scholarly journals Identifying Economic Resistance Components in COVID-19 Pandemic: The Case of Iranian Health System

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Erfan Kharazmi ◽  
Jamshid Bahmaei ◽  
Shima Bordbar ◽  
Gholamhossein Mehralian ◽  
Peivand Bastani
Keyword(s):  
Health System ◽  
Health Systems ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Economic Resilience ◽  
Step Method ◽  
Statistical Population ◽  
Resistance Components ◽  
Main Determinants ◽  
Iranian Health System

Background: As economic resistance is largely defined as the capacity of an economy to improve or adapt to the effects of unexpected, exterior shocks such as COVID-19 pandemic for health systems, the purpose of this study was to identify the economic resistance components of the Iranian health system during COVID-19 pandemic. Methods: This qualitative study was conducted using the content analysis method from 2020 to 2021. The statistical population of the study consisted of health system experts who are familiar with the subject of resistance economy. Using the snowball sampling method, semi-structured interviews with 30 selected participants were done. The reliability and transparency were determined by Guba and Linkon criteria such as credibility, transferability, confirmability, and consistency, or dependability. Data were analyzed using the Clarke and Braun thematic six-step method. Results: It was found that economic growth, economic stability, justice, and economic resilience, as four main components, affected the economic resistance of the health system in COVID-19 pandemic. Each of these components encompasses a number of sub-components that can help reinforce the health system in two restorative and resilient categories. Conclusions: To the best of our knowledge, a comprehensive study with an exploratory approach was not retrieved to find the main determinants of economic resistance components in COVID-19 pandemic. The present study can greatly contribute to the available knowledge to guide the policymakers for better understanding of the system during unexpected situations and applying the most applied solutions as well. It may help the health systems particularly those who encounter unpleasant macro-trends and unplanned crises, to keep their preparedness and readiness and improve their resilience.

scholarly journals The Reasons for Informal Payments from the Perspective of Health Care Providers and Recipients: A Qualitative Study in Iran

2021 ◽  
Author(s):  
Mohammad Arab ◽  
Bahman Khosravi ◽  
Hosein Safari ◽  
Hojat Rahmani ◽  
Ghasem Rajabi ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Providers ◽  
Great Effort ◽  
Care Providers ◽  
Snowball Sampling ◽  
System Transformation ◽  
Structured Interviews ◽  
Informal Payments ◽  
Iranian Health System

Abstract Background: Informal payments are one of the major obstacles to health system reform in many developing countries, and its elimination is on the agenda of health system policymakers in many countries, including Iran. This study was conducted to identify the causes of informal payments in the Iranian health system.Methods: This was a qualitative and exploratory study. The study population included health care providers and health care recipients. Data were collected using open-ended questions and semi-structured interviews. Convenience and snowball sampling methods were used to select the providers. Content analysis method was used to analyze the data.Results: In the present study, 6 participants were physicians, 4 were hospital managers or CEOs, 4 were treatment or technical managers, 2 were nurses and 12 were patients or their companions. Reasons for informal payments divided in 4 themes include Economic factors, Socio-cultural factors, Service delivery challenges and Legal-political factors.Conclusions: In the Iranian health system, there is a great effort in order to reduce and eliminate the informal payments phenomenon, especially with the implementation of the health system transformation plan. Knowing the causes of this phenomenon can help reduce or eliminate it.

scholarly journals Challenges of Payment Methods in the Iranian Health System and Solutions: A Qualitative Study

2020 ◽  
Author(s):  
Mohsen Barouni ◽  
Leila Ahmadian ◽  
Hossein Saberi Anari ◽  
Elham Mohsenbeigi
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Health Systems ◽  
Monitoring And Evaluation ◽  
Payment Systems ◽  
Structured Interviews ◽  
Negative Effects ◽  
Reimbursement Mechanisms ◽  
Policy Cost ◽  
Iranian Health System

