R Pakzad, F Alaeddini,
Volume 12, Issue 4 (2-2017)
Abstract
Calculation of Cronbach's Alpha which measures the internal reliability of a tool is easy, but misuse and misconception are widely observed. Common misunderstandings of the Cronbach's Alpha include inability to differentiate between being one-dimensional and consistency, and between raw and standardized alpha. Violations of the assumptions of alpha could also cause an increase or decrease in the calculated alpha. In this paper, we showed that a very large but confusing alpha coefficient could be obtained, particularly when the one-dimensional theory is violated. Also, the use of standard error measurement as an index of the reliability has been presented. Finally, the generalizability of alpha coefficient is also discussed.
S Aghamohammadi , E Kazemi, A Khosravi, H Kazemeini ,
Volume 12, Issue 4 (2-2017)
Abstract
Background and Objectives: By identifying the causes of death, interventions can be designed and implemented to reduce the risk factors of different diseases. The aim of this study is to determine the trend of ten leading causes of death in the Islamic Republic of Iran in 2011.
Methods: The study population comprised all deaths recorded in the death registration system of the Ministry of Health and Medical Education (MOHME) from 2006 to 2011. The data related to causes of death reviewed and modified in terms of quality, underreporting of deaths, and garbage codes using the Global Burden of Disease study methods. Finally, the data were analyzed by sex and age groups.
Results: The leading causes of death were cardiovascular diseases (46.12%), cancers and tumors (13.63%) and unintentional injuries (11.55%) in 2011. The 10 leading causes of death in the general population were myocardial infarction, stroke, transportation-related accidents; blood pressure induced heart disease, other cardiovascular diseases, diabetes, chronic pulmonary and bronchial diseases, gastric cancer, other heart diseases and renal failure.
Conclusion: Deaths from non-communicable diseases still account for a large proportion of total deaths. According to the Heath System Reform Plan in Iran and the need for new interventions, it is very important to register the exact causes of death to design service packages and also evaluate the success rate of ongoing interventions.
Z Boluki , A Bahonar, K Amiri, H Akbarin, H Sharifi, A Akbari Sari, R Partovi,
Volume 12, Issue 4 (2-2017)
Abstract
Background and Objectives: Brucellosis in livestock has led to a significant reduction in the economic capital in Iran. Estimation of the economic losses due to this disease helps to highlight the importance of the disease and makes it easy to justify brucellosis control programs.
Methods: Estimation was done based on the data received from the Iran Veterinary Organization and statistics book of the Iranian Ministry of Agriculture. Economic Loss was estimated assuming the equality of the incidence of the disease in total livestock population with its incidence in tested livestock. The direct costs of culled brucella positive animals, reduced milk production, reduced weight of animal, abortion, and reduced fertility were calculated based on the price of the animal or the product in each year. Due to inflation, the costs were adjusted using the discount rate. Therefore, the losses were compared in each year.
Results: The maximum loss due to brucellosis in the studied period occurred in 2014. Comparison of the losses due to bovine and ovine brucellosis showed that the total economic loss in the sheep and goat population was 5.53 times greater than the loss in the cattle population. Estimation of total economic loss in 12 years of the study was 8,129,116 million IRR (1 USD≅35000 IRR).
Conclusion: More serious attention should be paid to animal brucellosis from both health and economic points of view. Prevention from massive economic losses and human brucellosis control and eradication will not be possible without controlling the disease in the animal population.
M Karami, Sm Zahraei, Mm Gouya,
Volume 12, Issue 4 (2-2017)
Abstract
Background and Objectives: The Haemophilus influenzae (Hib) conjugate vaccine (HibCV) using a pentavalent formulation was introduced to the Iranian routine immunization program from November 2014. Iran is preparing to include Pneumococcal conjugate vaccines (PCV), as well. Measuring and monitoring the impact of HibCV and PCV are necessary to provide evidence for introduction and sustained administration of this vaccine.
Methods: We addressed the possibility of implementing the "3-tiered approach to IB VPD surveillance" as proposed by the World Health Organization using a feasibility study. Expert opinions were asked to address published literature regarding the study design and methods of measuring the impact of newly introduced vaccines.
