Journal of School of Public Health and

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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: Despite rapid diagnostic and therapeutic advances, patients with chronic coronary artery disease (CCAD) should adopt self-care behaviors. This study aimed to determine predictors of perceived health competence among CCAD patients in Tehran, Iran in 2019-2020.
Materials and Methods: This cross-sectional study was conducted among 700 patients with CCAD referred to Shahid-Rajaie Cardiovascular Center in Tehran selected using the available sampling method. Data were collected using the perceived health competence scale (PHCS), 12-item quality of life scale and Modanloo's adherence to treatment scale questionnaires. The content validity ratio and content validity index were used to determine validity, and the Cronbach's alpha to determine reliability, of the PHCS questionnaire. Data analysis was performed using descriptive statistics, Pearson correlation coefficient, Structural Equation Modeling (SEM), the software being SPSS₂₅.
Results: The multivariate regression analysis showed that perceived health competence had statistically significant direct associations with physical (β = 1.08, p< 0.001) and psychological (β = 0.85, p< 0.001) domains of quality of life, commitment to treatment (β = 0.12, p =0.01), willingness to participate in treatment (β = 0.12, p = 0.05) and uncertainty about implementation (p = 0.1, p‹ 0.001) of adherence to treatment. There was a significant indirect association between age and perceived health competence (β = -0.13, p = 0.03).
Conclusion: Based on the findings, considering a “very good” and a “poor” mean score for adherence and the quality of life among the patients, respectively, adopting strategies for promoting quality of life in both the physical and mental dimensions can lead to improvements in perceived health competence in cardiovascular patients. In addition, it seems that focusing on subscales of “willingness to participate in treatment” might help in improving the patients' perceived health competence.

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Background and Aim: It is essential to take action to strengthen the national primary health care (PHC) system. The purpose of this study was to conduct a comprehensive review to find ways to strengthen the PHC system in Iran based on the experiences of different countries.
Materials and Methods: This was a comprehensive review study. The relevant studies were retrieved using Science Direct, PubMed, Google Scholar, Scopus, Web of Science, Magiran, Iranmedex and SID databases. Inclusion criteria included all the studies that specifically focused on the factors enhancing the PHC system between 1998 and 2017. Finally, 30 articles were selected.
Results: Strategies for strengthening the PHC system were examined from two different angles: factors that facilitate the performance of the health care team, and ways to improve the implementation of PHC. In addition, strategies have been recommended for the following in order to strengthen the PHC system in Iran: trust-based relationships; widespread implementation of the National PHC Program with a focus on personnel training; teaching healthy lifestyle behaviors and drug side-effects; investing in information technology in the health sector in areas such as immunization, child care and prevention of chronic diseases.
Conclusion: Strengthening primary health care requires coordination and inter-sectoral collaboration; involvement and will of a wide range of health and non-health organizations; government support; strengthening of the referral system and the family physician; strengthening the health team; self-care and community participation; a public health-oriented and preventive approach in macro-policies; and, finally,  allocating more resources to the health sector.

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Background and Aim: One of the dimensions of health is social health. Social health indicates, in a way, the inviolability of the identity aspects of individuals in the community. From among the factors affecting social health, a sense of social security both in its objective and mental dimensions has a particularly significant effect, and also a fundamental impact, on the efficiency of individuals in the society. In this study the relationship between the two variables ─ social security and social health ─ was investigated empirically.
Materials and Methods: This was a quantitative survey including a sample of 400 residents in Lende City, Kohgiluyeh and Boyer-Ahmad Province, Iran in 1398. Data were collected using questionnaires.
Results: The findings showed that there were statistically significant relationships between the sense of social security and social health in most of their domains (P <0.05). Modeling of structural equations between these two variables also showed that the sense of social security with a regression weight of 0.54 had an effect on social health in a way that this variable alone explained 29% of changes in social health, while gender had no effect in this regard.
Conclusion: On the basis of the findings it can be concluded that the sense of social security has significant effects on social health and efficiency of people in the society. Therefore, if a society can protect the identity components of its citizens in its different ethnic, religious, linguistic and national aspects and increase their level of social tolerance, then it will be possible to create better conditions for promoting the social health of individuals in that society.