Background: The implementation of different reimbursement methods has various positive and negative effects on the health system of different countries. Identifying the challenges of these methods is essential to improve these reimbursement methods and modify them if required. This article aimed to qualitatively assess the challenges of current hospitals' payment systems in the Iranian health system and determine the required solutions for modifying these payment systems. Methods: This qualitative study was conducted in 2019. Semi-structured interviews were conducted recruiting 20 experts including operational, middle and top managers working in three different levels of health systems. Data collection was continued until it reached a saturation point. MAXQDA 10 was used for data analysis. The data content analysis method was used to analyze the data and the themes and categories were determined. Results: The challenges of the payment systems were categorized into four main themes regarding policy, cost, regulatory and functional challenges, and 15 sub-themes. The findings related to the proposed strategies were presented in six main themes consisting of legal solutions, structural reform, cost, quality improvement, service provider and client, and monitoring and evaluation; and 12 sub-themes. Conclusion: This study showed that the health systems in Iran face various structural and procedural challenges in terms of reimbursement mechanisms. Therefore, it is recommended that policymakers pay attention to these challenges before making any changes. Using hybrid payment systems can be one of the proper solutions.

scholarly journals Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia

2020 ◽  
Vol 5 (4) ◽  
pp. e002272 ◽  
Author(s):  
Dell D Saulnier ◽  
Hom Hean ◽  
Dawin Thol ◽  
Por Ir ◽  
Claudia Hanson ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Health System ◽  
Health Systems ◽  
Public Health System ◽  
Health Needs ◽  
Structured Interviews ◽  
The Public ◽  
Pregnancy And Childbirth ◽  
Childbirth Care

IntroductionResilient health systems have the capacity to continue providing health services to meet the community’s diverse health needs following floods. This capacity is related to how the community manages its own health needs and the community and health system’s joined capacities for resilience. Yet little is known about how community participation influences health systems resilience. The purpose of this study was to understand how community management of pregnancy and childbirth care during floods is contributing to the system’s capacity to absorb, adapt or transform as viewed through a framework on health systems resilience.MethodsEight focus group discussions and 17 semi-structured interviews were conducted with community members and leaders who experienced pregnancy or childbirth during recent flooding in rural Cambodia. The data were analysed by thematic analysis and discussed in relation to the resilience framework.ResultsThe theme ‘Responsible for the status quo’ reflected the community’s responsibility to find ways to manage pregnancy and childbirth care, when neither the expectations of the health system nor the available benefits changed during floods. The theme was informed by notions on: i) developmental changes, the unpredictable nature of floods and limited support for managing care, ii) how information promoted by the public health system led to a limited decision-making space for pregnancy and childbirth care, iii) a desire for security during floods that outweighed mistrust in the public health system and iv) the limits to the coping strategies that the community prepared in case of flooding.ConclusionsThe community mainly employed absorptive strategies to manage their care during floods, relieving the burden on the health system, yet restricted support and decision-making may risk their capacity. Further involvement in decision-making for care could help improve the health system’s resilience by creating room for the community to adapt and transform when experiencing floods.

scholarly journals Donors' Participation in Iran's Health System: Challenges and Solutions

2021 ◽  
Author(s):  
Ali Mohammad Mosadeghrad ◽  
Maryam Tajvar ◽  
Fatemeh Ehteshami
Keyword(s):  
Health System ◽  
Health Sector ◽  
Healthcare Services ◽  
Structured Interviews ◽  
Ethical Considerations ◽  
Senior Managers ◽  
Department Of Health ◽  
The Social ◽  
The Right ◽  
Iranian Health System

