Showing 108 results for Health
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.
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.
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, R Seyfaddini, M Ghandi, Mh Mehrolhasani,
Volume 13, Issue 0 (3-2018)
Abstract
Health and human rights are two inseparable and interrelated elements, whose provision and assurance enhance welfare in any society. Definition of welfare, human rights, and health as indicators of welfare development is controversial which is done in accordance with different approaches and discourses. Although the WHO definition is currently the only definition of health agreed upon by the member states of the Organization, it has been subject to criticism by the international society. In general, the most important criticisms include ambiguity, ideality, limitlessness, lack of comprehensiveness, lack of weighting to aspects of health, being non-operational, reductionism, and lack of a precise definition of the normal condition and disease. These criticisms would expose health systems to some challenges such as increased expectations of people, rapidly growing health expenditure, inconsistent expansion of technology-based systems, increased vulnerability to corruption, and equity and efficiency issues. Identifying and examining these criticisms can lead to a more informed decision to redefine health according to the favorable and context-sensitive discourse of the health doctrine in each country. This short review briefly describes the context and the most important criticisms of the WHO definition of health. Eventually, some policy suggestions are presented for redefining health according to Islamic-Iranian discourse.
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.
H Soori, J Hasani, N Entezami, Sm Hosseini, E Rafiei,
Volume 13, Issue 1 (6-2017)
Abstract
Background and Objectives: The Millennium Development Goals (MDGs) are common goals that were established by the United Nations in 2000. The aim of this study was to compare some of these indicators in Iran, the Eastern Mediterranean Region (EMR), and the world.
Methods: The existing data from the World Health Status in 2014 and some other available sources in Iran, EMR, and across the world were addressed. The most relevant health indicators included decreased childhood mortality, maternal well-being, prevention of AIDS, tuberculosis and other diseases, and environment quality assurance.
Results: The proportion of neonatal mortality to total mortality among those less than 5 years increased from 37 to 44 in the world compared to 39 to 46 in EMRO and 46 to 61 in Iran. About 14.5% (71000 out of 490000) of the AIDS/HIV cases reported in the EMRO belonged to Iran in 2002. The maternal mortality rate (MMR) showed a decline of 72.2%, 50% and 44% in Iran, EMRO and the World respectively. The proportion of delivery by skilled persons and the proportion of pre-delivery care had a positive trend in Iran and were higher as compared to EMRO and the world average.
Conclusion: Iran achieved many MDGs, however, despite a decline in the AIDS/HIV incidence rate, its prevalence rate has increased in Iran, EMRO and the world from 2001 to 2013. The proportion of neonatal mortality rate to under 5-year mortality rate has had an increasing trend. Decision-makers should give priority to indicators that have not achieved MDGs.
M Saatchi, Mh Panahi, A Ashraf Mozafari, M Sahebkar, A Azarpakan, V Baigi, K Holakouie Naieni ,
Volume 13, Issue 2 (9-2017)
Abstract
Background and Objectives: The awareness of the health knowledge level of a population and the weaknesses in people's health literacy is essential for educational planning. This community assessment study, which was conducted to develop an appropriate infrastructure for educational planning, examined the level of health literacy in Hormuz Island’s residents.
Methods: This analytical cross-sectional study was done on a sample of people over 18 years in Hormuz Island. Data were collected by two questionnaires which included basic information such as age, sex, marital status, age at marriage, and also indirect questions regarding the economic status of the individuals. Also, the Short Test of Functional Health Literacy in Adult (S-TOFLHA) was used to measure the patient's ability to read and understand health-related concepts. The linear regression analysis was performed.
Results: The data provided by 486 individuals were analyzed in this study. The mean age was 39 years (18-79) and 48% were female. The mean household size was 4.5 people. The mean score of the subjects was 58.06. Thirty-five percent had less-than-sufficient health literacy, 18.21% had sufficient health literacy, 12.29% had insufficient, and 7.14% had higher health literacy. Education level (P<0.001), economic status (P<0.001), and age (P<0.001) were the main variables influencing health literacy in the sample.
Conclusion: Community assessment showed that older age groups did not have sufficient health literacy. Low economic status accompanied by low levels of literacy makes individuals less motivated to improve their health knowledge and, consequently, leads to low levels of health literacy in Hormuz.
K Etemad, A Heidari, Mh Panahi, M Lotfi, F Fallah, S Sadeghi,
Volume 13, Issue 3 (12-2017)
Abstract
Background and Objectives: Data plays a major role in a health care system in development planning and health services support if they are correct, timely and accessible. The data of the Ministry of Health are not readily available and the limited access reduces their value. The aim of this study was to explore the challenges of access to the data of the Iranian Ministry of Health.