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Background and Aim: The “Package for mental and social health promotion and drug abuse prevention” was developed in response to the importance of, and concerns relate to, the mental and social health in the population. Since any policy and plan needs to be assessed to find its weaknesses, strengths and challenges to ensure its successful implementation, this study aimed to find and explain the executive leadership challenges of this service package from the service provider's perspective.
Materials and Methods: This study was a qualitative research, the data being collected through interviews and reviewing the relevant documents. The research population included experts from Kerman University of Medical Sciences, Kerman, Iran, those in charge of the package implementation, urban community health center officials and health care providers. The interviewees were selected using a targeted sampling method.
Results: Based on the interviews, the findings were categorized into four main themes: low public cooperation, difficulty in communication, missing links in design and implementation of packages, and methods of payment to service providers. In addition, the findings based on reviewing the documents were grouped as objectives, plans, activities, target groups, and interventions related to this service package.
Conclusion: Based on the findings of this study, it can be concluded that the implementation challenges of the mental health care package fall into three categories, namely, policy-making, facilities, and personal challenges. Proper changes and reforms at the public policy-making level, creating individual awareness and providing proper facilities for the implementation of the package can help overcome these challenges.

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Background and Aims: Heavy metals in atmospheric dust can enter the human body through ingestion, respiration and skin contact and cause various diseases. The aim of this study was to determine the concentration of lead, a heavy metal, in atmospheric dust and assess its health risk during the period between winter of 1397 and the fall of 1398 in regions 9, 10, 11 and 12 of Tehran Municipality, Tehran, Iran.
Materials and Methods: Atmospheric dusts were collected monthly during one year in the following locations in Tehran: west and east of region 9; east of regions 10, 11 and 12 (the locations in the west of these regions had common borders with the eastern part of the adjacent region). A factorial experiment was performed in a completely randomized design with three replications; the experimental factors included sampling locations and sampling times (seasons). The concentration of lead in the samples was then determined after extraction with hydrochloric acid and concentrated nitric acid (ration 3:1).
Results: The lowest (177.1 mg/kg) and highest (98.476 mg/kg) concentration of lead were found to be in location 9W (Tehransar) in winter and in location 11E (Vahdet-E-eslami Avenue) in autumn, respectively. Further analysis of the data showed that ingestion of the atmospheric dust was the main risk of exposure to lead and that more than 90% of the risk index for non-cancerous diseases caused by lead was related to ingestion hazard quotient (HQ, risk equation).
Conclusion: Based on the findings it can be concluded that in winter the hazard quotient (HQ) and hazard index (HI, non-cancer Risk Index) for lead were lower than the maximum permitted levels for adults and children and, so, did not pose any health risk for these age groups. However, in spring, summer and autumn the risk index for lead was higher than the maximum permitted level for children and, thus, the risk of children developing non-cancerous diseases was high in all the sampling locations.

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Background and Aim: The health system financing is the process of collecting, pooling and managing financial resources and purchasing healthcare services. Health financing plays an important role in achieving the health system goals and objectives specially universal health coverage. The aim of this study was to strategically analyze the Iranian health financing system and recommend strategies to strengthen it.
Materials and Methods: Using the scoping review method, all published studies about the strengths, weaknesses, opportunities and threats of the Iranian health financing system were searched in eight databases including "PubMed", "Scopus", "Science Direct", "Embase", "ProQuest", "SID" and "Magiran", as well as the "National Database of Medical Science Theses" and two search engines, namely, "Google" and "Google scholar". Finally, 29 studies were selected and analyzed using the framework analysis method and MAXQDA software. 
Results: Extended health insurance coverage, reduced out-of-pocket payments following the national health transformation plan, and increased healthcare tariffs were the strengths of the Iranian health financing system. On the other hand, regressive financing, high out-of-pocket payments and increased number of health insurance companies were the weaknesses of Iran’s health financing system. Political sanctions, financial crises and increased healthcare demands were the threats, while supportive laws, the NGO’s financial support, increased number of health care organizations and modern technologies were among the important opportunities for the Iranian health financing system. Increasing the health system financial resources through prepayments, structural and policy unification of health insurance system, health service tariff reform and enhancing health system efficiency and healthcare services quality are essential to strengthen the Iranian health financing system.
Conclusion: The Iranian health financing system is not resilient and faces several challenges. The health system policy-makers and senior managers should adopt the recommended strategies to strengthen the national health financing system.

