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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UV radiation is selected as the primary disinfection technology in numerous water and wastewater treatment plants of EU and North American countries having different ranges of capacities. It is expected that the method, often regarded as the best available technology, will replace chemical disinfection. As UV is claimed to be the only modality with no detrimental health effects for operators, consumers and the environment -even in high doses- it is important for directors of treatment plants to know how to apply new design criteria for UV to meet the different objectives of treatment. The recent guidelines are based on testing the UV system at various hydraulic loading rates (expressed in liters per minute per UV lamp) . The rate that corresponds to the desired germicidal dose is used in the design of the system. Other design factors include water quality and characteristics of the lamp and quartz sleeves. According to this new approach, the lamp’s output is assumed to drop by 50% over its lifetime. Besides, sleeve fouling seems to reduce nominal UV light intensity by 20%. This article describes the types of data that must be collected through pilot testing on the site of treatment plant it also shows how to use these data in the process of system design. The main advantage of this approach is that variability in the most important parameters is reflected in the design. In addition, it makes it possible to determine the number of lamps required in worst–case conditions and to meet the most stringent treatment standards.

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The aims of the present study were to assess preparedness and function of health system in the management of withdrawal symptoms in opioid dependents after Bam earthquake, the methods that medical staff used for identification of dependents, the viewpoints of the medical staff as well as opioid dependents about the roles of health system, and the appropriate methods for managing opioid dependence after disaster. This qualitative study was carried out in the city of Bam, one of its nearby villages and eight hospitals in Tehran and Kerman, admitting earthquake victims. Our analysis was based on 163 semi-structured interviews, with drug abusers, their family members, people living in Bam, service providers, and the authorities. No specific training for drug abuse was reported by medical staff. No guideline or program was available for prevention and management of drug dependence in disasters. Most of the medical staff had negative attitudes toward involvement in treatment of opioid dependence. During the first two weeks after the earthquake, medical management of the withdrawal symptoms was inadequate. Most of the interviewees suggested managing the withdrawal symptoms with prescribing opioid agonists and then treating the opioid dependence following improvement of physical injuries and stability of social situation. In disaster situations, the consequences of inadequate management of opioid dependence can be ominous. Such consequences consist of a change in incidence of substance use, intensity of use and dependence, type of substance and route of use to more dangerous ways. Therefore, a practical protocol (disaster planning) is needed for prevention and management of substance dependence in the times of crises.

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Background and Aims: In this study we measured the quality, corrosiveness, Ryznar stability index, and heavy metal leakage in the drinking water distribution networks of Ahvaz.

Materials and Methods : A total of 76 sampling sites were selected for this purpose the sites included inlet and outlet points in water treatment plants as well as consumers taps. We collected 456 samples in six stages and over a period of six month, following the procedures outlined in the Standard Method. Data were analyzed using the SPSS 11.5 software package.

Results: The average values obtained from the specimens were as follows: temperature (19 0C), turbidity (1.97NTU), pH (7.31), pHs (7.88), EC (1678µs/cm), TDS (1006mg/l), Alkalinity (129mg/l), Calcium (109mg/l), DO (6.78mg/l), Cl- (293mg/l), SO4-- (264mg/l), Ryznar stability index (8.43). Average heavy metal levels in tap water were as follows: Pb (8.48µg/l), Cd (0.972 µg/l), Zn (3.18 mg/l), Cu (0.168 g/l), Fe (0.257 mg/l), and Mn (0.031mg/l).

Conclusion: The results showed that the water quality has been affected in such a way as to cause corrosiveness, heavy metal leakage and aesthetic problems. We also showed that in comparison with USEPA and Iranian standards, the quality indices of the drinking water in Ahvaz were at an acceptable level, with the notable exception of a few indices such as TDS, EC, and hardness. The Ryznar stability index indicated that the drinking water in Ahvaz has corrosive properties and this could be one of the reasons behind the high rates of heavy metal leakage detected in this area.

