Journal of School of Public Health and

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Background and Aim: Improvement of national and provincial health indices requires intersectoral collaboration and community participation So, National High Health and Food Security Council and Provincial Health and Food Security Councils (PHFSC) have been implemented since 2006. The main responsibilities of PHFSCs are, assessment of province health situation and effects of executive organizations on it's improvement, to define and approve the province health strategic plan, developing of AIDS and HIV prevention and control plan and resolving intersectoral issues of health. The goal of this study is first 3 years performance assessment of the PHFSCs.
Materials and Methods: This is a descriptive evaluation study which included all the PHFSCs. The outcome assessment indicators were determined by content analysis of "the approved tasks" and also "the essential aspects for promoting of PHFSCs" by focus group discussions. Situational analysis was provided by two researcher made questionnaires one for co Assessment of the contents of content analysis of PHFSCs all meetings minutes (from establishment year to the end of 2008) and another for gathering viewpoints of Secretaries of PHFSCs.
Results: Data analysis shows that the meeting's agendas of the PHFSCs have less followed the prioritized major health issues of provinces and national burden of diseases most issues were in the domain of ​​communicable disease control and non-communicable diseases risk factors control included scarcely. Only in two Universities of Medical Sciences (UMSc) province comprehensive health plan were proposed. None of the UMSc approved a secretariat for PHFSC in its organizational top chart. PHFSCs secretaries believed that, the main obstacles of the PHFSCs' successes, are weak financial resources, and lack of decisions executive enforcements.
Conclusion: PHFSCs performances are moderate and moderate to low due to lack of comprehensive strategic plan and no implementation model for intersectoral decisions, other organizations believe on the effectiveness of the PHFSCs less and the main burden of disease of the provinces not mostly included in the agenda of PHFSCs. Following proposals are highly recommended for PHFSCs promotion: training and empowerment of UMSc and organizations for developing comprehensive health plan in the province and defining the responsibilities of each organizations for, determining policy priorities of common health issues of the provinces by High Health and Food Security Council and publicizing them by the Ministry of Health and the other relevant ministries and approving the structure and working system of the PHFSC secretariat in UMS by the Board of Trustees of UMS.

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 Background and Aim: Definition of World Health Organization 1948 for Health includes social domain which two other domains of health, physical and mental, have counter effects on it. Quantity and quality of an individual relation to community in order to improve population welfare is a definition for social health. Social capital and security improvement and reduction of impoverishment and inequity is the impact of this relation and it's opposite side is increasing social problems. In this article, by reviewing social health situation of Iranian community and analysis of it's determinants, improvement strategies have been provided and role of Ministry of Health and Medical Education(MOHME) proposed.

 Materials and Methods : This is a descriptive and analytic study A conceptual framework were described based on a nationally committed definition of social health and used for description and analysis. Secondary data of reviewing existing research and documents were utilized for situational analysis Focus group discussion of steering/stakeholder committee members and review of the best evidences and international experiences made analysis and proposed interventions.

  Results: The evidences show that average increasing rate of social problems during recent years is 15% annually. Albeit, it is not possible to draw the increasing or decreasing trend of social health indices precisely since past 2 decades due to the lake of surveillance system. Several social problem reduction and social health improvement interventions are running by organization but, inadequate sensitivity of responsible persons, not to evaluate the current interventions, inadequate utilization and coverage of population from primary level preventive services, inappropriate selection of essential interventions, allocation of most available resources to tertiary level of prevention(after harm services), weakness of activity implementation system and intersectoral collaboration for executing interventions, disintegration of social health related financial resources and inadequate sensitivity and competencies of people in combating to social problems and risks are obstacle to effective interventions in improving social health indices. Economical, political, international and technological big changes should be added to these reasons.

  Conclusion: Social health progress will not be achieved without intersecotral collaboration Improvement of existing situation is not under duties and responsibilities of MOHME, so proposed direction including vision, strategic objectives and interventions, for social health should be implemented partially by MOHME Remaining parts required advocacy to be done by other sectors. It is essential that the proposed program be approved in health policy council of MOHME for implementation of this direction and achieving to it's objectives and then be approved by health and food security high council and social council of country after that the intersectoral collaboration agreements of social health improvement should be supervised deeply.