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Background and Aim: One of the dimensions of health is mental health that could be affected by the quality of occupational life. The purpose of this study was to determine the effect of job satisfaction on teachers' mental health with due consideration of the moderating role of gender and the subjects taught.
Materials and Methods: This was a quantitative survey using a questionnaire including a sample of 373 teachers, selected by multistage random sampling, from among all (n = 1500) the secondary school first- and second-grade teachers in Najafabad city, Isfahan Province, Iran. Data analysis was done using the software AMOS and SPSS.
Results: The confirmatory factor analysis of the items showed that these items could explain 63.25% of the variance of the mental health construct. In addition, the standard effect of job satisfaction on mental health was found to be 0.37 (p <0.001), explaining 13% of the mental health construct variance. Further analysis of the data showed that the teachers’ mean mental health construct (66.64) and their mean of job satisfaction (73.90) were lower and higher than the means of the respective spectra (p <0.001), respectively.
Conclusion: Job satisfaction, which has been proven to affect the teachers’ mental health, can improve their personal and social life and make them more efficient in education. In this regard, gender and the type of subject taught can have moderating effects on the relationship between job satisfaction and mental health of the teachers. Based on the beta-values (0.55 for the women group and 0.68 for the experimental science teachers group), the gender female and teaching experimental science can have a stronger effect on the teachers’ mental health than gender male and teaching subjects other than experimental science.

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Background and Aim: Despite the increasing prevalence of infection with some blood-borne viruses, no standard precautions have been developed so far based on the Health Belief Model (HBM). This study aimed to assess, based on the HBM, the predictors of adherence to standard precautions in preventing needle stick injuries among the Personnel of Sanandaj Teaching Hospitals, Sanandaj City, Iran in 2020.
Materials and Methods: This cross-sectional study included 444 medical and non-medical staff members of the Sanandaj teaching hospitals in Sanandaj City, Iran, using a researcher-developed questionnaire. Descriptive and analytical data analysis was performed using Mann-Whitney U and Kruskal-Wallis tests, Pearson correlation coefficient, one-way analysis of variance, multivariate regression and the chi-square test, the software being SPSS version 22.
Results: The results of multivariate regression analysis showed that from among the HBM constructs, three constructs, namely perceived sensitivity (p=0.033), perceived benefits (p=0.032) and self-efficacy (p=0.001), were the predictors of staff duty performance (implementation of  standard precautions) in preventing needle stick injuries. As regards the implementation of standard precautions, 22%, 75.3% and 2.7% of the staff members had a low, medium and high performance level, respectively.
Conclusion: The constructs of perceived sensitivity, perceived benefits and self-efficacy are the strongest predictors in adherence to standard precautions.

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Background and Aim: The realist review has been introduced to review and synthesize the evidence related to the implementation of complex healthcare interventions. This method interprets the results of an intervention by explaining the causal relationships between the intervention and the results. This study aimed to explain the methodology of realist review in the health system.
Materials and Methods: This study was conducted using the scoping review. The following databases were used to find articles using appropriate search strategies and relevant key words: Pubmed, Scopus, Science Direct, and Embase electronic databases, as well as Google Scholar and Google search engines. Finally 49 articles were selected (in the period between January 1990 and December 2020) for review.
Results: The realist review is a theory-based approach to synthesize evidence related to the complex interventions, explaining the reasons for the successes or failures of interventions based on the causal relationships between the interventions, contexts, mechanisms and outcomes. A protocol was introduced to conduct a realist review composed of three phases ─ explaining, development and correcting the intervention program theory ─ and including seven steps of determining research questions; explaining the initial program theory; developing search strategies; collecting, evaluating and selecting evidence; synthesizing evidence; modifying the initial theory; and making suggestions. In addition, the structure of a realist review article was described and a checklist for evaluation of a realist review study was introduced.
Conclusion: The realist review is a suitable method for reviewing the complex health system interventions, explaining how an intervention relates to the results obtained. A realist review explains how, under what conditions and for whom a health and therapeutic intervention works.