Results: There are different methods and study designs to measure the impact of new vaccines, including population based active surveillance systems and vaccine effectiveness studies. The results of the feasibility study and expert opinions highlighted the superiority of a sentinel hospital-based surveillance system in Iran.
Conclusion: It is necessary to conduct some systematic reviews and meta-analyses to provide evidence for the trend of Hib and Streptococcus pneumonia related diseases, i.e. invasive bacterial diseases including meningitis, pneumonia, and sepsis. To monitor indirect effects of the PCV vaccine, implementing periodic surveys on the prevalence of nasopharyngeal carriers are recommended.
A Salahi Moghaddam , A Heydari Hengami , M Heydari Hengami ,
Volume 12, Issue 4 (2-2017)
Abstract
Background and Objectives: Iran is classically located in the Palearctic zoogeographic zone, but southern pasts of Iran are drastically different from other parts in terms of fauna and flora. Nowadays, considering the technological advances and the ability to locate the zone border using aerial photos, and the need for comparing the prevalence of the diseases in different locations, it is necessary to identify the border of tropical-like zones as detailed as possible.
Methods: The shapefile of the political classification of Iran was used as the base map and metrological and terrestrial data were obtained from Iran Climatologic Research Center and literature review. Data were arranged in the Geospatial Information System and after geostatistical analysis, a raster map was generated and a probability map for all tropical conditions was calculated and generated as a raster map. Tropical areas were proposed in two layers.
Results: According to our study, between 113 to 125 districts from 8 provinces were located in tropical-like zones. Three of these districts had typical criteria of the Indo-Malayan zone and others resembled the Afrotropical zone. The table of the districts located in the tropical-like zones and the shapefile of these areas are available on the website of Iran Epidemiology Society.
Conclusion: Although Iran in located in the Palearctic zoogeographic area, there are some southern areas which resemble tropical regions and accurate definition of borders is a basic essential need for geo-referenced epidemiology and determining the disease pattern. This study provided a preliminary map for this field of study.
S Sharifi, M Karami, N Esmailnasab, Gh Rooshanaei, Farsan,
Volume 12, Issue 4 (2-2017)
Abstract
Background and Objectives: Cardiac diseases are a major cause of death in Iran. The number of deaths from cardiac diseases can be reduced through controlling air pollution. The aim of this study was to determine the relationship between increased air pollution and mortality from respiratory and cardiac diseases in Tehran.
Methods: The average daily concentrations of five pollutants, including carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), sulfur dioxide (SO2), and particulate matter less than 10 microns (PM10) were collected from 8 stations in Tehran, Iran. Then, their effects on the number of daily deaths due to cardiovascular and respiratory diseases were calculated using time series and Poisson GLARMA model (generalized linear autoregressive moving average). The climatic elements such as mean, maximum, and minimum temperature and daily humidity were considered as confounding factors.
Results: After adjustment for potential confounding variables of the final model of the pollutants, the mean daily ozone level (P = 0.02) and particulate matters less than 10 microns (P <0.001) had a significant correlation with the number of daily deaths.
Conclusion: According to the results of this study that addressed the relationship between air pollutants and death using new statistical methods, it is necessary to take more effective measures to control ozone and particulate matters less than 10 microns to reduce the mortality of heart and respiratory diseases in Tehran.
S Mirshekar, Sm Safavi, Gh Yadegarfar,
Volume 12, Issue 4 (2-2017)
Abstract
Background and Objectives: Food is one of the major needs of the humans that is defined in the context of food security. The objective of this study was to find the relationship between food insecurity and stunting combined with obesity and overweight in children aged 7-11 years old in Zabol.
Methods: This study had two phases. In the first phase (cross-sectional), 3443 students aged 7-11 years old were selected with stratified – cluster sampling. In the second phase, all of the children with stunting and obesity or overweight based on the CDC growth chart comprised the case group and 112 students with normal height and weight based on the CDC growth chart comprised the control group. The case and control groups were matched in terms of age, sex, and school. The food security USDA questionnaire that consists of 18 items was completed through interview with mothers to evaluate the family food security.
Results: The prevalence of stunting, obesity, and overweight was 17.95%, 4.56%, and 10.98% respectively and the prevalence of stunting combined with obesity and overweight was 1.71% in the first phase of the study. There was a significant relationship between food insecurity and stunting combined with obesity and overweight. Food insecurity had a significant relationship with low economic status, living in rented homes, labor job and unemployment of the household head, and low education level of the household head in the case group.