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Background and Aim: Intersectoral Collaboration and Community Participation are two main strategies for sustaining equity in health. Based on the 4th 5years country development plan, Health and Food Security High Council(HC) as a strategy for developing intersectoral collaboration. Reviewing members' opinions of HC may show the clear way of improving intersectoral collaboration for health promotion of the population to senior officials of Ministry of Health and Medical Education. Materials and Methods: This was a descriptive and qualitative study. Information were gathered by structured interview to HC members and content analysis of the documents and gray materials related to initiation and performance of the HC since it's opening. Content analysis and adding up the interviews were done by hand after defining the main domains. Results: Most of HC members believed that the HC effectiveness is very low or low. For the 1st step, defining health priorities and then responsibilities and expectations of each organization were proposed. Organizations necessity to introduce a sustained representative, creating taskforces for deep working on the issues, regular meeting in secretariat, concurrent information sharing to the members, strengthening similar structure in provinces and giving more authority to them and connecting the council to the scientific committees of health elites are main improvement approaches. Conclusion: There is gap between the performance of the HC and the law makers' expectations. Implementing secretariat of HC including expertise and special working system of intersectoral collaboration will mostly cover the weakness. Defining periodical roles and expectations of organizations and capacity building of health collaborators of the ministries and organizations, and incentivizing organization which have effective contribution, will strengthen and continue the collaboration more.

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Background and Aim: Since health is a multidimensional issue and several factors affected on it, forming a structure which can manage these factors at provincial level is difficult but possible. Analysis of Stewardship function of Iranian Health system showed that an effective platform for operationalizing the national policies has not been provided in provinces yet So, study the current situation of policy making and planning process and designing a model for provinces was necessary. Materials and Methods: This is a descriptive and analytic study which used system designation mathod. Information were gathered by reviewing scientific literatures of policy making systems, critical review of documents related the policy making and planning structures in universities of medical sciences(UMS) in the country and written survey of the chancellors. Synthesized information presented to steering committee, that had been selected after stakeholder analysis, and the principles and requirement of designation were agreed by them. Based on the principles, Components of the proposed system as "Provincial Health Policy Secretarite(PHPS)" including mission and goals, system process, procedures and standards, management style and financial, human and information resources prepared and finalized by running several focus group discussion sessions, presenting selected health experts and steering committee. Results: Scattering of policy and decision making centers in UMSs, weakness of monitoring and evaluation of provincial health policies and programs, weakness of coordination of education, research and health services policies, weakness of evidence based policy making system in 3 levels of UMS, board of trustees and health and food security technical taskforce of the province, weakness of presence of key stakeholders in preparing policies in UMS are the most important improving opportunities of provincial health policy and planning system. Considering existing gaps, PHPS could operationalize brokering, supervising and surveillance roles of the chancellor (Vice Minister of Health at Province) and ensure the attainment of the three streams: following the standards of academic and community engagement, evidence based policies and plans and monitoring progress of provincial health indices improvement policies and plans among executive organizations. Conclusion: Several units effective on policy and planning in province should be coordinated. PHPS not only prevent the parallel structure but can improve the other structures functions as well. Formal implementation of PHPS in top chart of UMSs and training experts of the unit will help integrated policy and planning and facilitate to achieve the best health indices in the province and the country.

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  Background and Aim : Equitable improvement of the national health situation in Iran requires a sufficient and logical balance between preventive and curative needs. Considering the profound changes that have occurred in disease patterns and the population over the last three decades, it is essential to review the ongoing preventive services with due consideration of the current and future needs of the population in an attempt to provide more effective and appropriate services. The provincial health deputies (PHDs, vice-chancellors of the universities of medical sciences), who are responsible for establishing and adjusting new preventive health services, are confronted with many challenges in this matter. A thorough knowledge of these challenges will help greatly in developing strategies aiming at improving the national preventive health services.

  Materials and Methods : The participants in this study were the PHDs throughout the country. Data were collected through interviews and focus-group discussions. The main question was "What are the challenges and procedures in the area of preventive health services in the Iranian universities of medical sciences in the stewardship/supervision, resources and services domains?".