Methods: This qualitative study was conducted in 2015. Twenty-three academic and administrative experts were selected purposefully. Semi-structured interviews were conducted to collect the data. The transcripts of the interviews were analyzed using content analysis.
Results: The results of this study provided 4 main themes (challenges of access to the data of the surveillance system, challenges of access to the data of national surveys and ordered projects, challenges of access to the data of electronic health records, and challenges of access to confidential data) and 15 sub-themes.
Conclusion: Given the multiple challenges of access to the data of the Iranian Ministry of Health, it is suggested to design access mechanisms in a systematic manner in the form of guidelines and organizational structures for data access management.
M Parvareh, Gh Moradi, B Nouri, F Farzadfar, N Rezaei,
Volume 13, Issue 3 (12-2017)
Abstract
Background and Objectives:In order to determine the workload of health workers(Behvarz), this research was conducted for work measurement and time assessment in rural health centers(health house).
Methods: This cross sectional study was conducted in 30 health centers during a routine working day in Saghez in 2015 using the “stop watch method”. The time and frequency of the processes were recorded in a checklist. We estimated and compared spent, standard, expected and pessimistic time, and also the mean repetition for each process per day and month as the unit of time.
Results: The mean real working time was about 157.5 minutes (33%) per day, which was mostly (35.5 minutes) spent on the affairs of health volunteers. Care for non-communicable diseases was the most frequent task with an average of 2.4 times per day. In a month, family planning was undertaken more than other processes. The time of most activities like mother care, elderly care, care for communicable and non-communicable disease was significantly lower than the expected and pessimistic times (P<0.05).
Conclusion: The time spent by health workers was low and unscheduled, particularly for important activities of primary health care. It seems that it is necessary to revise the models and methods of service provision in health centers. Efficient use of existing personnel, reducing unnecessary activities and adding more service packages according to the health system priority seem to be important requirements in the first level of health system.
S Mirzaei, H Safizadeh , N Oroomiei,
Volume 13, Issue 3 (12-2017)
Abstract
Background and Objectives: Today, justice is one of the main priorities of policy makers, and equitable distribution of health is one of their concerns. The concept of justice is a health policy objective. International human rights framework places particular emphasis on moving towards equity in health through attention to social determinants of health. In this study, for better recognition of available social determinants of health models, seven common determinants of health frameworks are presented.
Methods: This was a comparative study. The research environment included all social determinants of health models in the world, of which seven models were selected by targeted search. The criteria for selection were justice, evidence-based decision-making, strategic and comprehensive approach, and importance of family in health. The models were studied in detail.
Results: In this study, seven models were identified and investigated in terms of level, type, basis and focus area.
Conclusion: There are many models around the world to demonstrate the determinants of health, and each of these models has its advantages and disadvantages. Wider Determinants of Health Model is the most frequently used model in Iran. This research can help policy makers and researchers in selecting models for analyzing social determinants of health according to the dominant discourse.
S Noori Hekmat, Aa Haghdoost, R Dehnavieh, R Ghorbani Nia,
Volume 14, Issue 0 (1-2019)
Abstract
Background and Objectives: In 1995, a huge revolution occurred in Iran’s health system when the entire medical-related educa-tion program was integrated into the Ministry of Health. This paper was conducted to provide a review of all studies investigating this integration and to synthesize their results.
Methods: This study was a systematic review and qualitative meta-synthesis of the papers on integration using the Walsh and Downe process. An extensive search of the databases of ScienceDirect, PubMed, EMBASE, ISI, Google Scholar, Scopus, SID, Magiran, and Irandoc revealed 187 articles of which 25 were selected. The content of the studies was analyzed and combined using the Walsh and Downe technique.
Results: The results showed 5 main concepts, including the goals and reasons of the medical education integration, integration achievements, challenges, and barriers to achieving the goals of integration, and the future of integration. The greatest success of the integration program was related to health services, while the least positive effects were related to medical education and research.
Conclusion: A review of available documents shows that not all dimensions of integration have been well analyzed and their economic, social, developmental and scientific effects have not been studied. The majority of the limited studies in this regard were surveys and overview studies and few studies used economic analysis and modeling. Therefore, the effects of the integration cannot be evaluated using the available studies.
Mh Mehrolhassani, Mr Amiresmaili, M Iranmanesh,
Volume 14, Issue 0 (1-2019)
Abstract
Background and Objectives: Human resources is a key factor in achieving the Millennium Development Goals. Lack of indicators and standard tools for monitoring and evaluating human resources may cause limitations in achieving these goals. This study was done to develop evaluation indicators of human resources in the health sector.