Conclusion: Because of the significant relationship between food insecurity and stunting combined with obesity and overweight, it is necessary to design interventional programs to prevent or reduce food insecurity.
S Hamzeh, Ar Soltanian, J Faradmal,
Volume 12, Issue 4 (2-2017)
Abstract
Background and Objectives: When computing a confidence interval for a binomial proportion p, one must choose an exact interval that has a coverage probability of at least 1-α for all values of p. In this study, we compared the confidence intervals of Clopper-Pearson, Wald, Wilson, and double ArcSin transformation in terms of maintaining a constant nominal type I error.
Methods: Simulations were used to compare four methods of estimating a confidence interval, including the Clopper-Pearson, Wald, Wilson, and double ArcSic. The data were generated from the binomial and Poison distribution with parameters p, n and µ=np, 1000 were produced . Type I error of each method was calculated per simulation. The above methods were used to estimate confidence intervals in a meta-analysis study.
Results: The results of the simulation study showed that double ArcSin keep confidence interval at [0,1], but for some proportion has high type I error or low coverage probability. The Clopper–Pearson interval guarantees that the coverage probability is always equal to or above the nominal confidence level for any fixed p.
Conclusion: This study showed that confidence interval estimations the Clopper-Pearson than other methods of calculating the type I error fixed and smaller.
V Yazdi Feyzabadi , Mh Mehrolhassani, M Emami, S Khosravi,
Volume 13, Issue 0 (3-2018)
Abstract
The human approach to health and identification of the factors affecting it over time has changed. Understanding these approaches is helpful in promoting policymaking and good governance can be helpful in the health sector. Biomedical, psychological, health promotion, health determinants, health in all policies and one health are the most important health approaches that have emerged in different years in order. Each of these approaches has many challenges and strengths. Documents and studies show that although these health approaches have been inconsistently addressed in Iran, no specific doctrine has been define to guide the health policies. Therefore, in practice, what seems to be that a biomedical approach to health is the dominant approach in Iran's health system.
V Yazdi Feyzabadi , Z Khajeh, S Radmerikhi, Mh Mehrolhasani,
Volume 13, Issue 0 (3-2018)
Abstract
One of the main functions of the health systems in each country is health services delivery which includes a wide spectrum of four levels. The first level includes the reduction of disease prevalence, the second level includes early detection, screening and timely treatment. In the third level, we have rehabilitation and relief services, and finally the fourth level is reducing and controlling unnecessary medical interventions. Health services delivery should encompass all of the health needs of each population in the form of these levels. The focus on just one level leads to a reduction in the importance of other levels, and disrupts comprehensive services delivery. It is obvious that, paying attention to the prevention levels can have a significant impact on reducing the later costs and consequences. At present, the provision of services at different levels of Iran's health system is not balanced, and the promotion of these services requires more attention from health policymakers. The health system of Iran is more focused on treatment and medical services and there are many challenges such as poor stewardship and disadvantages of integrated systems in the rehabilitation, relief and palliative services.
Aa Haghdoost, H Hashemi, S Noori Hekmat , M Haji Aghajani , Gh Janbabaee, A Maher, Am Javadi, S Emadi, H Haghighi, Mr Rajabalipour, R Dehnavieh, M Ferdosi, Hr Rashidinejad, F Moeen Samadani , R Rahimisadegh,
Volume 13, Issue 0 (3-2018)
Abstract
Background and Objectives:Among health sector resources, hospital beds are the primary unit of calculation for the capacity of the health service and vital capacity in patient care. Lack of appropriate distribution in different parts of the country leads to transfer of patients and irreparable problems. The aim of this study was to provide accurate information on the number and distribution of hospital beds in the country in 2016 and to estimate the number of beds required by 2026.
Methods:This descriptive-analytic study was conducted in 2016. The population of the study comprised 439 counties covered by 46 medical universities of the country. In this study, the data of 2016 were used and information about the number and ownership of beds and the size of hospitals were obtained from the treatment deputies of medical universities.
