Journal of School of Public Health and

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Evaluation assures the success of each project, program or activity. It is one of the most important components of any management process. Because of its high importance, loss of an effective evaluation mechanism in a hospital not only increases costs, but also endangers community health. The current study tries to assess the perceptions and expectations of hospital managers and decision-making boards in Hamedan regarding the evaluation system and to determine gap between them. This is a cross-sectional study. Its target group in each hospital includes: head, manager, matron, emergency administrator, managers of medical records, laboratory, radiology, pharmacy sections plus the afternoon and night shift supervisors. The study took the form of a census, involving a total of about 400 subjects.The data were collected through a questionnaire and analyzed using the SPSS program . Findings: 1. The highest levels of target group expectation regarding evaluation indices were related to the “patient safisfaction” index. 2. The highest levels of target group perception of the evaluation indices were related to the “ values and norms” index. 3. All the gaps detected between target group’s perception and expectation from evaluation indices were significant. 4.The highest percentage of difference between target group’s perception and expectation was related to the “staff satisfaction” index and the lowest one was related to the “values and norms” Index.

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Background and Aim: The purpose of this study was the assessment of inappropriate admissions and hospital stays and reasons for this in the hospitals affiliated to Tehran university of Medical Sciences.
Materials and Methods: We used the Appropriateness Evaluation Protocol (AEP) to evaluate the appropriateness of 258 admissions to Dr. Shariati and Imam Khomeini hospitals and 1732 days of hospital stay for the same patients. Findings indicate that on the whole, 22.8% of admissions were inappropriate and the length of stay for patients who were inappropriately admitted was significantly shorter than for those whose admission was judged to be appropriate.
Results: Results show that 8.6% of the total number of patient stay days were unnecessary the figures differ significantly between the two hospitals. The most frequent reason for inappropriate hospital stay was the delay in the discharge process .Consultations and delay in surgical operations were other causes of inappropriate patient stay.
Conclusion: A substantial proportion of hospital admissions and stays were found to be inappropriate due to hospital procedures and inadequacies in the lower levels of healthcare. Efficient use of hospital resources should be promoted by modifying procedures, improving the performance of the healthcare system and revising insurance policies.

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Background and Aim: Experience at the national and international levels shows that internal evaluation, especially at the level of academic departments, can play a critical role in warranting having a university with high standards. The objectives of the present research project were to determine (a). the quality of the structural elements of the Epidemiology and Biostatistics Department (EBD) School of Public Health,  Tehran University of Medical Sciences,  and (b). The strengths, weaknesses, opportunities and threats, on the basis of which action could be taken to improve the quality of activities in the Department.

Materials and Methods: The study was conducted with the collaboration of the head and faculty members, all of the students (residents, Ph.D. and M.S. students), and the graduates, of the EBD. Nine variables were studied, namely, 1). Aims and objectives 2). Organizational and management structure 3). Faculty members 4). Students 5). Teaching and learning process 6). Courses and curricula 7). Graduates 8). Research and educational facilities and equipment and 9). Research activities of the faculty members. First the initial weight of the 9 variables were  determined by opinion poll carried out among all the faculty members of EBD. Then unrelated data were identified through proper tests and omitted and the final weights extracted. The tools used to collect the data included interview, observation, and 7 self-prepared questionnaires and 2 check lists.

Results: The mean score for the 9 factors studied was 59.8%, the range being between 37.0% (for objectives and mission) and 72.0% (for graduates).

Conclusion: The graduate domain is one of the key areas in internal evaluation of the Department of Epidemiology and Biostatistics. On the other hand, the lower score for objective and aims domain implicates the need for future intervention in this domain.

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Background and Aim: Economic evaluation of health interventions is critical for efficient allocation of resources. The aim of this study was to critically review empirical studies on the cost-benefit of health interventions published over the last 40 years.

Materials and Methods: This study was carried out by searching seven  databases (PubMed, Cochrane Database of Systematic Reviews, Web of science, Science Direct, Scopus, Springer Link, and SID) using appropriate keywords to find articles on the cost-benefit of health interventions published during 1975-2015. All the relatedretrieved articles were analyzed after quality assessment using a valid check list.