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Backgrounds and Aim: One of the remuneration methods in the hospital system in Iran is per case, based on a classification system termed Global system (GS). The GS, supported by Iran's Ministry of Health and Medical Education (MOHME), was established in 1999 and is now used for cost reimbursement in the second- and third-levels of health care services. In this system, patients are classified into 60 categories, based on the most frequent surgical operations. However, it now appears, that there are many questions about this system. This study aims to compare the global operations reimbursement rates with actual costs in the Cancer Institute, Tehran, in 2003 and 2004.
Materials and Methods: This survey was a retrospective, analytical-descriptive one aiming at comparing the global operations reimbursement rates with actual costs in 646 global operations carried out in the Cancer Institute in 2003 and 2004. The global-operations and actual-costs data were gathered from Hospital Information Systems (HIS) and High Council of Insurance annual regulations, respectively, and analyzed using SPSS 11.5 software and the Wilcoxon non-parametric test.
Results: The differences between the cost reimbursement rates of global operations and their actual costs were lower in 2004 as compared to those in 2003. Also, the actual costs of operations were higher than the global operations reimbursement rates in both years and the difference was significant statistically in either year (P<0/001).
Conclusion: Some of the MOHME and Cancer Institute's authorities and experts believe that the decrease in differences between the cost reimbursement rates of global operations and their actual costs in 2003 compred to 2004 is due to increased awareness of physicians and the accounting and discharge units' personnel of the global operations and related regulations, as well as increasing global operations reimbursement rates. Also, they believe that the differences between the global operations reimbursement rates and their actual costs in either year could be attributed to not considering the actual inflation rate, hospital types, patients' co-morbidities, etc. in calculating the global operations reimbursement rates. It is suggested to make more realistic calculations, taking into account such variables as the actual inflation rate, hospital types, patient co-morbidities, etc.

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Background and Aim: The district health information system (DHIS) converts raw data into useful manegerial information. The main purpose of DHIS is to improve quality of health services in service delivery points. This study was conducted to investigate the DHIS performance.

Materials and Methods: A total of 200 health service-delivery units were selected by systematic random sampling, and the calculation of 47 primary health care indicators was assessed by the provincial health center statistics supervisor.

Results: On the average, 41.9% of the indicators had been calculated in each unit. In the district health center, the proportions of outcome measures and process performance indicators calculated were 50% and 5.6%, respectively. On the basis of the indicators obtainable from the vital horoscope, 79% of the indicators in the district health center and 66% of those in the health service-delivery units had been calculated. Finally, there were 97 disease-surveillance forms, 35 environment-health forms, 21 family-health forms, and 23 other forms at the district level.

Conclusion: Re-designing the structure of the health information management process and determining indicator packages at the district and service-delivery level are vital steps for improving the health information system at the district level.

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Background and Aim: Rabies, a viral and zoonotic disease, causes acute and fetal encephalitis in humans and other mammals and is a cause of death in developing countries. It is usually transmitted by animal bite, but other routes of transmission are mucus membranes, breathing, placenta, contaminated instruments, and organ implanting. This study shows the mapping of geographical distribution of animal bite cases, rabies, and death due rabies in 3 Caspian Sea littoral provinces, namely, Golestan, Mazandaran, and Gilan.

Materials and Methods: Data on human and animal rabies cases and animal bites were collected from the Reference Rabies Center of the Pasteur Institute in Tehran and the Rabies Diagnosis Section of the Amol Research Center during 2002-2007.The data was analyzed by the SPSS (11.5) software and mapping was done by Arc GIS 9.2.

Results: During the 6-year period, of the 670,743 animal bite cases reported in Iran 63890 (9.5%) had occurred in Golestan, 25,767 (3.8%) in Mazandaran, and 22,874 (3.4%) in Gilan. The distribution of animal bite cases in the 3 provinces was as follows: Agh ghala, Bandar Torkaman, Azad shahr and Kolaleh in Golestan Galugah, Behshahr, Ramsar and Neka in Mazandaran and Shaft, Masal, Siahkal and Fuman in Gilan. The data also showed that of the total 2,312 animal rabies cases, in Iran, 9.22% had been reported from Golestan, 4% from Mazandaran, and 2.6% from Gilan. Furthermore, animal rabies cases had occurred mostly in Gonbadekavoos, Bandar Torkaman, Gorgan and Kolaleh in the Golestan Province Behshahr, Neka and Chalus in the Mazandaran Province and Masal, Fuman and Rezvanshahr in the Gilan Province. The most important disease vector (91.3%) for both human and animal rabies was the dog. A total of 41 human deaths due to rabies had been reported during the period, 2 being from Mazandaran.