Results:The number of active beds in the country was 117580 in 2016, and it is estimated that in order to meet the needs of the community, this number should reach 194471 beds by 2026. There were 1.47 beds for 1,000 people in 2016, which will increase to 2.9 in 2026 by implementing the NEDA project. The coefficient of variation in 2016 was 36%, which will reach 19% by 2026 according to estimates in the Iran's roadmap project.
Conclusion:The distribution of beds was differed in different regions of the country and there are not enough hospital beds in some areas. If the Iran roadmap is implemented, 2026 beds will be distributed more evenly across the country.
Mh Mehrolhasani, V Yazdi Feyzabadi , N Oroomiei, R Seyfaddini , S Mirzaei,
Volume 13, Issue 0 (3-2018)
Abstract
Background and Objectives: Different governance approaches have various definitions and systems about health. The purpose of this study was to compare the appropriateness of the health system performance with the ideology of the selected countries.
Methods: In this comparative study, liberal countries (America, Canada, France), social countries (Russia, China, Cuba) and mixed countries (Sweden, Norway, England) were selected purposefully. Data were obtained from World Bank and WHO’s published documents and discourse literature studies. Causal layered analysis framework was used for data analysis.
Results: Comparison of health indicators showed that mixed countries were in a better position than the other two groups. The health system’s stewardship of the liberal, mixed, and social countries were decentralized, semi-centralized, and centralized, respectively. Discourses of the liberal states were based on the capitalist economy, with lack of reliance on natural resources. Socialist countries, a socialist economy system emphasizes the use of natural resources. In these countries governmental involvement is maximum. Mixed countries have a constitutional monarchy government and benefit from both of these approaches to create welfare based on the ideology of liberalism and the welfare state approach.
Conclusion: Mixed countries with appropriate economic- social conditions, semi-centralized structure of service delivery, suitable financing system, and regional and local management of services (highlighting the role of municipalities), have better health status than other countries. The ideology of the countries forms the social, economic, and political structures as well health. Iran should consider various layers of metaphor, discourse, casual structures, and litany for redesigning the health system.
V Yazdi Feyzabadi , Mh Mehrolhassani, S Khosravi,
Volume 13, Issue 0 (3-2018)
Abstract
Background and Objectives: One of the issues affecting the health sector is the presence of regional inequalities. The purpose of this study was to evaluate the trend of inequality in the distribution of human resources and health facilities in the health sector of Iran.
Methods: In this study, inequality in the distribution of human resources and health facilities in the health sector was assessed using the Gini coefficient in 2006, 2011, and 2015. The variables included human resources (6 indicators) and health facilities (10 indicators). Data were collected from the Statistical Center of Iran and the Statistics and Information Technology office of the Ministry of Health. For a Gini coefficient less than 0.35, 0.35-0.5, 0.5-0.6, more than 0.6 indicated relatively balanced inequality, relatively unequal inequality, high inequality, and very high inequality, respectively.
Results: The maximum Gini coefficient belonged to radiographic centers (0.61) and the minimum was Behvarz (0.23). In human resources indicators, inequality decreased over the study years from 0.57 to 0.27. However, inequality showed a slight increase in Behvarzes from 0.24 to 0.26. Among the facilities indicators, the Gini coefficient of urban health centers, health care facilities, beds, and radiology centers decreased from 0.45 to 0.31, whereas other indicators had an increasing trend from 0.24 to 0.59. In the private sector, there was a high inequality (0.5 to 0.61).
Conclusion: Eliminating inequalities in the distribution of health sector resources can help to improve justice in health outcomes. Therefore, policymakers should be pay more attention to eliminating inequalities.
M Haji Aghajani , H Hashemi, Aa Haghdoost, S Noori Hekmat, Gh Janbabaee, A Maher, R Rahimisadegh, S Emadi, Mr Rajabalipour, H Haghighi, R Dehnavieh, F Dehnavieh Tijang ,
Volume 13, Issue 0 (3-2018)
Abstract
Background and Objectives: Iran is a large country that is often an importer of major medical equipment. There is no comprehensive databank of the status of the equipment in the country. The present study provides a clear description of the dispersal status of major medical equipment in the country in 2016 and the estimated number of required devices in 2026.
