What the policy and stewardship landscape of a national health research system looks like in a developing country like Iran: a qualitative study

BACKGROUND: The health research system (HRS) is an important national priority that requires a systematic and functional approach. Evaluating the HRS of Iran as a developing country and identifying its challenges reveals the stewardship-related role in how the whole system is operating well. This study aims to assess the HRS in terms of stewardship functions and highlight the enhancement points. METHODS: This study was carried out between March 2020 and April 2021 using a systematic review and meta-synthesis of evidence to examine the Iranian HRS stewardship challenges and interview 32 stakeholders, using a critical case sampling and snowballing approach which included both semi-structured and in-depth interviews. The interviewees were selected based on criteria covering policy-makers, managers, research bodies and nongovernmental organizations (NGOs) in health research-related fields like higher education, research, technology, innovation and science. All data were analysed using content analysis to determine eight main groups of findings under three levels: macro, meso, and micro. RESULTS: Analysis of the findings identified eight main themes. The most critical challenges were the lack of an integrated leadership model and a shared vision among different HRS stakeholders. Their scope and activities were often contradictory, and their role was not clarified in a predetermined big picture. The other challenges were legislation, priority-setting, monitoring and evaluation, networking, and using evidence as a decision support base. CONCLUSIONS: Stewardship functions are not appropriately performed and are considered the root causes of many other HRS challenges in Iran. Formulating a clear shared vision and a work scope for HRS actors is critical, along with integrating all efforts towards a unified strategy that assists in addressing many challenges of HRS, including developing strategic plans and future-oriented and systematic research, and evaluating performance. Policy-makers and senior managers need to embrace and use evidence, and effective networking and communication mechanisms among stakeholders need to be enhanced. An effective HRS can be achieved by redesigning the processes, regulations and rules to promote transparency and accountability within a well-organized and systematic framework

Foresight based on MADM-based scenarios' approach: A case about comprehensive sustainable health financing models

As indicated by a worldwide common perspective about health and sustainable health systems, the health structure as a part of public health is a key theme of many societies. The future is shaped by probable future scenarios, for which dealing practically has many complications. This study is focused on the future scenarios for a comprehensive sustainable health financing model to support a superior structure for a decision and policy-making pilot for the society. This aim is followed based on multiple attribute decision making (MADM)-based scenarios using two MADM methods, step-wise weight assessment ratio analysis (SWARA) and weighted aggregated sum product assessment (WASPAS), as a hybrid model which is the first real case study of the approach. Four main probable future scenarios are identified and selected based on experts' viewpoints about sustainable health financing models. These scenarios include membership in the World Trade Organization (WTO), dynamic basic insurance, international cooperation, and effective resources management. The process of evaluating based on the approach works as a wider picture, including all criteria and alternatives together. Sustainable medical services, empowering the private sector in both production and technology, and employing international managers took place as the top priority for considering the most applicable alternatives in the future. This structure is designed and developed in Iran's context, and the Institute for Futures Studies in Health is the pilot of the research. © 2020

Foresight based on MADM-based scenarios' approach: A case about comprehensive sustainable health financing models

As indicated by a worldwide common perspective about health and sustainable health systems, the health structure as a part of public health is a key theme of many societies. The future is shaped by probable future scenarios, for which dealing practically has many complications. This study is focused on the future scenarios for a comprehensive sustainable health financing model to support a superior structure for a decision and policy-making pilot for the society. This aim is followed based on multiple attribute decision making (MADM)-based scenarios using two MADM methods, step-wise weight assessment ratio analysis (SWARA) and weighted aggregated sum product assessment (WASPAS), as a hybrid model which is the first real case study of the approach. Four main probable future scenarios are identified and selected based on experts’ viewpoints about sustainable health financing models. These scenarios include membership in the World Trade Organization (WTO), dynamic basic insurance, international cooperation, and effective resources management. The process of evaluating based on the approach works as a wider picture, including all criteria and alternatives together. Sustainable medical services, empowering the private sector in both production and technology, and employing international managers took place as the top priority for considering the most applicable alternatives in the future. This structure is designed and developed in Iran’s context, and the Institute for Futures Studies in Health is the pilot of the research.This article belongs to the Special Issue Multi-Criteria Decision-Making Techniques for Improvement Sustainability Engineering Processe

An investigation of prescription indicators and trends among general practitioners and specialists from 2005 to 2015 in Kerman, Iran