Results: A total of 33studies on the cost-benefit of health interventions during the last 40 years were included in the review; 39%, 37%, 21% and 3%of the studies had been conducted in Asia, America, Europe and Africa, respectively. The subjects dealt with in most ofthe studies (79%) were related to immunization, education, healthy nutrition and use of health technologies. Further analysis of the data showed mental health education, healthy nutrition, use of safety equipment while driving, vaccination, diagnostic and screening tests, and oral and dental healthto have considerable clinical and economic benefits.

Conclusion: The number of studies on the cost-benefit analysis of health interventions is increasing. Preventive and promotive interventions can help planners and policy-makers to better utilize the limited resources in the health sector aiming at promoting health of the people.

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Background and Aim: Human resources in any organization are its main capital. They are the only unique asset that are not liable to depreciation over time, but they even create more added value. The Social Security Organization (SCO) as a social insurer organization needs urgent assessment of its human resource management. In this regard, it appears that such an essential assessment can be done using the European Foundation for Quality Management (EFQM) model.

Materials and Methods: This project was an applied descriptive study conducted at the Social Security General Department in Tehran, Iran. The data collection tool was a standard questionnaire for performance assessment based on the EFQM model, the reliability of which (0.989) was determined by using the Cronbach's alpha coefficient. A total of 388 questionnaires were distributed, of which 311 were completed and returned to the researcher; the response rate was 81%. Analysis of the data was done using the SPSS-16 software.

Results: The human resource managers in the SCO achieved a score of 495.72. The empowerment and results dimensions rated 261.34 and 198.38, respectively. In the empowerment dimension, policy and strategy criteria had the highest score (56.12) and process the lowest (51.28), while in the results dimension, community criteria had the highest (50.27) and the customers criteria the lowest (51.18) score.

Conclusion: Based on the findings it can be concluded that the European Foundation for Quality Management (EFQM) model is suitable for assessing both the performance, strengths and weaknesses of the Tehran Security General Department human resources and improving its performance. Certainly better implementation of programs and achieving excellence will be possible through sustainable collaboration.

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Background and Aim: Economic evaluation of health interventions by comparing the relevant costs and benefits will result in optimum allocation of resources and increasing the effectiveness of the health system and, through improving equity and increasing accessibility to health services, will lead to increased effectiveness of the health system. The purpose of this study was to critically evaluate the Cost Effectiveness Analysis (CEA) studies on health interventions worldwide.
Materials and Methods: A critical review of the published CEA studies on health interventions was conducted. Seven databases including PubMed, Cochrane Database of Systematic Reviews, Web of science, Science Direct, Scopus, Springer Link, and SID were searched between 1975 and 2018, using appropriate keywords. The retrieved articles were evaluated using the Drummond (2005) quality assessment checklist. Overall, 173 articles met the entry criteria and were included in this study.
Results: CEA of health-related interventions were classified into six categories, namely, studies on immunization, education, nutrition, sexually transmitted diseases prevention, gynecological diseases prevention and vector-borne diseases and, eventually, cost-effective interventions were identified. Further analysis of the data showed that the methods used in health intervention CEA studies are very heterogeneous and lack sufficient scientific quality especially in developing countries. Researchers working in this area should pay more attention when designing studies and follow valid guidelines for CEA, particularly as regards research methods, sample size, CEA model, cost and benefit calculations, determining effectiveness, timeframe and, finally,  analysis of  the sensitivity and validity the research data.
Conclusion: The number of cost effectiveness analysis and cost utility studies has increased greatly during the last two decades. In order to improve the quality of these studies it is essential to revise the guidelines and procedures for economic evaluation of health interventions and train and update researchers in this area.

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Background and Aim: The health financing system is "the process of collecting, pooling and managing financial resources and purchasing healthcare services”. Iran's health financing system is facing challenges. The aim of this study was to evaluate the Iranian health financing system.        
Materials and Methods: This descriptive study retrospectively evaluated the health financing system of Iran between 2000 and 2019 using archival data. Data were collected from the World Bank website and analyzed using the Excel software.
Results: Iran's health expenditure per capita increased by 3.7% annually between 2000 and 2019 and reached $868 (purchasing power parity) in 2019. Iran's total health expenditure increased from $32 billion in 2000 to $72 billion (purchasing power parity) in 2019 (5.9% annual increase). Iran accounted for about 0.6% of the world total health expenditure in 2019. In that year about 6.7% of the country's gross domestic product was spent on health, the global average being 9.8%, while the general government health expenditure (% of the then current health expenditure) in Iran and the world were 49.5% and 59.8%, respectively. Out-of-pocket expenditure (% of the then current health expenditure) decreased in the last decade in Iran, reaching 39.5% in 2019, compared to 18% worldwide.
Conclusion: Iran’s health system costs are increasing at a faster rate than the growth of its Gross Domestic Product (GDP). The country’s health expenditure (% of GDP) and, as a result, the general government health expenditure (% of general government expenditures) has decreased and out-of-pocket expenditure (% of current health expenditures) has increased. Therefore, reforms should be implemented to strengthen the country's health financing system.
 