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Background and Aim: Public health expenditures and the quality of governance are among factors affecting the health status of a population. Therefore, the purpose of this study was to investigate the interaction effects of good governance and public health expenditures on the health status of children in upper-middle income countries.
Materials and Methods: This descriptive-analytical applied study was performed using the panel data regression with the fixed effects method and quantile regression for panel data for the years 2000-2017 in 2020. The statistical population was upper-middle income countries, and annual time series data were extracted from the World Bank databases. The models and required tests were determined using the Stata-16 software.
Results: The coefficient of good governance variable and the index of interaction effects of good governance and the public health expenditures for the under-five child mortality as the dependent variable were -0.002 and -0.003, and for the infant mortality as dependent variable -0.002 and -0.002, respectively. Also, the coefficient of the index of the interaction effects of good governance and public health expenditures in the quantiles of 0.25, 0.50 and 0.75 for the under-five child mortality as the dependent variable were -0.0333, -0.0447 and 0.048, and for the infant mortality as the dependent variable were was -0.044, -0.048 and -0.049, respectively.
Conclusion: Improvement of governance indicators will increase the efficiency of public health expenditures and improve the children’s health status. Therefore, in order to improve health status, especially in countries with higher child mortalities, it is recommended to improve good governance, increase public health expenditures and government investment in health infrastructure, as well as increase gross domestic product and women's employment.

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Background and Aim: The human mental health is a multidimensional and complex issue affected by a wide range of biological, psychological, sociological, economic and cultural factors. Considering the social nature of human life, the purpose of this study was to investigate the relationship between some social variables, e.g., social support, social bond, social trust and social status, and teachers’ mental health.
Materials and Methods: This study was a cross-sectional quantitative survey using a questionnaire to collect. The sample included 373 primary school teachers (first and second grades) in Najafabad, Isfahan, Iran selected in 2020 by multi-stage random sampling.  Data were analyzed using the structural equation modelling technic, with the SPSS-25 and Amos-23 software.
Results: The confirmatory factor analysis of the items showed that they could explain 63.25% of the variance of the teachers' mental health variable, the social support, social status and social trust variables affecting it (0.65, 0.45 and 0.18, respectively), with a confidence interval of 99% and p<0.001. On the whole, the independent variables could explain 76% of the variance of the teachers’ mental health. In addition, moderation analysis showed that in general gender moderates the effects of social variables on the teachers’ mental health, the female gender having stronger effects in these relationships.
Conclusion: The results of this study show that primary school teachers' mental health, which is an individual/private phenomenon, is greatly affected by their quality of social life, some factors such as social support, social status and social trust potentially influencing it. Moreover, this effect is much more pronounced among women than men.        

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Background and Aim:  The health financing system is the process of collecting, pooling and managing financial resources to purchase health services. Sustainable financing of the Iranian health system is crucial for achieving universal health coverage. The purpose of this study was to identify strategies for sustainable financing of the Iranian health system.
Materials and Methods:  This study was conducted using the scoping review in 2020. The following databases and search engines were searched systematically between 21.03.2002 and 21.09.2020 to find studies related to sustainable financing strategies for the Iranian health system: PubMed, Web of Science, Scopus and Embase, Magiran, Iranmedex and SID databases, and two search engines; i.e., "Google" and "Google scholar”. Finally, 47 studies were selected and analyzed using the MAXQDA software and the framework analysis method.
Results: A total of 40 strategies were identified for strengthening the sustainability of Iran's health financing system, which were grouped into three categories: collecting funds, pooling funds and purchasing health services. The most frequently cited strategies for sustainable financing of the Iranian health system were the following: increasing the health share of gross domestics product, expanding tax revenues, pre-payment methods of health financing, strengthening public-private partnership, increasing the efficiency of the health system, reducing health system costs, consolidating insurance funds, eliminating insurance overlaps, value-based health service tariffs, optimizing health services support packages, and fixed payment methods based on  the performance of the health service providers.
Conclusion: The Iran's health financing system must be strengthened in such a way as to make it possible to collect, pool and manage sufficient financial resources to be used to purchase health services for the people to ultimately ensure universal health coverage leading to the promotion of the public’s health.

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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.