Background: Philanthropic activities play an important role in health systems. Donors contribute to financing, generating resources, and providing healthcare services in Iranian health system. However, they face many challenges. This study aimed to identify barriers to donors' participation in the Iranian health system and to provide solutions. Methods: This qualitative study was performed using semi-structured interviews with 38 donors and 26 policymakers and managers in the social affairs department of health ministry and medical universities in 2018. In addition, document analysis was performed and the relevant data were extracted. Thematic analysis was used for data analysis. All ethical considerations were followed in this research. Results: Insufficient structures, poor communications, low trust, ineffective working processes, bureaucracy, insufficient senior managers’ support, weak legal support and poor monitoring were the most important challenges for donors’ participation in the Iranian health system. Effective donor participation in the health system requires the creation of an appropriate system including the right structures, processes, culture, and management. The necessary changes must be planned, led and monitored to promote donors’ participation in healthcare. A conceptual model was developed to strengthen donors’ participation in the health system. Conclusion: Iranian donors face structural, procedural, cultural, and managerial challenges when financing the health system, generating resources, and providing health services. Policymakers and managers should tackle these challenges and adopt strategies to reinforce donors' participation in the health system. Planning, organizing, leading, monitoring, evaluation, transparency, accountability, and a commitment to meet donors’ needs are necessary for successful philanthropy initiatives in the health sector.

Perspectives on healthcare providers’ role in health promotion among cancer survivors.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24037-e24037
Author(s):  
Karina I. Halilova ◽  
Nataliya V. Ivankova ◽  
Laura Q. Rogers ◽  
Maria Pisu ◽  
Fontaine R. Kevin ◽  
...  
Keyword(s):  
Health Promotion ◽  
Cancer Survivors ◽  
Health System ◽  
Health Systems ◽  
Cancer Survivorship ◽  
Cancer Care ◽  
Healthy Lifestyle ◽  
Healthcare Providers ◽  
Structured Interviews ◽  
Web Based

e24037 Background: To further integrate health promotion into cancer survivorship care, we explored multilevel perspectives on potential roles healthcare providers could have in promoting uptake of web-based healthy lifestyle programs among cancer survivors. Methods: In developing the Aim, Plan, and Act on Lifestyles (AMPLIFY) Survivor Health diet and exercise web-based program, we conducted 10 focus groups with 57 cancer survivors and 27 individual semi-structured interviews with stakeholders representing advocacy groups (e.g., cancer survivorship support foundations; n = 8), cancer organizations (e.g., industry, health system; n = 11), and survivors’ supportive partners (n = 8). Verbatim transcripts were analyzed by multiple coders using inductive thematic analysis with NVivo 12. Results: Survivors (49% female; 40% African-American, mean age 63.7 years) and stakeholders (60% female) stated that healthcare provider and health system recommendation and support are vital for ensuring acceptance and use of web-based healthy lifestyle programs by cancer survivors. Survivors expressed that physician’s (e.g., oncologist, other physician) recommendation and support would motivate them to join and participate. Supportive partners also endorsed the importance of provider recommendations and the key role of health system support (e.g., reminders in doctor’s office, hospitals, web-based portal, and endorsement from cancer centers). Advocacy group representatives underscored the importance of data-driven support for the effects of such programs as critical for promotion. Moreover, technology supported continuous cancer care (e.g., physician communication and feedback) were seen as critical for sustained participation. Stakeholders from cancer organizations suggested survivors in need could be identified and referred during assessments in various cancer care clinics. This group also emphasized the need to integrate evidence-based healthy lifestyle recommendations into continuing medical education, medical board certifications, support and referrals into existing standard of cancer care, and to involve other key stakeholders and larger scale health systems in promotion. Conclusions: Healthcare providers and health systems have important roles in promoting and sustaining participation in web-based healthy lifestyle programs among cancer survivors. Further work developing, testing, and refining strategies to enhance their role in promoting the acceptability and uptake of healthy lifestyle programs by cancer survivors are needed.

scholarly journals Empowering Researchers and Knowledge-Producing Organizations for Evidence-Informed Health Policy Making: Interventions in the Iranian Health System

2020 ◽  
Author(s):  
leila Doshmangir ◽  
Hakimeh Mostafavi ◽  
Reza Majdzadeh
Keyword(s):  
Health Policy ◽  
Health System ◽  
Policy Making ◽  
Scientific Evidence ◽  
Effective Interaction ◽  
Evidence Based ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Community Based Interventions ◽  
Iranian Health System

