with higher prevalence of anemia. Conclusion: Although this study was conducted in a rural area of Tabas, where their average incomes were lower than average income of major cities in Iran, the prevalence of anemia was lower than the rate reported in previous studies carried out in other locations of Iran, even in high risk (pregnant women) groups

Thematic analysis of iranian female adolescents′ perceptions about hiv/aids: A qualitative study

Background: HIV/AIDS continues to be a major global health problem. The aim of this study was to evaluate common opinions and beliefs about HIV/AIDS among Iranian teenager girls. Methods: This Qualitative study (face-to-face interviews with tape recording) was conducted among fifty female teenager school students in Urmia-Iran. Results: The thematic analysis indicated the main information sources for HIV/AIDS among teenage girls to be their mother and teachers. The participants had little concern about the dissemination of HIV/AIDS in Iran. Using a common syringe is mentioned as the main risk factor for HIV transmission. There were some misconceptions about the at-risk group among teenage girls. Conclusions: Considering the misconceptions among the teenage girls, their beliefs should be reformed and reorganized in order to reduce the risk of exposure to HIV. The best practice is training life skills in the school level

A community assessment model appropriate for the Iranian community

Community assessment is one of the core competencies for public health professionals; mainly because it gives them a better understanding of the strengths and drawbacks of their jurisdictions. We planned to recognize an appropriate model that provides a conceptual framework for the Iranian community.This study was conducted in Tehran, during 2009-2010 and consisted of two parts: a review of the literature and qualitative interview with selected experts as well as focus group discussion with health field staff. These steps were done to develop a conceptual framework: planning for a steering committee, forming a working committee, re-viewing community assessment models and projects, preparing the proposed model draft, in-depth interview and focused group discussions with national experts, finalizing the draft, and preparing the final model.Three different models published and applied routinely in different contexts. The 2008 North Carolina Community Assessment model was used as a reference. Ten national and 18 international projects were compared to the reference and one and six projects were completely compatible with this model, respectively.Our final proposed model takes communities through eight steps to complete a collaborative community assessment: form a community assessment team, solicit community participation and gain inter-sectoral collaboration, establish a working committee, empower the community, collect and analyze community's primary and secondary statistics, solicit community input to select health priorities, evaluate the community assessment and develop the community assessment document, an develop the community action plans

Investigating Effective Factors In Out-Of-Pocket Health Payment And Its Catastrophic Expenditure Among Households With Elderly People In Iran: An Application Of Heckman Model To Control Sample Selection

Introduction: Universal health coverage is a critical goal for low- and middle-income countries, with equitable access to healthcare services being essential to achieving this objective. With the elderly population requiring greater healthcare services, it is crucial to plan for their healthcare needs. This study aims to evaluate the determinants of out-of-pocket payment (OOP) and catastrophic healthcare expenditure among households with elderly individuals in Iran. Methods: This study analyzed the 2018 Household Income-Expenditure Survey in Iran to examine the socio-economic factors affecting OOP (per purchasing power parity International Doller – PPP. Int $) and catastrophic healthcare expenditure in households with elderly members. Using survey probit regression model with Heckman selection, the study identified determinants of OOP and catastrophic healthcare expenditures. A survey probit regression model with Heckman selection has been applied to identify the determinants of out-of-pocket (OOP) and catastrophic healthcare expenditures. The approach allowed for the examination of variables that may have impacted the likelihood of incurring OOP and catastrophic healthcare expenditures, while accounting for potential selection bias. Results: Rural households (with difference 60.78 PPP. Int$) and non-owning homes (with difference 98.83 PPP.Int$) had higher OOP than their urban and owning counterparts, respectively. Larger households also had higher OOP, with those with five or more members having the highest. High-income households also had higher OOP. Additionally, smaller households had a lower chance of facing catastrophic healthcare expenses. Lastly, the Mills ratio was negative. Conclusion: Our study reveals insufficient observed out-of-pocket (OOP) payments for healthcare in Iran to cover the "needed" OOP, indicating a possible financial burden on households. This highlights the need to address inequalities in healthcare access and expenditure for households with elderly individuals, particularly in rural areas and larger households. Policymakers should implement targeted interventions to reduce OOP for these vulnerable groups. Future research should include socio-economic factors that affect access to healthcare service

Higher Education Initiatives for Disaster and Emergency Health in Iran

Iran’s health system is expanding the disaster and emergency higher education programs over the country to enhance the capacity of human resources for effective and efficient disaster mitigation, preparedness, response and recovery. In this article we present an overview about the initiatives and progress of disaster and emergency health higher education in Iran. Following the Bam earthquake, in collaboration with the Ministry of Health & Medical Education and National Institute of Health Research, School of Public Health at the Tehran University of Medical Sciences, Iran took the initiative to develop a Master of Public Health (MPH) with disaster concentration in 2006, a PhD in disaster and emergency health in 2011, and a well constructed certificate course in 2008 entitled Disaster Health Management and Risk Reduction (DHMR). Iran, Kerman and Shahid Beheshti Universities of Medical Sciences and University of Social Welfare and Rehabilitation are other academia that joined this initiative. Regarding the importance of programs evaluation, we have planned for a comprehensive evaluation of MPH and DHMR programs in 2013-4 and the Accreditation and Evaluation Board of Disaster & Emergency Health, based in MOH&ME, is responsible for evaluation of the PhD program in 3-5 years from initiation