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Background and Aim: Social capital is a social component affecting health outcomes considered to be one of the important factors influencing health inequity in the communities; it is one of the main concerns of health system in the suburbs. This study aimed to determine social capital and its relationships with demographic factors and perceived health status in the suburbs of Mashhad, Iran in 2020.
Materials and Methods: This was a descriptive-analytical study including 300 residents in the suburbs of Mashhad, Iran selected using the cluster sampling method. The data collection tool was a questionnaire containing demographic and perceived health status questions, as well as the Onyx and Bullen social capital questionnaire. Data were analyzed using the t-test, Pearson correlation test, one-way analysis of variance and multiple linear regression, using SPSS-version 24.
Results: The mean age of the individuals was 34.6± 11 years and their social capital score 53.63± 10.52. Among the eight social capital components, the value of life (57.91± 17.7) and participation in the local community (44.28± 15.28) were found to have the highest and lowest mean scores, respectively. Further analysis of the data showed that sex, education level and perceived health could predict 23% of the changes in the total social capital (p <0.001).
Conclusion: In this study, the level of social capital of the participants was low, but the demographic factors and health status were related to social capital. Therefore, policymakers and social and health planners should design and implement community-based interventions to improve the level of social capital.

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Background and Aim: The Primary Health Care (PHC) system is the most comprehensive, equitable and efficient way to promote people's health and social welfare by providing preventive, curative, rehabilitative and palliatvie services in a place close to where people live and work. Iran's PHC system faces challenges that limit its effectiveness and efficiency. The aim of this study was to identify strategies to strengthen Iran's PHC system.
Materials and Methods: A realistic review method was used in this research. Published articles on strategies to strengthen the PHC system between 1978 and 2019 were searched in eight databases and Google scholar search engine. Finally, 29 articles were found to be eligible for inclusion in this study; framework analysis was done using the MAXQDA-10 software. 
Results: Twenty-nine strategies were identified for strengthening the PHC system. A well designed PHC system is one with the following characteristics: realistic goals and appropriate strategies  equipped with necessary resources, organized in multidisciplinary teams that provide comprehensive and quality health services (intervention program), with strong governance and leadership, financing, work force, equipment and medicines, information systems and robust health services delivery processes and well adpated to the external environment (context). Such a PHC system will increase healthcare providers’ satisfaction and commitment, as well as the  patients’ trust, participation and satisfaction (the mechanism) and, finally, promotes, restores, and maintains the people health (result).
Conclusion: A strong PHC system is a pre-requisite for strengthening a health system. Various strategies such as strengthening management and leadership, improving organizational structure and culture, improving the information system, empowering human resources and increasing population coverage can lead to an improved PHC system. Historical, social, cultural and economic factors affecting the health system should be considered in redesigning and stregtening a PHC system.
 

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Background and Aim: The process of identifying Covid 19 cases over time (the trend) can provide valuable information about the coverage of diagnostic and screening programs over time. This study aimed to investigate the outpatient trend of Covid-19 in selected comprehensive health service centers of Tehran University of Meical Sciences, Tehran, Iran.
Materials and Methods: This was a descriptive cross-sectional study. The data collected inculded the number of referalls and Polymerase Chain Reaction (PCR)-positive individuals between April 13 and December 25, 2020. Central and dispersion indices (mean, median, standard deviation and interquartile range) were used to describe quantitative variables. In addition, linear and bar charts were used to describe the trend of the variables over time. All analyses were performed using the Excel 2016 and SPSS 22 software.
Results: The highest numbers of suspected cases of Covid-19 were found to be in April, June and October. There were 2 peaks in the trend of positive cases of Covid 19, and the highest proportions of daily positive cases of Covid 19 was seen in late June and early July, as well as in late September, October, and December. The highest numbers of individuals referred and tested were observed in the South of Tehran Health Center.
Conclusion: Considering the occurrence  of two epidemic peaks during the study period, the occurrence  of further epidemic peaks is almost certain to occur if there is no proper planning for public health services and primary health care by the responsible health authorities and policy-makers.
 