  Results : Results of the study reveal that PHDs have various challenges that have increased over time because of their persistency and the additional burden of the family physician program and referral system, and the effects are quite apparent in both the staff domain and in the universities where the family physician program is being executed. Although the challenges in all the three domains of stewardship, resources and service provision are not equally distributed, service and resource provision domains suffer most. However, solutions to the problem proposed by the participants emphasize on improvement of stewardship in the domain of public health. The universities consider the Ministry of Health and Medical Education to be the main culprit for these problems.

  Conclusion : The existing challenges will prevent establishment of legal articles of the 5^th ational Development Plan in the health sector. In order to promote the health situation in Iran on an equitable basis (achievement of better health indices), at least ten actions to be taken in the universities of medical sciences at the national level are required: activation of the High Council of Health and Food Security and encouraging social accountability of all the governmental, private, and nongovernmental sectors developing a ten-year plan for preventive health and intersectoral collaboration specifying general and specific annual expectations from preventive health departments of medical universities in the form of memoranda of understanding (MoUs) and creating health oriented competition among provinces and cities adopting a model for provision of health services in cities and suburban areas in coordination with the family health program and the referral system evaluating and integrating the existing preventive health programs elimination of overlapping units in the organizational chart at the central level increasing funds for the national preventive health services programs and not letting use of these funds for other programs measuring general satisfaction of the preventive health managers and employees and maintaining and promoting human resources of the health sector expansion of preventive health services coverage down to the district level and, finally, better management of the facilities, equipment and standards of health centers.

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Background and Aim: The Pars Energy-Economic Special Zone, as the energy capital of Iran, needs a healthy productive workforce. In order to be able to promote equitable health indicators of the Zone, it is essential to first obtain information about the situation of the health system in the region.

Material and Methods: This was a cross-sectional qualitative study. Data were collected using an essential public health services (EPHS) performance assessment questionnaire and a researcher-developed questionnaire for strengths, weaknesses, opportunities and threats (SWOT) analysis of the Zone health system. In the next phase, stakeholder analysis was done:  the major stakeholders were invited and asked, after explaining the methodology to them, to complete, individually, the EPHS performance assessment and the SWOT analysis questionnaires, followed by grouping and summarizing the results. Finally, content analysis of results of the group discussions was done and the main domainsا extracted.

Results: The EPHS overall average score was 37.8 (out of 100, the standard score). The greatest weakness was allocated to information functioning. Delivering public health services by the district health networks was the most important strength. Further analysis of the data showed that the far external environment in all the subdomains was the major threat to the public health in the zone.

Conclusion: Based on the findings, it can be said that the organizational status of the Zone is in a weak and threat position. One of the root causes is poor functioning of the public health system. It is essential that the Ministry of Petroleum and the Ministry of Health and Medical Education find effective ways for integrated leadership of the public health services in the Zone.                 

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Background and Aim: One of the main functions of municipalities, as a social institution, is providing, maintaining and improving health of citizens. Scattered attempts have been made with the objective of expanding equitable health service networks in cities, particularly suburban areas. The present study aimed at designing an integrated system for urban health managent center.

Material and Methods: This was a descriptive-analytical study. Based on the viewpoints of experts and relevant stakeholders, global evidence, national experience, and existing legislations, a conceptual framework for designing an urban health management center was developed and requirements for its implementation were determined. On the basis of the conceptual framework, regulations for designing model for a regional urban health management center (RUHMC) was prepared.

Results: The proposed model has 5 important characteristics which would provide an excellent opportunity as a response to the existing challenges of the health network in cities through active participation of the municipality, as a social institution, and other organizations:

                    1. Facilitating intersectoral collaboration, as against individual movements of the

 governmental health sector;   

2.   Defining and providing social health services and influencing the social determinants of health components;

3.   Providing active, rather than passive, services;

4.   Decentralization by forming a board of trustees and/or coordination council;

5.   Direct community participation in all phases, from decision-making (membership in the coordination council) to service provision.

Conclusion: Pilot implementation and evaluation of the proposed RUHMC model is recommended before expanding it to other parts of the city. In addition, it is essential that, before expanding the model to the other cities, the final regulations be examined and ratified by the High Council of Health and Food Security.

