Journal of School of Public Health and Institute of Public Health Research

Sustainable Health Financing Methods in Developing Countries: A Scoping Review

Mahdieh Heidari

Background and Aim: Health system financing is the process of collecting, pooling, and allocating financial resources to maintain, restore or promote the health of the people. Developing countries face many challenges in mobilizing, managing and allocating health financial resources. The aim of this study was to identify sustainable financing methods in developing countries.
Materials and Methods: This study was conducted using the scoping review. All the studies related to health system financing methods in developing countries were searched in the English electronic databases (i.e., Pubmed, Scopus, Science Direct, and Web of science), Persian electronic databases (i.e., Magiran, Iranmedex, and SID) and Google Scholar and Google search engines using appropriate keywords. Finally, 94 suitable documents were selected and analyzed using the framework analysis method and MAXQDA software.

Results: Forty-two methods were identified to strengthen the sustainability and resilience of the health financing system in developing countries; these methods were grouped into three categories: collection and management of financial resources, pooling of financial resources and purchasing of health services. The most frequently used solutions to strengthen the sustainability of the health financing system in developing countries were as follows: expanding social health insurance plans, integrating multiple health insurance plans, strengthening public-private partnerships, establishing a robust referral system, imposing taxes on harmful commodities, using perspective fixed payment methods, defining needs-based health service packages, promoting donors’ contributions, and reforming health service tariffs.

Conclusion: The health financing system in developing countries should be strengthened. The financial reforms of the health system should be accompanied by reforms in providing health services to make possible efficient and effective results. Health policymakers and senior managers should strengthen the governance of the health financing system at the macro level. In addition, healthcare managers should increase the efficiency and reduce resource wastage by strengthening budget capacity and financial management at the micro level.

Predicting Corona Vaccine Acceptance Based on Corona Anxiety, Optimism and Rumination in Medical Sciences Students

Mehdi Rezaei

Background and Aim: Public vaccination programs are a way to control the Covid-19 disease. The success of a vaccination program requires the acceptance of the Corona vaccine by the society. The aim of the present study was to predict the acceptance of the Corona vaccine by medical students based on their anxiety, optimism and rumination.
Methods and Materials: This was a descriptive and correlational research. The study population consisted of all the medical students of Azad University, Tehran, Iran during the academic year 2021-2022, from among whom a sample of 509 was selected by the available sampling method. Data were collected using the Acceptance of the Corona Vaccine (KAPC), Anxiety of the Corona Virus (CDAS), Life Orientation (LOT) and Ruminative Responses Scale (RRS) questionnaires. The data were analyzed using the Pearson correlation, partial correlation and standard regression tests.
Results: Data analysis showed that several variables including corona anxiety (with components of mental and physical anxiety), optimism (with components of expectation of a positive outcome and hope for the future) and confidence in the safety of vaccine could positively predict the acceptance of the Corona vaccine. Rumination (with two components of depression symptoms and brooding) negatively predicted the acceptance of corona vaccine. Finally, the reflecting component, age and gender could not significantly predict the acceptance of the Corona vaccine.
Conclusion: To increase the acceptance rate of corona vaccine, paying attention to the roles of psychological factors such as corona anxiety, optimism, trust, and rumination can be helpful.

Applying Shannon's Entropy Index in Explaining Corruption Prevalence in Iran's Healthcare System

Seyed Samad Beheshty

Background and Aim: Considering the destructive consequences of corruption in Iran’s healthcare system, the present study aimed to explain the roots and causes of corruption prevalence in this system.
Materials and Methods: This was a qualitative study with quantitative content analysis conducted in Iran’s Ministry of Health and Medical Education (MHME). Data were collected based on in-depth interviews with 13 experts in the MHME headquarters selected by theoretical and snowball sampling. The unit of analysis of the interviews was the sentence and the conducted interviews were analyzed through thematic analysis using the Shannon Entropy index.
Results: Data analysis showed that legislative fields with an importance coefficients (IC) of 0.293 ranked first, followed by social and cultural fields (IC 0.26), economic fields (IC 0.175), decision-making fields and organizational factors (IC 0.174), and, finally, individual factors and micro-level fields (IC 0.102).
Conclusion: Considering the importance coefficient of individual factors and micro-level fields,
it can be concluded that the personality and individual characteristics of the experts/relevant persons are less important in the corruption occurrence, while the legal, social and cultural variables paly crucial roles in explaining corruption in the Iran’s healthcare system.