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Background and Aim: Using a proper method to prioritize and develop a basic health services package is a serious challenge. This study was conducted to design a process for developing and revising a basic health services package in Iran.
Materials and Methods: A combined study of quantitative and qualitative methods was used in this study. The qualitative part was conducted through holding 25 in-depth individual interviews and two focus group discussions with experts from the Ministry of Health and Medical Education, Program and Budget Organization and insurance organizations, while the quantitative part was a descriptive cross-sectional study including 277 experts using a valid and reliable questionnaire.  Data analysis of the qualitative and quantitative parts was done using a content analysis and the SPSS-23 software, respectively.                                                                                                                             
Results: The process of developing a basic health services package includes 4 steps, namely, explaining the list of services in the basic health services package, extracting the criteria for including services in the service package, prioritizing the criteria for including services in the package, and comparing services with priority criteria. In the prioritization stage, disease burden criteria, target groups and community needs were found to have the highest means and recognized as the most important criteria.
Conclusion: The process designed in this study for developing and revising a basic health services package provides policymakers with the required scientific evidence by emphasizing the introduction and continuity of services that have higher priorities and the elimination of services that have lower priorities.
 

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Background and Aim: Delivering health services to the elderly is one of the most important responsibilities of the health care system of any country. In order to improve the provision of health services to the elderly population under its coverage, the National Social Security Organization conducted this study with the aim of designing, implementing and evaluating a model for providing outpatient health care services to the elderly population under the coverage of its Tehran Province Office. 
Materials and Methods: This was a sequential-exploratory mixed-method study. The initial model was developed and validated using the integrated review method and the final model using the Delphi technique and group discussions with experts. Then the educational program was developed and implemented for the health team. Assessment of the effectiveness of the program was done using a researcher-made knowledge and attitude questionnaire (pre- and post-test). The model was then implemented in the Khandan-e-Hakim Clinic. The effectiveness of the model implementation was determined based on the qualitative content analysis of the interviews with the elderly and qualitative content analysis of the health team comments.
Results: The outpatient care model of the elderly included an organized clinical process consisting of 6 phases. The mean age of the health team members was 45.7±15.11 years. The difference between the health team satisfaction total scores before and after participating in the educational program was statistically significant (P≤0.05). Further analysis of the data showed, based on the interviews with the elderly, the main categories to be "assessment of cognitive function, mood and behavior", "physical assessment", "appreciation of the health and dignity of the elderly" and "satisfaction of the elderly and their companions". Analysis of the comments of the health team revealed their satisfaction with the implementation of the model.
Conclusion: The introduced model can make possible rapid identification of health problems and timely intervention in the elderly population. This implementation model will help disease prevention and complications at different levels. The findings of this study can help service providers to provide better care and health services for the elderly.
 

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Background and Aim: Primary health care is a holistic approach that aims to maximize people's health and well-being as quickly as possible in their immediate living environment. The primary health care system is the first point of contact of the people with the health system. Therefore, increasing its resilience will play a significant role in controlling and managing pandemics. This research aimed to identify strategies to strengthen the resilience of the primary health care system in the Covid-19 pandemic.

Materials and Methods: This study was conducted using the scoping review method. Using appropriate keywords search was done on the subject of the study in PubMed, Web of Science, Scopus, SID, Iranmedex and Magiran databases and Google and Google Scholar search engines. Finally, after screening and reviewing the titles, abstracts and texts of the retrieved documents, 36 articles were selected and strategies to strengthen the resilience of the primary health care system in the Covid-19 pandemic were extracted from them.
Results: A total of 48 strategies/solutions were extracted to strengthen the resilience of the primary health care system, categorized into 6 groups, namely, governance and leadership, financing, human resources, medicines and equipment, health information systems, and health service delivery. Among the most frequently solutions mentioned were the following: Dynamic and accountable leadership, using valid research evidence in policy-making, contingency planning, increasing inter-sectoral cooperation, advocacy for health policies, community involvement, sustainable financing, recruiting additional staff and training and supporting them, providing sufficient stocks of medicines and diagnostic kits, developing and modernizing public health information systems, facilitating people's access to health centers, continuing to provide health services, and increasing the community’s health literacy.
Conclusion: The structural and process components of the primary health care system including "governance and leadership", "financing", "staff", "equipment, vaccines and medicines", "information" and "health care delivery" should be strengthened in a coordinated manner in the primary health care system to be prepared for future epidemics.