Abstract Background: Providing appropriate information to policymakers by strengthening evidence-based capacity is a key factor in the development of evidence-based policy making (EIPM). This study aims to examine the necessary interventions in the Iranian health system for empowering researchers and knowledge-producing organizations to strengthen EIPM.Methods: This qualitative study was conducted using interviews and document review. The views and experiences of enterviewees were extracted through semi-structured interviews. Purposive sampling was used and continued until data saturation. Thematic framework analysis and MAXQDA 12 software were used for data analysis.Results: Necessary interventions for empowering researchers and knowledge-producing organizations were categorized into health system interventions, community-based interventions, organization interventions, and individual interventions.Conclusion: Incompatibility of health policy decisions with scientific evidence derived from research highlights the importance of creating a common language among health policymakers and researchers. In this regard, developing scientific and practical interventions, educating health researchers on knowledge translation, and using mechanisms and networks for effective interaction will be constructive.

scholarly journals Senior Managers’ Experience with Health, Happiness, and Motivation in Hospitals and the Perceived Impact on Health Systems: The Case of Meru County, Kenya

Healthcare ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 350
Author(s):  
Rose Nabi Deborah Karimi Muthuri ◽  
Flavia Senkubuge ◽  
Charles Hongoro
Keyword(s):  
Mental Health ◽  
Health Status ◽  
Health System ◽  
Health Systems ◽  
Health Workforce ◽  
Negative Impact ◽  
Phenomenological Approach ◽  
Structured Interviews ◽  
Senior Managers ◽  
Perceived Impact

Hospitals play a significant role in health systems. Studies among the health workforce have revealed their experiences with mental health challenges. In comparison, there is limited literature on their positive mental health. The purpose of this study was to explore senior managers’ experiences with health status, happiness, and motivation in hospitals and the perceived impact on the health system in Kenya. This qualitative study applied a phenomenological research design. Senior managers within the hospital management teams were selected using purposive sampling. Semi-structured interviews were carried out among senior managers across eleven hospitals in Meru County, Kenya. Among the eleven participants 63.6% were female and 36.4%, were male and the mean age was 44.5 years. The audio-taped data were transcribed and analyzed using Colaizzi’s phenomenological approach. The five themes revealed were: (1) Happiness in the health system; (2) Health status in the health system; (3) Motivation in the health system; (4) Challenges in the health system; (5) Possible solutions to the challenges in the health system. This study revealed the positive and negative impact of the three domains, challenges, and solutions, from the senior managers’ perspective. Healthy, happy, and motivated senior managers and healthcare workers are more responsive and perform better. Policy interventions and programs promoting happiness, health status, and motivation are necessary for strengthening the health workforce and health system.

scholarly journals Provider and administrator-level perspectives on strategies to reduce fear and improve patient trust in the emergency department in times of heightened immigration enforcement

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256073
Author(s):  
Carolina Ornelas-Dorian ◽  
Jacqueline M. Torres ◽  
Jennifer Sun ◽  
Alexis Aleman ◽  
Emmanuel Cordova ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health System ◽  
San Francisco ◽  
Active Role ◽  
Constructivist Grounded Theory ◽  
System Level ◽  
Immigration Enforcement ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Building Safety

Study objectives Heightened immigration enforcement may induce fear in undocumented patients when coming to the Emergency Department (ED) for care. Limited literature examining health system policies to reduce immigrant fear exists. In this multi-site qualitative study, we sought to assess provider and system-level policies on caring for undocumented patients in three California EDs. Methods We recruited 41 ED providers and administrators from three California EDs (in San Francisco, Oakland, and Sylmar) with large immigrant populations. Participants were recruited using a trusted gatekeeper and snowball sampling. We conducted semi-structured interviews and analyzed the transcripts using constructivist grounded theory. Results We interviewed 10 physicians, 11 nurses, 9 social workers, and 11 administrators, and identified 7 themes. Providers described existing policies and recent policy changes that facilitate access to care for undocumented patients. Providers reported that current training and communication around policies is limited, there are variations between who asks about and documents status, and there remains uncertainty around policy details, laws, and jurisdiction of staff. Providers also stated they are taking an active role in building safety and trust and see their role as supporting undocumented patients. Conclusions This study introduces ED-level health system perspectives and recommendations for caring for undocumented patients. There is a need for active, multi-disciplinary ED policy training, clear policy details including the extent of providers’ roles, protocols on the screening and documentation of status, and continual reassessment of our health systems to reduce fear and build safety and trust with our undocumented communities.