The Impact of the Imam Khomeini Relief Committee Services on the Social Health of the Client: Household Female Heads in Shiraz City, Iran

Seyed Samad Beheshty

Background and Aim: The social health of people is a phenomennon that can play an essential role in the development of the society. A question is: to what extent has the Imam Khomeini Relief Committee (IKRC), an organization established at the beginning of the Iranian Islamic revolution to deliver services and help and empower the poor people to get them out of poverty, been successful in affecting the social health of the household female heads? This study aimed to answer this question.
Materials and Methods: This research was conducted with a quantitative and survey approach, including 221 female heads of households under coverage of IKRC in Shiraz, Iran selected by the multi-stage cluster sampling method. The data collection tool was a questionnaire.
Results: The findings showed that the social health of the household female heads under coverage of IKRC and all its components were higher than the average level.
Conclusion: Based on the findings it can be concluded that the educational, health and financial
services provided by the Imam Khomeini Relief Committee could not have influenced significantly the social health of the service-seekers, although they could have affected some aspects of their lives. It is, thus, essential that the Committee revise the contents and the form of services delivered to female heads of households to promote their social health.

Validation of the HSE Assessment Tools in the Kerman Province Steel Industry Complex: A Case Study

Hossein Parvaresh

Background and Aim: The health, safety and environment (HSE) system is an integrated system that tries to create a healthy, pleasant and lively environment with no accidents, damages and injuries by converging and synergizing human resources, facilities and equipment. The purpose of the present study was to investigate the validation of the revised scale of HSE performance.
Materials and Methods: This was a descriptive and analytical research conducted using the psychometric method. The statistical population included all workers of the steel companies in Kerman Province, Iran in 1400. Using the cluster sampling method based on psychometric criteria a sample of 100 was selected for the convergent validity and a sample of 578 for the construct validity section. Data were collected through two scales of HSE performance and job stress (Cohen et al., 1983). Content validity, convergent validity and factor analysis methods were used to check the validity of the scale. The reliability of the scale was checked using the internal homogeneity and classification reliability (dividing in 2 haves). The SPSS version 22 software was used for data analysis.
Results: Confirmatory factor analysis confirmed the six-factor model. The questionnaire was used along with the 35-item occupational stress questionnaire of Cohen et al. (1983) which had good reliability and validity. The alpha coefficient obtained for the whole scale was 0.79, and for the subscales as follows: resilience 0.93, demand 0.90, role 0.93, control 0.85, support 0.72 and relationships 79.0. In addition, the reliability coefficient of the scale was also calculated using the classification method. The classification coefficient for the first and second halves of the data was 0.87 and 0.62, respectively, the correlation between the two halves being 0.248. These findings indicated a favorable internal consistency coefficient for the HSE performance scale (P<0.001).
Conclusion: According to the findings obtained based on the HSE validation, which showed that the fit of the model is high and also that the evaluation of HSE performance has a great role in the health of employees, more attention should be paid to the establishment and implementation of HSE management in Kerman steel companies.