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Background and Aim: The most important healthcare reform in Iran during the last decade has been implementation of the family physician and referral system in rural areas and small towns with a population of less than 20000. The program was expanded (as a pilot project), with small modifications, to rural areas of 2 provinces, namely, Fars and Mazandaran. This study was initiated to assess the achievements, challenges and weak points of the pilot project before deciding to expand it to other provinces.

Materials and Methods: This qualitative study was conducted in winter 2013. Data were collected using document desk reviews, semi-structured interviews with key informants, and focus-group discussions. Relevant family health policy makers, managers and service providers in the two provinces were invited to the meetings. The data were analyzed and categorized based on the content analysis method.

Results: The data showed that the family physician program is faced with several challenges regarding objectives; stewardship; service providing; and human, financial and information resources. It is to be noted, however, that the program has had achievements such as increased access to services, increased coordination among insurance organizations and medical universities, and organizing and managing health files.  

Conclusion: The program should not be expanded to other provinces before redesigning in order to assure that it is more complete and comprehensive and create commitment and adequate guarantee among stakeholders. It is essential that all the stakeholders agree on general and specific objectives of a 5-year program and prepare an operational plan for each specific objective. 

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Background and Aim: Considering the key role of the Ministry of Health and Medical Education (MOHME) in the implementation and follow-up of the health system reform, its organizational culture can play an important role in the success of this transformation. The aim of this study was to determine the dimensions and orientations of the current organizational culture of the MOHME headquarters.

Materials and Methods: This was a cross-sectional descriptive and explorative study. The study population was the central staff of MOHME. Data were collected using a questionnaire and analyzed by SPSS version 11.5. Descriptive statistical methods (mean, standard deviation, coefficient of variation and interval) were used to describe quantitatively the cultural dimensions, followed by a qualitative analysis as well.

Results: Analysis of the data showed the following: 1. Organizational cultural dimensions existing at a high level include self-supervision and identity; 2. Organizational cultural dimensions existing at a moderate level include authority and freedom in operations, clear goals and expectations, communication, coordination and coherence; and 3. Organizational cultural dimensions existing at a low level include innovation, learning, fair reward system, acceptance of change, management support and criticism.

Conclusion:  Considering the key role of the MOHME headquarters staff in designing and implementing health promotion programs, bringing about changes in the organizational culture should be a top priority of the ministerial high authorities.

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Background and Aim: Sustainable development to address the global economic, environmental and social issues has been introducedby prominent scientists and is widely used by governments, international organizationsand NGOs. This study aimed to assess the current sustainable development situation influencing health and the future of health in Iran.

Materials and Methods: This was a descriptive study. The sample size was determined using the targeted intentional method and data were collected through targeted search, semi-structured interviews and focus group discussions.

Results: Sustainable development situation in the country has improved in terms of quantitative indicators of child and maternal mortality and Human Development Index.Have However, badair quality, unemployment, inflation and other social harms have had undesirable trends.The most important  causes of slow sustainable development have been reliance on oil revenues, unemployment, increased inflation, inequity in incomes,  poverty, and insufficient intersectoral coordination due to lack of a multi-ministerial secretariat. The health sector should have a comprehensive approach to promoting health of the population.

Conclusion: Based on the findings, it is recommended to include training courses for managers based on sustainable development principles, as well as management techniques in academic training and in-service training of managers. It is essential to create a multi-ministerial infrastructure and, even, a infrastructural power, for cohesion and coordination in order to ensure sustainable development.

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Background and Aim: The purpose of phenylketonuria (PKU) screening is to assess the risk of, and prevent, the disease in the newborns likely inflicted with it. The aim of this study was to investigate why and how PKU screening was decided to be included in the national health agenda, initiated and implemented in Iran.
Materials and Methods: This qualitative study was conducted based on the Kingdon’s framework model in 2015. The participants were thirty-eight policy-makers, managers and researchers selected by purposeful sampling.Data were collected using semi-structured interviews and analyzed using framework analysis.
Results: The physical and mental disabilities, medical and maintenance costs and the need for rehabilitation services were examples of the problem stream. In addition, sampling based on the National Congenital Hypothyroidism Program and implementation feasibility at the national level were examples of the policy stream. Finally, pressure by the patients' families, the Scientific Children Association and executive managers were examples of the political will stream. When the three streams occurred simultaneously, health policy-makers agreed to implement the program and then was opened the window of opportunity.                                                                                                          
Conclusion: Successful implementation of the National Phenylketonuria Screening Program in Iran has been the result of interactions among three streams, namely, nature of the problem, political will and optimal use of policy-makers of the window of opportunity opened.