scholarly journals Pursuing health systems strengthening through disease-specific programme grants: experiences in Tanzania and Sierra Leone

2021 ◽  
Vol 6 (10) ◽  
pp. e006615
Author(s):  
Charlotte Devon Hemingway ◽  
Mohamed Bella Jalloh ◽  
Richard Silumbe ◽  
Haja Wurie ◽  
Esther Mtumbuka ◽  
...  
Keyword(s):  
Health System ◽  
Sierra Leone ◽  
Health Systems ◽  
Geographical Location ◽  
Health Systems Strengthening ◽  
Health System Strengthening ◽  
Local Health ◽  
Structured Interviews ◽  
Health Partnership ◽  
Disease Specific

IntroductionDisease-specific ‘vertical’ programmes and health system strengthening (HSS) ‘horizontal’ programmes are not mutually exclusive; programmes may be implemented with the dual objectives of achieving both disease-specific and broader HSS outcomes. However, there remains an ongoing need for research into how dual objective programmes are operationalised for optimum results.MethodsA qualitative study encompassing four grantee programmes from two partner countries, Tanzania and Sierra Leone, in the Comic Relief and GlaxoSmithKline ‘Fighting Malaria, Improving Health’ partnership. Purposive sampling maximised variation in terms of geographical location, programme aims and activities, grantee type and operational sector. Data were collected via semi-structured interviews. Data analysis was informed by a general inductive approach.Results51 interviews were conducted across the four grantees. Grantee organisations structured and operated their respective projects in a manner generally supportive of HSS objectives. This was revealed through commonalities identified across the four grantee organisations in terms of their respective approach to achieving their HSS objectives, and experienced tensions in pursuit of these objectives. Commonalities included: (1) using short-term funding for long-term initiatives; (2) benefits of being embedded in the local health system; (3) donor flexibility to enable grantee responsiveness; (4) the need for modest expectations; and (5) the importance of micro-innovation.ConclusionHealth systems strengthening may be pursued through disease-specific programme grants; however, the respective practice of both the funder and grantee organisation appears to be a key influence on whether HSS will be realised as well as the overall extent of HSS possible.

scholarly journals Empowering Researchers and Knowledge-producing Organizations for Evidence-informed Health Policy Making: Interventions in the Iranian Health System

2020 ◽  
Author(s):  
Leila Doshmangir ◽  
hakimeh mostafavi ◽  
Reza Majdzadeh
Keyword(s):  
Health Policy ◽  
Health System ◽  
Policy Making ◽  
Scientific Evidence ◽  
Effective Interaction ◽  
Evidence Based ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Community Based Interventions ◽  
Iranian Health System

Abstract Background: Providing appropriate information to policymakers by strengthening evidence-based capacity is a key factor in the development of evidence-based policy making (EIPM). This study aims to examine the necessary interventions in the Iranian health system for empowering researchers and knowledge-producing organizations to strengthen EIPM.Methods: This qualitative study was conducted using interviews and document review. The views and experiences of enterviewees were extracted through semi-structured interviews. Purposive sampling was used and continued until data saturation. Thematic framework analysis and MAXQDA 12 software were used for data analysis.Results: Necessary interventions for empowering researchers and knowledge-producing organizations were categorized into health system interventions, community-based interventions, organization interventions, and individual interventions.Conclusion: Incompatibility of health policy decisions with scientific evidence derived from research highlights the importance of creating a common language among health policymakers and researchers. In this regard, developing scientific and practical interventions, educating health researchers on knowledge translation, and using mechanisms and networks for effective interaction will be constructive.

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