Conclusion: The results show that a more effective disease control and surveillance system is essential and can help improve planning for service provision in the health care centers.

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Background and Aim: Non-communicable diseases (NCD), also referred to as chronic or lifestyle-related diseases, are a serious health problem in most countries today. The World Health Organization (WHO) has discussed this issue and presented solutions for it in its annual meetings. This paper reviews and reports on the action taken by the Medical University of Isfahan (MUI) through its Non-communicable Disease Control Program based on the WHO "Prevention and control of non-communicable diseases: implementation of the global strategy", which is a comprehensive program for controlling non-communicable diseases.

Materials and Methods: In this descriptive-analytical study, the activities of 21 Non-communicable Disease Units in Isfahan Province affiliated to MUI in its Non-communicable Disease Surveillance System aiming at combating non-communicable diseases were assessed using a self-assessment technique and the relevant documents reviewed. All the NCD officers (n=30) were enrolled in the study. A validated researcher-designed questionnaire containing items related to six areas based on the WHO "Prevention and control of non communicable diseases: implementation of the global strategy", the reliability of which had been confirmed, was used. The data were analyzed using the SPSS software, the statistical tests being the t-test.

Results: The general self-assessment score of MUI in the activities related to non-communicable disease surveillance and control program was 1.44 0.59 (out of 4). From among the six strategies studied, the "increasing public awareness about non-communicable diseases" strategy and the "improving collaboration and participation in prevention and control of non-communicable diseases" strategy achieved the highest and the lowest score, respectively. Documentation was weak (less than 50%), and there was no significant difference between the scores of actions documented and those not documented (P = 0.1).

Conclusion: Isfahan Medical University is one of the leading universities in Iran. It has taken important valuable measures in the area of non-communicable disease control and surveillance programs. However, our findings show that there are several weaknesses in these programs. Not paying sufficient attention to documentation, for example, is a serious weakness, since documentation plays an important role in the performance and excellence of an organization, guaranteeing its success.

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Background and Aim: Visceral leishmaniasis is a systemic parasitic disease with a high fatality rate in under-5-year-old children. The disease is endemic in some parts of Iran, particularly in the north-west region. In 2001 a visceral leishmaniasis (VL) surveillance system was established for children aged ≤ 12 years in the primary health system in Meshkin-Shahr District, Ardebil Province, situated in the north-west of Islamic Republic of Iran.

Materials and Methods: All cases with clinical signs and symptoms of VL and confirmed positive by the direct agglutination test (DAT) were referred for physical examination and treatment.

Results: The mean annual incidence of VL decreased significantly from 1.88 per 1000 children before (1985-2000), to 0.77 per 1000 child population after (2001-07), the intervention. In the control area with no surveillance, it increased from 0.11 to 0.23 per 1000.

Conclusion: Early detection of VL using serological tests and timely treatment of cases can decrease the mortality and morbidity rates of VL in endemic areas.

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Background and Aim: Priority setting is one of the most important issues in health research systems. No national health system can afford to finance all research projects proposed by researchers, especially in developing countries. Therefore, we decided to set the main national health research priorities in Iran using the Essential National Health Research (ENHR) method.

Materials and Methods: All of the Iranian universities of medical sciences and other stakeholders collaborated in this study. The methodology for research priority setting was based on needs assessment and ENHR. 

Results: The total number of research priorities gathered from universities of medical sciences was 6723. The proportions of topics related to basic science, applied and development subjects were 17%, 78% and 5%, respectively. Further analysis of the data showed that almost half (46.3%) of the research priorities were descriptive, 36.0% analytical, and 17.6% interventional. The research priorities were divided into 9 main areas, namely, communicable diseases, noncommunicable diseases, health system research, pharmaceutical sciences and industrial pharmacy, basic science, traditional and herbal medicine, nutrition, environmental health, and dentistry.

Conclusion: Up to now the common procedure for research priority setting has been, with a top-to-bottom approach, managed by a limited number of researchers and experts, while in the method presented in this paper a bottom-to-top approach is used, which is more effective.