Methods: This study was conducted in 2016 in Iran. The study included 8 MRI, CT scan, gamma camera, linear accelerator, PET scan, cardiac angiography, peripheral angiography, and CT angiography devices. The data of the number of equipment in each city were collected through a census of devices.
Results: At the beginning of the year 2016, 3.5 MRI devices, 6.93 CT scans, 2.18 gamma cameras, 1.23 linear accelerators, 0.04 PET scans, 2.3 cardiac angiography devices, 0.27 peripheral angiography devices, and 0.25 CT angiography devices per million population were active in Iran. CT scan and MRI devices were the most available equipment. It is estimated that the same pattern should be maintained in 2026, but the distribution of devices as well as the total number of devices in the country should improve.
Conclusion: In 2016, for most of the devices, the proportion of the device to the population in the whole country was close to the global average, but there was a large accumulation of devices in large cities. This problem has been identified and interventions have been planned to move towards reducing inequalities In Iran's Health Roadmap.
V Yazdi Feyzabadi , Mh Mehrolhasani, Mr Baneshi, S Mirzaei, N Oroomiei,
Volume 13, Issue 0 (3-2018)
Abstract
Background and Objectives: Urban family physician program(UFPP), a program for improving equity in access to, financing, and quality of health services, is piloting in two provinces of Fars and Mazandaran, Iran since 2012. This study aimed to examine the association between the implementation of program and financial protection measures.
Methods: This cross-sectional, ecological study was performed on aggregated data of financial protection measures and some independent variables in the above provinces from 2008 to 2015. At first, the Lasso regression model was used for selecting independent variables affecting financial protection indexes. After adjusting the selected independent variables, in separate models, the association between the UFPP and financial protection measures, as outcome variables, was examined using a backward linear regression model.
Results: The percentage of households facing catastrophic health expenditure(CHE) in the years of UFPP implementation was 1.82% higher than the years before implementation(P<0.05). This increase was 1.37% in rural areas. the percentage of medical impoverishment in the two provinces increased by 0.83% during the implementation years than the years before(P<0.05). Finally, no significant relationship was observed between UFPP implementation and the Kakwani index and out of pocket payment(as % of total health expenditure) in the two provinces(P>0.05).
Conclusion: Despite the achievements attained by UFPP in improving physical access to health services, it seems that this program has had no success in improving financial protection measures and equitable health care financing. However, further research is warranted in this regard.
R Dehnavieh, S Noorihekmat, A Masoud, Ma Moghbeli, H Rahimi, A Poursheikhali , M Hoseinpour, S Salari,
Volume 13, Issue 0 (3-2018)
Abstract
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.
M Haji Aghajani , Aa Haghdoost, S Noori Hekmat , Gh Janbabaee, A Maher, Am Javadi, R Rahimisadegh, Mr Rajabalipour, H Haghighi, R Dehnavieh, S Emadi,
Volume 13, Issue 0 (3-2018)
Abstract
Background and Objectives: The imbalance between the existing human resources and future needs of the health system disturb the service delivery process. The present study aimed at determining human resources needs in the health sector for a 10-year planning program. For this purpose, the researchers examined the geographical distribution of different groups of health system staff in 2016 and 2026.
Methods: This descriptive-analytic study was carried out in 2016. The population of this study included 46 universities of medical sciences. Data of the number and distribution of health care staff working in public, private, charity, and semi-public sectors of medical departments of medical universities were collected. The Qlik View software was used for data integration and designing information dashboards.
Results: At the beginning of 2016, the ratio of nurses, nursing groups, midwives, pharmacists, dentistry and general physician per 100,000 individuals was 133, 199, 32, 17, 22, and 53 respectively, which are estimated to reach 223, 272, 37, 26, 27, and 79 in 2025, respectively. The coefficient of dispersion variation of the above was 39%, 32%, 43%, 33%, 43%, and 44% in 2016, respectively, which are estimated to reduce by 2026 if the Iran medical roadmap is implemented.
Conclusion: The high dispersion index of the medical personnel relative to the population in the cities covered by medical universities indicates unbalanced distribution. If the estimates of the Iran's 2026 medical roadmap are implemented, more appropriate distribution of the medical staff is expected.