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Background and Aim: Performance evaluation is a useful way to obtain information for decision-making and management of healthcare organizations. The purpose of this study was to assess the performance of health houses in rural areas in Kerman City, Iran during the outbreak of Covid-19.
Materials and Methods: This cross-sectional study was conducted in 2021-22 using descriptive and analytical methods. The research population included all the health houses in Kerman City (n=57), Iran. The tool for data collection was the Health House Performance Evaluation Checklist of the Ministry of Health and Medical Education developed to supervise the performance of health houses during the outbreak of Covid-19. Data analysis was done using SPSS 26 software, the statistical tests being descriptive statistics (mean and standard deviation) and analytical statistics including independent t-test, one-way analysis of variance and Pearson and Spearman correlations.
Results: The average performance score of the health houses (n =55) in managing Covid-19 was 96.37 out of 136. Installation of the village map on the wall of the health house  (92.3%), screening and following up the positive-test individuals and informing the health care team to track and isolate individuals in close contact (84.6%) were found to have the highest, and injecting the third dose (78.8%) and the second dose (75%) of the Covid vaccine the lowest,  scores. From among the characteristics investigated the variable of native Behvarzes (the personnel of health houses) had a statistically significant positive relationship with the performance score (p=0.01). In addition, the health houses with more than one Behvarz were found to perform better than those with only one Behvarz (p=0.05).
Conclusion: Assessing the performance of health care units at times of crisis, including communicable diseases epidemics, will make it possible to identify the bottlenecks that need improvement for better preparedness in the future. Based on the findings of this  research, the expansion of the coverage of the covid-19 vaccination, updating the disease incidence, the performance of health care teams at home visits, and the progress of the operational plan were the variables that needed improvement most.
 

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Background and Aim: The Integrated and Comprehensive Geriatric Care Program (ICGCP) of the Ministry of Health and Medical Education (MOHME), Iran was designed about a decade ago and is being implemented to maintain and improve the health of the elderly. The program has not been evaluated so far. A comprehensive evaluation of this program is deemed necessary to determine whether this program requires revision or process improvement. Therefore, this study aimed to evaluate the ICGCP of MOHME using the Context, Input, Process, Product (CIPP) model in Qom province.
Materials and Methods: This descriptive-analytical cross-sectional study included the entire personnel of the health centers in Qom province as the statistical population. The data collection tool was a two-section questionnaire containing items on demographic information and a researcher-made evaluation questionnaire of the current elderly care program based on the four areas of the CIPP evaluation model. Participants meeting the study's inclusion criteria were enrolled through census sampling. The data were analyzed using the SPSS software version 24.
Results:  The mean age of the participants was 34.92 ± 6.98 years, 140 (84.3%) being females. Data analysis showed the following results as Mean ± SD: (1). A regards the context, for the items "Target group's need for the program" and "Identification of the potential of other influential organizations in program implementation": 3.71 ± 1.01 and 2.21 ± 0.99, respectively. (2). As regards input, for the items "Identification of program audiences" and "Necessary budget and funding for the program": 3.70 ± 0.95 and 2.23 ± 0.95, respectively. (3). As regards process, for the items "Program evaluation by officials and executing personnel," and "Recording and tracking issues during the program”: 3.16 ± 0.90 and 2.69 ± 0.85, respectively. (4). As regards product, for the items "Satisfaction with work, commitment and work ethic" and "Conducting case studies in this area":  3.65 ± 0.81 and 2.64 ± 1.01, respectively. In the overall program evaluation, the mean scores for "Program necessity" and "Program delivery quality" were 2.88 ± 0.89 and 2.12 ± 0.80, respectively.
Conclusion: The evaluation of the ICGCP of the Ministry of Health and Medical Education using the CIPP model identified the strengths and weaknesses of this program based on the opinions of health center personnel in Qom province. Policymakers and other relevant authorities can use these findings to enhance the program further.