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Background and Aim: The first step in establishing a safety system is hazard identification.  If this is not done properly, the subsequent steps steps will not be done effectively either. Since any given identification technique often targets the hazards of one or two of the main elements of a safety system, it is not possible to identify all hazards by a single technique

Materials and Methods: This cross-sectional study was conducted to explore the available scientific literature aiming at finding practicable hazard identification techniques that can potentially determine the highest number (%) of hazards in a safety system. First five techniques were implemented and the number of identified hazards by each was determined, followed by calculation of the coefficient of hazard identification effectiveness for each technique. Using this approach two techniques in two different safety systems were tested

Results: The number of hazards identified using the hazard and operability analysis (HAZOP) technique, and, as a result, its coefficient of hazard identification effectiveness was the highest as compared to other techniques. Individually, the HAZOP and AEA techniques, used as primary hazard identification techniques, identified only 20-80% of all the hazards which could otherwise be identified if all identification techniques had been used.

Conclusion: The results show that the HAZOP technique can identify a higher number of hazards than any other technique. However, if used alone, this technique will probably identify only 40% of all the hazards. The important point is that selection of an appropriate technique plays an important role in identifying a higher number of hazards.

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  Background and Aim: Investigation of seasonal suicide might help in learning about the etiology of suicide committers’ behavior. Literature search indicates that a large number of preliminary studies have been carried out on this subject, in many of which seasonal and climatological aspects of suicide have been investigated. In the present study, the seasonal and time pattern of suicide incidence in Iran was determined based a systematic review.

  Materials and Methods : Search was performed in the national databases, namely, SID, Iranmedex, Magiran and Medlib, as well as international databases such as PubMed, Scopus and Google scholar, using such keywords as Iran/Iranian, seasonality and suicide. The technical quality of papers was assessed using checklists. Data of each of the preliminary studies were extracted in terms of general variables and such specific variables as season, month, hour, weekdays and climatic conditions.

  Results: Of a total number of 49,522 documents obtained from a primary electronic search, eventually 32 papers were included in this study. The highest numbers of suicides committed were 7 and 8 in summer and spring, respectively. Similarly, among the primary studies that had reported only the monthly occurrence of suicide, the highest rate in 7 cases was spring and 7 in summer. In most of the studies (8 cases) the highest number of suicides had taken place between 1:00 and 6:00 PM.

  Conclusion: These findings indicate that suicide occurrence in Iran has a seasonal pattern, most cases committed being in spring and summer.

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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 National Malaria Control Program was developed, in 2011, into the National Malaria Surveillance Program. It is one of the most comprehensive surveillance systems in Iran. The aim of this study was to evaluate the impact of malaria elimination program on data quality and accuracy in the national malaria surveillance system.

  Materials and Methods : This was a cross-sectional study conducted in four malaria-prone provinces in Iran to determine and assess the completeness and accuracy of the information collected in the malaria surveillance system. The purpose was to compare data reporting forms 3 and 4 (reporting positive cases from selected district health centers) between two time points, namely, 2009-2010 (before starting the program) and 2010-2012 (after starting the program).

  Results: The total number of reporting forms included in the study was 1927, nearly 54% from the initial time point and the rest from the final time point. The highest and lowest proportions were 94.78% and 17.30% from Iranshahr and Hormozgan University health centers, respectively. On the whole, the degree of completeness of the forms was 84% (83.7% and 85% before and after starting the program, respectively). Based on the Chi-square test, the differences were not statistically significant.

  Conclusion: Only a minor change occurred in the degree of completeness of the forms between the two time points: a 4% increase in form 4 and a 3% decrease in form 3. It can be concluded, then, that the elimination program h ad no significant effect on the completeness and accuracy of the reporting forms.

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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: Anemia in pregnant women is a common disease in developing countries, the prevalence ranging between 35% and 100%. Based on a systematic review in 2005 anemia prevalence among Iranian pregnant women was estimated to be 12.4%. The objective of the present systematic review and meta-analysis was to determine anemia prevalence among Iranian pregnant women between 2005 and 2016.

Materials and Methods: This systematic review, using standard key words, included databases Magiran, Iranmedex, IranDoc, SID, Medlib, Scopus, PubMed, ScienceDirect, Cochran, Embase, Springer, Web of Science, and  Online Library Wiley, as well as the Google Scholar search engine of for the period 2005-2016. All the reviewed papers meeting the inclusion criteria were included in the study. Data were analyzed using the random effect model based on meta-analyses, the software being Stata Ver.11.1.