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Background and Aim: For achievement of equity in the population health the implementation of health in all policies is essential. The most crucial intervention in this approach is inter-sectoral collaboration.
 Materials and Methods: This was a qualitative study based on the national policy framework. Data were collected using literature review, in-depth interviews and focus group discussions with the stakeholders. The results were categorized into three sections, namely, situational analysis and factors affecting it, developing goals and objectives, and requirements and interventions.
 Results: Currently inter-sectoral collaboration in the Iranian health system potentially allows to have health in all policies policy in terms of explicit legislative support, national macro-policies/upstream documents and organizational structure. It will require proper planning as regards designing and institutionalizing appropriate mechanisms for collaboration, as well as cultural and skills capacity building, for stakeholders within and outside the health sector.
Conclusion: The findings of this study can be used in annual operational planning of the High Council of Health and Food Security secretariat.

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Background and Aim: Prostitution is one of the alarming social harms in any population with considerable challenges and concerns. Many prostitutes have been victims of unfavorable social conditions. The purpose of this study was to determine and explain the goals, service patterns, challenges and proposed solutions for the Program of Rehabilitation of Socially Harmed Women in the Iranian Welfare Organization (IWO).
Materials and Methods: A qualitative study was conducted in 2016. The participants included managers and experts of the general departments of the IWO in 31 provinces, 21 members of public mediators and stakeholder organizations, and 5 senior staff managers and senior experts of the IWO Deputy Director’s Office for Social Affairs. Data were collected using document analysis and in-depth individual interviews and focus group discussions and analyzed using the content analysis method.
Results: Based on the data collected, the challenges of the program implementation were found to be as follows: non-acceptance of these women by the society, identity problems of the children borne to them (legally), poor chances of employment, sexual abuse of the women by the employers and mental disorders of the women, as well as poor intersectoral collaboration in IWO and lack of sufficient manpower. Proposed solutions for improvement of the situation included increasing financial credits, creating a national database, informing and sensitizing the people and approving some new judicial laws, as well as reforming some of the existing judicial laws.
Conclusion: Despite the services delivered in this national program, the program faces challenges at the government and public levels. In order to improve the current situation, it is essential to apply the proposed solutions, as well as review and modify the relevant processes.

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Background and Aim: According to the definition proposed by WHO, social health is a health dimension that impacts, or is affected by, the two physical and mental dimensions. Based on the definition given by the Academy of Medical Sciences of Islamic Republic of Iran, social health includes reciprocal qualitative and quantitative behaviors by individuals towards welfare of the society. Pro-social behaviors and an encouraging environment are considered as the two main components of social health promotion. The purpose of this study was to identify pro-social behaviors in the Iranian society.
Materials and Methods: This was a qualitative study. Data were collected using 1). Literature review based on sources related to Iranian culture and religious advice, as well as published international experiences, and 2). Expert opinions based on focus group discussions on eight specialized disciplines. The data obtained were content analyzed.
Results: Analysis of the data of this study showed twenty pro-social behaviors (possible to be categorized into three domains/areas of social thinking, speech and expression, and behavior):
acceptance of diversity and altruism, understanding human rights, not telling lies, cooperation, humbleness, donation/free contribution, being critical, patience and forgiveness, lack of distrust/suspicion, speaking competence, proper balance/equilibrium, sense of responsibility, brotherhood, personal discipline/order, fidelity, trustworthiness, consultation, cultural exchange, self-identity and, finally, respecting the environment.
Conclusion: Behavior change requires applying evidence-based models, e.g., social marketing. It is, thus, suggested that after investigating and surveying pro-social behaviors in the Iranian society, barriers to pro-social behaviors should be investigated and social marketing programs be developed and implemented aiming to help improve these behaviors.