Background The World Health Organization (WHO) aims to promote strategies that ensure efficacy, safety, suitability, and cost effectiveness of medicine prescription. Health systems should design effective mechanisms to monitor prescription and rational use of medicines at all healthcare settings. This study aimed to determine and analyze prescription patterns of general practitioners and specialists in Kerman/Iran from 2005 to 2015. Methods This is an explanatory mixed method study. Data were gathered during two phases. At the first phase, prescriptions issued by physicians during 2005-2015 were reviewed to extract information required to develop eight main prescription indicators. In the second phase, the indicators trends were presented to experts participating in expert panel to have their opinions and analyses on the data obtained in the first phase. Experts were selected based on their experience and expertise in medicine and/or health policy and/or experience in implementation of polices to promote rational use of medicines. Some experts attending the panel were a sample of physicians whose prescriptions were included in the first phase. Results Findings revealed that two indicators of the average price of prescriptions and the maximum number of medicines in each prescription had an increasing trend over the study period. Reasons including unprecedented devaluation of the Iranian Rial and willingness of young physicians to prescribe more medications were proposed as the primary contributors to the observed increasing trends. However, other indicators including types of prescribed medicines, average number of medicines per prescription, the percentage of prescriptions with more than four medications, a percentage of encounters with a corticosteroid prescribed, a percentage of encounters with an antibiotic prescribed, and a percentage of encounters with an injection prescribed decreased in the study period. Reasons of controlling initiatives adopted by the Ministry of Health, the higher responsibility of physicians, adoption of continued medical education (CME) programs, and improved knowledge of pharmacists, physicians, and patients about irrational use of medicines were proposed by participants as the main reasons for the decreasing trend. Conclusion Findings indicated that prescription indicators were better in Kerman than those of country average over the study period based on comparing the results of this study and others in Iran. However, they were non-desirable when compared to the international average. The number of factors contributes to the irrational use of medicines, including lack of knowledge among healthcare providers and patients, patients’ misunderstanding about the efficacy of some particular medicines, the high cost of drug development and manufacturing, and unavailability of effective medicines

Evaluation of the trend of qualitative and quantitative growth of scientific products in prioritized health fields during 2010-2017 based on scientometric Indicactors

Background and Objectives: Before any development in scientific health activities, we have to observe its scope and compare it with health sector. Accordingly, the aim of this study was to determine the quality and quantity of the health-prioritized disciplines mentioned in the comprehensive health plan of Iran. Methods: This scientometric cross-sectional study was done during 2010-2017. The study population was 26 prioritized areas in three categories of survival, excellence, and infrastructure according to comprehensive health plan of Iran in 2010. The data collection tool was the SCImago database. The number of documents, citation indicators, and h-index were analyzed by Excel. Results: The findings of the research showed that the highest h-index of Iran in the excellence, survival, and infrastructure category was in Nano (90), infectious diseases (67), and systematic ecology (56), respectively. Moreover, the highest ranked citations in three categories of survival, infrastructure, and excellence were related to traditional medicine, family medicine, and dentistry with a global rank of 8, 9 and 15, respectively. In categories of excellence, survival and infrastructure; public health, bioinformatics, and infectious diseases had the highest number of products with 7045, 5371 and 5135 articles. Conclusion: There has been a marked improvement in the quality and quantity of all the subject categories over time. The general domains of excellence, survival, and infrastructure categories had the highest mean H-index, and the highest average growth rate of scientific productions was related to excellence, infrastructure and survival categories, respectively

Evaluating the tabriz health complex model, lessons to learn

Background and Objectives: One of the decentralized models that has been formed based on universal health coverage is the model of health complexes in Tabriz. This study was conducted to evaluate the model.   Methods: This case study was conducted in 2017. Beside observation, 28 individuals, including informed experts in the field of establishment of health complexes in Tabriz University of Medical Sciences, were purposefully selected and semi-structured interviews were also conducted. To analyze the interviews and the results of observations, the framework analysis was used based on the components of the Primary Care Evaluation Tool (PCET) model.   Results: The strengths of the health complex model are decentralized planning, strengthening the private sector participation, have more appropriate methods for assessing the performance of the health team, creating a sense of delivering effective services in providers, using electronic information registration system, using the prospective payment method, strengthening the referral system, enhancing service continuity, and facilitating financial and geographical access, especially in marginalized areas. However, there are some problems such as lack of some facilities and equipment, lack of some workforces and high workload, financial instability, and lack of insurance organizations cooperation with the plan.   Conclusion: The health complex model has improved organizational, financial, and geographic access to health services. It seems that if the resources are more stable and by cooperation of basic insurances, the results of this project will be better

Preventing plagiarism in academic literature, lessons learned from European union member states

Background and Objectives: Plagiarism is the most prevalent type of scientific misconduct, and various rules and strategies have been proposed to combat it in different countries. A review of other countrieschr('39') experiences in this area contributes to good policymaking. The present study was conducted to introduce preventive interventions of plagiarism in the leading countries. Methods: The present study was a qualitative review study of applied practices. In this study, preventive interventions of scientific plagiarism in the 27 European ::::::::union:::::::: countries were studied due to the appropriate coherence and structural similarity at national, organizational, and individual levels. The national-level interventions were analyzed using the content analysis method in mentioned countries. Results: The results of analyzing the national-level interventions were categorized into eight main themes, including reaching a national agreement on examples of scientific plagiarism and misconduct; policy development; monitoring and supervision; financial support development; development of databanks and software; compiling educational programs for faculty members and students; dissemination and use of successful experiences; and eventually establishment of laws related to scientific misconduct, plagiarism, and punishments activities. Conclusion: Using preventive interventions at a national level proves the commitment and determination of policymakers to control and prevent plagiarism. Proper use of preventive interventions at a national level strengthens the controlling and preventive infrastructures of this issue at the organizational level, and enhances moral commitment and professional skills among the countrychr('39')s researchers