Result: Twenty-five studies with a total sample of 56610 pregnant women met the inclusion criteria.  The prevalence of anemia was estimated to be 17% (95% CI: 14-20). The highest (23%) and lowest (12%) prevalence rates were observed in the center and west of the country, respectively. The prevalence was estimated to be 21% in urban areas and 8% in the rural areas.

Conclusion: The prevalence of anemia in Iranian pregnant women has increased over the last 11 years. Therefore, appropriate intervention programs must be implemented in premarital counseling and pregnancy clinics.

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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: The content of the hygiene education and health promotion course in schools is crucial for raising the awareness of, and development of hygiene culture in, pupils. In this study we aimed to develop a hygiene education course with a fully suitable content.

Materials and Methods: In this research the content analysis technic using the "Shannon Entropy" method was used, in which data processing in discussing the content analysis is done with a new approach both quantitatively and qualitatively. In the information theory entropy is an index to measure the uncertainty which is expressed by a likelihood distribution. The content was investigated considering the respondents’ perspectives (all textbooks of elementary school sixth grade) and 12 main elements and 58 sub-elements related to hygiene education and health promotion.

Results: The results of content analysis based on the Shannon Entropy showed that the element of mental health with 732 items and physical activity with 735 items had the maximum frequencies, while the control and prevention of diseases with 6 items had the minimum frequency.

Conclusion: In the official textbooks some elements of health education are treated insufficiently or not at all, despite the fact that health is the most important factor in the progress of the society and a guarantee for survival. Thus, designing, implementation and management of the health component of national development plans are extremely vital.

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Background and Aim: All hospitals need to be monitored and continuously evaluated. Pabon Lasso graphical model assesses the efficiency of hospitals using a combination of their input data and performance indicators. The aim of this study was to determine the effects of Iran Health System Evolution Plan on Tehran University of Medical Sciences (TUMS) hospitals’ performance indicators using the Pabon Lasso model in 2016.
Materials and Methods: This was a descriptive-analytical and cross-sectional study including 8 general and specialized hospitals. The hospital input data and performance indicators were collected by permission of TUMS Vice-chancellor’s Office for Therapeutic Services. Chi-square and the two-sample T2 tests were used for data analysis, and hospital performance was assessed using the Pabon Lasso Model.
Results: The results showed that the number of TUMS hospitals located in zones 3 and 4 had increased after implementation of the Iran Health System Evolution Plan, which indicates improved efficiency of these hospitals, as confirmed by the chi-square test.
Conclusion: Based on the Pabon Lasso graphical model, it can be concluded that the performance indicators of the hospitals show improvements in performance after implementation of the Iran Health System Evolution Plan. The successful experience in the management of the hospitals in this study can act as a practical guide for managers of other hospitals throughout the country for better management. 

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Background and Aim: Human resources are of paramount importance in the success of any organization. In the health care system, nurses play a great role in the delivery of high-quality care. In this regard, in the process of providing high-quality and efficient healthcare delivery, justice perception of performance appraisal system and organizational citizenship behavior (JPPAS & OCB) are strong tools for performance management. The aim of this study was to determine the association between JPPAS & OCB among nurses in Tehran University of Medical Sciences hospitals in Tehran, Iran.
Materials and Methods: This was a cross-sectional study with a sample size of 346 nurses working in Tehran University of Medical Sciences hospitals. Data were collected using two questionnaires, namely, the JPPAS & OCB and a general demographic questionnaire. SPSS 24.0 for windows was used for statistical analysis of the data.
Results: Analysis of the data showed that justice perception of performance appraisal system (2.70) and organizational citizenship behavior (2.66) are at a moderate level. Based on the correlation analysis, a significant positive association was found between performance appraisal and organizational citizenship behavior. In the final analysis it was shown that performance appraisal could predict organizational citizenship behavior (30.9% of the variance).
Conclusion: Justice perception of performance appraisal system can positively influence loyalty, job satisfaction and employees’ commitment, as well as create organizational confidence, enhance productivity and improve participation.