The Experiences of Managers and Employees of the Zahedan Medical University Public Health Deputy in the Covid-19 Pandemic: A Qualitative Study

Fatemeh Setoodehzadeh

Background and Aim: As a pandemic disease, Covid 19 has taken the lives of many people all over the world and has put a lot of pressure on the health care system and health care personnel. The experiences of managers and employees can help increase the efficiency of the health systems in future crises. This study was carried out in order to use the experiences of the personnel of the Crisis Section of Zahedan Medical University Public Health Deputy (ZMUPHD) in controlling the Covid-19 epidemic.
Materials and Methods: This was a qualitative research conducted in 2021-22 using the content analysis method including 30 employees of the Crisis Staff of the ZMUPHD selected by purposeful sampling. Data were collected based on semi-structured, in-depth interviews and analyzed in eight stages including typing the text of the interviews, determining semantic units, coding the text, revising the codes, classifying and developing the classes, revising the classes, identifying the themes and reporting the data.
Resulte: The experiences of the managers and employees of the ZMUPHD to deal withا the Corona pandemic were identified and extracted in 5 main areas including "Legislative", "Operational", "Manpower", "Supervisory" and "Financial", and 13 sub-areas.
Conclusion: Based on the results of the present study, one of the problems in the administration and management of the Covid crisis was the lack of sufficient supervision and political requirements in order to control and prevent the spread of the disease, as well as the lack of a single decision-making organization. Also, financial problems and problems related to human resources were found to be among the most important issues. On the other hand, from the point of view of the interviewees, the use of the 4030 system was one of the turning points in crisis management.

Simultaneous Comparison of Pharmacological Interventions in Obese Women with Polycystic Ovary Syndrome: A Systematic Review and Network Meta-Analysis

Mina Morsali

Background and Aim: So far various medicinal treatments have been introduced to treat obesity. In this study we compared the available drugs for the treatment of obesity in women with polycystic ovary syndrome (PCOS).
Materials and Methods: This study was conducted using systematic review and network meta-analysis (NMA) methods. The major international databases including PubMed, Web of Science, Scopus, Cochrane Library and Embase were searched, the search ending in March 2022. Only randomized controlled trials (RCTs) comparing medicinal interventions in women with PCOS were included in the study. Two of the researchers were responsible for screening the retrieved sources. The Cochrane tool was used to assess the risk of bias. The loop-specific and design by treatment interaction approaches were used to assess the consistency assumption. Treatments in each network were ranked using the P-score. The random effects model was used to report the results. The results were reported at %95 confidence interval (CI). I²statistic was used to check the heterogeneity of the studies.
Results: Out of the 9335 retrieved references, 9 studies met the eligibility criteria. There were two networks for the treatment of obesity in women with polycystic ovary syndrome: Liraglutide (1.2), [P-score=0.86, MD=-8.02(-20.99, 4.94)] as the best treatment in the first network, and Orlistat (120), [P-score=0.88, MD=-3.49 (-5.17, -1.81)] as the best treatment in the second network.
Conclusion: Based on the results of network meta-analysis, it seems that the best medicinal interventions for obesity in women with polycystic syndrome rare Liraglutide (1.2) and Orlistat (120).

Investigating the Mineral Ingredients of Dust Fall in Agricultural Areas in Poldokhtar, Iran (2019-2020)

Davood Jalili Naghan

Background and Aim: Dust storms have negative effects on public health, social economy and environment and, thus, lead to many damages in human resources, health sector and agriculture. Iran is one of the areas affected by particulate matter, with serious damages annually. For these reasons particulate matter increases should receive particular attention in Iran.
Materials and Methods: This research was conducted on solid/mineral section of dust fall in Poldokhtar, Lorestan Province, Iran. Sampling of the particles was done in nine spots in three stages during three months to measue heavy metals, cations and anions. Analysis of the samples for cations and anions was done using the Ic Metrohm system and that for heavy metals using the Icp OES-arcoss system.
Results: Sampling of dust fall was done in February, March and April 2019. Data analysis showed the most highly concentrated cation and anion were SO₄and F, respectively, while the concentrations of Fe and Al were the highest among heavy metals.
Conclusion: The highest amounts of dust fall were found to occur in February 2019, followed by that in March 2019, and the lowest occurring in April 2019. Due to the fact that compounds/elements with both natural and unnatural origins were found in this study, it can be concluded that the origins of the compounds/elements observed could be both natural and unnatural.