Methods: The present study was carried out using the Delphi technique to extract the indicators of human resources evaluation in 2017. To conduct this study, three independent stages including a review of theoretical concepts, preparation of initial indicators of human resources evaluation, and consensus building were undertaken. The data were collected by a panel of 12 experts and representatives of related organizations in three rounds, with a scorecard designed to score from 1 to 10. In each round, the indexes that attained at least 8 out of 10 by two thirds of the experts were confirmed in the final model.
Results: In the first stage, 220 indicators were identified. The final model of human resources evaluation had 45 indicators in 11 main criteria. Four criteria were accepted at the stage of entrance to job market, (qualified applicants for health education, accreditation, capacity and outsourcing of health education institutions, approval and licensing). Five criteria were confirmed during the work (main indicators of availability and distribution, activity, productivity of labor force, waste and renewal, desirable governance on the information system of labor). Two criteria were accepted at the exit stage (transfer and withdrawal).
Conclusion: Despite the complexity of the human resources assessment, three different stages of the life cycle of the workforce (input, active labor force and output) should be considered for evaluation and monitoring. The indicators presented in this study make it possible to assess and monitor the health workforce.
E Ehsani Chimeh , A Ghadakchi, V Yazdi Feyzabadi, S Sadrossadat , A Mahi, Mh Mehrolhassani, M Iranmanesh,
Volume 14, Issue 0 (1-2019)
Abstract
Background and Objectives: Quantitative and qualitative improvement of human resources inequality have a significant effect on achievement to health system goals. The purpose of this study was to investigate the trend of geographic, supply, and gender distribution inequality of human resources of the Ministry of Health and Medical Education (MOHME) in Iran.
Methods: In this descriptive study, the trend of human resources of the Ministry of Health during the years 2009-2015 was investigated based on gender, level of education, and type of employment. In order to study the inequality, Lorenz curve and Gini coefficient index were used. Data were collected from the Human Resources Office of the Deputy of Management Development and Resources of the MOHME and analyzed by Excel 2013 and Stata-14 software.
Results: In the present study, women had the highest portion with a growth rate of 6.66% in 2015 and a Gini coefficient of 0.29 except in 2011. The highest and lowest growth rate compared to the base year in 2010 was related to specialist doctors (83.12) and general practitioners (-19.61), respectively. The lowest and highest Gini coefficient was related to the associate degree (0.26) and subspecialty (0.45), respectively.
Conclusion: The present study was the first study to investigate the trend of changes in the human resources characteristics of the MOHME at a national level. Since this study only considered the quantity of the trend of human resources changes, it is recommended that the quality of human resources be investigated in the future studies.
R Dehnavieh, Aa Haghdoost, S Noori Hekmat, M Bamir, A Masoud, A Poursheikhali, Mr Cheshmyazdan,
Volume 14, Issue 0 (1-2019)
Abstract
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.
A Sadeghi Zerisfi , Z Zeinaddiny Maymand , Aa Haghdoost,
Volume 14, Issue 1 (6-2018)
Abstract
Background and Objectives: People living with HIV (PLHIV) experience severe psychological pressure in most communities; however, this pressure is more prominent in women. Therefore, it is very important to monitor different aspect of psychological pressure and psychosocial supports in this group of patients. Based on this need, in this study, we assessed the status of mental health, hope, and social support in female PLHIVs visiting health centers of Kerman, Iran.
Methods: In a triangulation study comprising a combination of qualitative and quantitative components, PLHIV women were recruited and their information were collected using Goldberg’s General Health Questionnaire, Sarason’s Social Support Questionnaire, and the Miller’s Hope Scale.
Results: Our findings showed that female patients’ status improved markedly after visiting the health centers (hope: 92%, general health: 80%, social support: 93%). In addition, the results showed a strong positive the correlation between general health and hope (r=0.61, P<0.0001).
Conclusion: Our results showed that such multi-disciplinary service providing centers may substantially improve the quality of life and general health of these women who rigorously need social support.
Mr Jamali, A Shojaee, M Ghanadi, J Jamali,
Volume 14, Issue 2 (9-2018)
Abstract
Background and Objectives: Evaluation of the epidemiologic pattern of diseases requiring hospitalization is one of the effective factors in better management of hospitals, which can provide health managers and planners with a realistic and appropriate view on procuring the equipment and furnishing and equipping the hospitals in the country. This study was conducted to investigate this pattern based on the International Classification of Diseases (ICD-10) using the information recorded in Tehran Health Insurance Organization in a ten-year period.
Methods: In this descriptive research, we examined all records of hospitalized cases registered in the hospital information system of Tehran Health Insurance Organization during 2005 to 2014. The data of more than two million records, including case number, gender, and age of the patients as well as the diagnosis code were extracted from the hospital information system.