A Maher, Aa Haghdoost, S Noori Hekmat , M Haji Aghajani , Gh Janbabaee, H Vaezi, Gh Khademi, S Emadi, R Rahimisadegh, H Haghighi, R Dehnavieh, Mr Rajabalipour,
Volume 13, Issue 0 (3-2018)
Abstract
Background and Objectives: The aim of this study was to provide a clear description of the pre-hospital emergency setting and risk management in accidents and disasters in accordance with current Iran’s standards in different regions of the country. This study was part of the national project "Iran Roadmap (Neda 2026)".
Methods: The data of the major medical equipment was gathered from 48 medical universities covering all of the country's 32 provinces. Goal standards were obtained from the “Ministry of Health” and the “Department of Statistics for Medical Accident and Emergency Management Centers” in all universities. Coefficient of dispersion was calculated to evaluate any dispersion in major medical equipment.
Results: The results of this study showed that in 2017, the highest and lowest coefficient in “pre-hospital facilities” was related to the ambulance engine (301%) and the operational base personnel (93%), respectively. Nio national standards were implemented in “Risk Management in accidents and disasters needs” in most provinces of Iran. In 2026 estimates, all of the factors improved and dispersion decreased.
Conclusion: Despite the poor distribution of prehospital indicators in 2017, forecasting showed desirable conditions in distribution of facilities in the pre-hospital emergency and risk management of accidents and disasters.
R Dehnavieh, Aa Haghdoost, Sr Majdzadeh, S Noorihekmat, H Ravaghi, Mh Mehrolhasani, O Barati, H Salari, A Masoud, A Poursheikhali, N Mirshekari , S Ghasemi, A Esfandiary,
Volume 13, Issue 0 (3-2018)
Abstract
Background and Objectives: Universal health coverage will have a problem in achieving it’s goals if it doesn’t consider the quality. This study aimed to Background and Objectives: Universal health coverage cannot achieve it’s goals if it doesn’t consider the quality. This study wants to assess the quality of health services in Iran, identify existing challenges and provide solutions.
Methods: This study was a mixed qualitative and review study. In the first stage, the national main indicators of the quality of services were reviewed. Then, the orientation of the available upstream documents on the quality of services was explained. The most important challenges, trends, and recommendations of health quality improvement were extracted via interviews.
Results: Proper observation of the Iran health care quality requires appropriate framework and indicators. Upstream documents strongly emphasized on the government's responsibility to play a key role as stewardship and that the health system should provide the necessary structural, procedural, and consequential requirements besides determining appropriate model. Quality management programs had obstacles in some aspects like the performance of managers and human resources, structural/communicational requirements, education, payment system, culture, use of quality management indicators and models, financial, information, and equipment resources, laws and regulations, and supervision.
Conclusion: Improving the quality of health services in Iran requires strategies in organizing, resource generation, payment, laws and regulations, and behavior of policy makers and planners. Quality tools should be used without haste and should pay attention changes in the nature of diseases, expectations of stakeholders, and increased global attention to this issue in designing related plans.
Aa Haghdoost, M Emami, M Hossienpour, F Rakhshani, Mh Mehrolhasani,
Volume 13, Issue 0 (3-2018)
Abstract
Background and Objectives: Promoting health indicators is a key issue in most societies. In this regard, health deputies, through stewardship, monitoring, and coordination, take meassures to promote these indicators. The aim of the present study was to design a model for ranking the performance of the deputies.
Methods: This applied qualitative study was conducted in 2012. The research team included 12 health experts who were selected according to management records and long experience in the health deputy. In this study, a review of the literature and documents was done and then, with the focus group discussions and expert opinions, key indicators were defined.
Results: a model consisting of 9 process criteria (13 general indicators and 15 specific indicators) was identified for ranking of health deputies. The general processes included leadership and management, programs and strategies, resources and partnerships, manpower, and comprehensive information and statistics system And specific processes included primary health care (PHC), family physician (FP), social determinants of health (SDH) and pilot national plans. The range of indicators scores was between 1-8, which were compared with the zero indicator.
Conclusion: The findings showed that the process components and indicators were more effective in determining the status of the health deputies’ performance, and the proposed model is based on the matter. So, it is recommended that the Ministry of Health ranks health deputies every two years to improve process components and criteria of the model based on practical results.