Results: From 2008859 cases, 51.9% of patients were male and the mean age of the patients was 24.60±44.22 years. In children less than one year, “certain conditions originating in the perinatal period”, in children aged one to four years “symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified”, in children 5 to 14 years “neoplasm”, in patients 15 to 44 years “pregnancy, childbirth and the puerperium”, and in patients above 45 years, “diseases of the circulatory system” were the most common diagnostic categories in hospitalized insured patients.
Conclusion: Due the specialization of diseases and various causes of hospitalization, to prevent wastage of financial and human resources, health policymakers and planners should allocate resources to insurance companies according to the scope of their activities.
T Yousefinezhadi, H Soori, E Mohamadi,
Volume 14, Issue 3 (12-2018)
Abstract
Background and Objectives: The sustainable development goals include 17 goals, one of which is exclusively related to health. The aim of this study was to assess the status of indicators of sustainable development goals related to health in Iran compared to countries in the region and the WHO countries.
Methods: Secondary data were used to examine the status of indicators of sustainable development goals related to health. The data reported by the World Health Organization in 2017, the World Bank, and other available resources at the international levels such as the UN and UNICEF were addressed. The indicators according to which the situation in Iran was below the average of the region were selected for further exploration and analysis. A checklist, which met the research objectives, was used for data collection.
Results: The status of the maternal mortality ratio (25 in 100,000 people), incidence of tuberculosis) 16 in 100,000 people), and incidence of malaria (0.5 in 1000 people) was favorable. The indicators with an unfavorable status in Iran compared to the regional average were the mortality due to natural disasters, unintentional poisoning, road traffic injuries, and alcohol consumption per capita.
Conclusion: Iran has achieved many SDGs goals; however, there is a need for carefully designed plans for controlling and reducing some indicators. Prioritizing indicators in which Iran has had little success should be taken seriously by decision makers.
Mm Vakili, A Moazen, S Sharifi, K Kamali,
Volume 14, Issue 3 (12-2018)
Abstract
Background and Objectives: The results of recent studies suggest that model-based health education programs are more effective in changing health behaviors. Interventional programs based on health education theories can be used to explain individual and psychological behavioral determinants in order to reduce the risk of HIV/AIDS. This study was conducted with the aim of psychometric analysis of an HIV scale based on model, population and culture of Iran.
Methods: We used qualitative and quantitative methods during August 2015 to December 2017. The items were generated based on a literature review and interviews with an expert panel. After providing a primary list of the instrument items, we used content and face validity. The first step of the study was done in a sample of medical and non-medical college and high school student from Zanjan. The exploratory factor analysis, internal consistency reliability, and test-retest reliability of the scale were measured.
Results: Fifty-eight items were generated from interviews with experts and review of the literature. After measuring the face and content validity, the items decreased to 53 items. The exploratory factor analysis discovered five factors (perceived susceptibility, severity, benefits, barriers, and self-efficacy), including 30 items for high school students and 31 for university students, that predictive more than 58% of the observed variance. The Cronbach’s alpha coefficient for the sub-scales ranged from 0.80 to 0.86, and the ICC was above 0.86.
Conclusion: The results showed that the HBM was a valid and reliable tool for measuring the HIV/AIDS beliefs and could be used in future investigations.
F Bidarpoor, Kh Rahmani, B Akhavan, A Rahimzadeh, A Pourmoradi,
Volume 14, Issue 4 (3-2019)
Abstract
Background and Objectives: Despite the implementation of the health reform plan and the increasing number of comprehensive centers of health services in 2014 in Iran, many people still do not attend these centers for various reasons. The aim of this study was to determine the reasons why urban households do not attend comprehensive centers of health services in Sanandaj.
Methods: This study was carried out using two quantitative and qualitative approaches. In the quantitative section, data were collected through a checklist and interviews with 200 household heads who did not attend. In the qualitative section, the views of physicians, other health providers, and household heads were obtained using semi-structured interviews.
Results: A feeling of no need for health services, paying more attention to treatment, working on morning shifts, physical problems, inappropriate location of centers, inadequate informing services to community members, inconsistency between existing services and clients’ needs, and inappropriate treatment of some health providers were the most important barriers to non-attendance of clients. Despite four years of implementation of the health reform plan in Iran, 53.5% and 60% of participants had no awareness about the presence of mental health and nutrition experts and their free services in the centers, respectively.
Conclusion: Although there are many reasons for people not attending comprehensive centers of health services in cities, informing and introducing services to the community and considering the clients’ needs are essential.
