مجله تحقیقات نظام سلامت حکیم
سال بیست و یکم شماره 3 (پیاپی 82، پاییز 1397)

One of the most important dimensions of strategic purchasing is to consider what kind of service should be purchased, how to set up a basic health insurance package, and how much health care must be covered. Addressing this issue requires conducting scientific studies for relevant policy analysis. The present study aimed at policy analysis of health insurance benefit package and providing policy options. This study was conducted qualitatively during 2014 - 2017 to analyze health policymaking. It was carried out retrospectively and prospectively in two phases. Data were gathered with interviews, document examination, and observation and were analyzed by content analysis using MAXQDA V. 11 software. After the policy analysis of the health insurance benefit package, 10 topics, 22 themes, and 168 subthemes were identified. In the phase of problem identification, by analyzing the findings of the previous step, 20 challenges and constraints were investigated and then, 64 policy options were retrieved under 27 general solutions. Paying attention to the financial and economic resources of the health sector and taking advantage of effective economic and policy measures are among the modifications that need to be considered in the development and implementation of the health insurance benefit package

The increasing costs of health care, the limited capacity of financial systems, and the inefficiency of the traditional health sector practices led to more government investment in health and paved the way for necessary reforms through the implementation of the health system reform plan by the Ministry of Health. The aim of this study was to evaluate the implementation of health system reform plan in two contexts of “promoting vaginal delivery” and “reducing the payment of hospitalized patients” in Hamadan University of Medical Sciences affiliated hospitals in 2014. This cross-sectional study was conducted in 2015. Information about the bills of hospitalized patients and the statistics of the delivery type in 15 hospitals was extracted from the registration forms of admitted patients and vaginal delivery data system. The plan was evaluated by comparing the data before and after the implementation of the plan and by concerning the criteria set by the Ministry. The results showed that the program for promoting vaginal delivery led to a 2.3% decrease in cesarean section cases. In addition, out-of-pocket payment of hospitalized patients in university hospitals dropped to 8.86%. The implementation of the health care reform plan has been successful in hospitals of Hamadan University of Medical Sciences and has achieved its goals. However, in some cases, it is possible to achieve the full success of the program by taking serious measures to identify and resolve the existing problems.

The urban physician program as a new health program requires the provision of resources and facilities. This study aimed to investigate the status of physical resources and related requirements in the family physician program in Fars and Mazandaran provinces. This cross-sectional study was carried out in winter 2016. According to the sample size estimation, 98 clinics and centers, in Mazandaran province, and 135 clinics and centers, in Fars province, were selected by a systematic random sampling method. The data collection tool was a researcher-made questionnaire; its validity and reliability were confirmed. Data were analyzed using Kruskal-Wallis and Chi-square tests. Out of 233 studied units, 105 (45.3%) had more than one physician. The structural status of the physical space in 183 units (79.9%) and the general cleaning of 178 units (78.1%) were desirable. The specification of service providers in the urban family physician program was completed from 42.1% to over 70%. One hundred and four units (45.8%) had an intact EKG, 195 units (85.5%) had an intact Ophthalmoscope, 227 units (97.4%) had an intact laptop or computer, 178 units (77.7%) had an intact gynecology bed, and 125 units (58.8%) had working autoclaves. Concerning supplying physical resources and meeting the requirements, there was mostly a significant difference between the provinces (P < 0.05). The results showed that some of the facilities and requirements were not provided in a number of execution units; so, effective measures must be taken.

The formation of any effective intersectoral collaboration requires a coherent and stable structure in order to build a sustainable collaboration. There is little evidence of the characteristics of an effective intersectoral collaboration structure, especially in the field of health, which highlights the need for research. This was a qualitative study with grounded theory approach to explore the dimensions of an effective intersectoral collaboration structure for controlling childhood obesity in 2 to 6-year-old children in Kerman. Data were collected using face-to-face deep interviews. Coding the data was done by MAXQDA V. 10 software. Data analysis led to the identification of four key features of an effective intersectoral collaboration structure including the characteristics of collaboration members, the characteristics of collaboration core, the roles and responsibilities of collaboration members, and collaboration working processes. Given the growing importance of intersectoral collaboration for health community promotion, it is necessary to have a proper and systematic structure for these collaborations. This study tried to provide a suitable platform for designing such partnerships to promote community health and prevent problems such as obesity in children by considering the two characteristics of the members and the core of the collaboration, along with the explanation of the role of the members and the processes of the structure.

The massive un-exploded landmines in Iran every year take many victims among the citizens of the landmine areas. The aim of this study was to investigate the health-related consequences of landmine explosions in Kurdistan province. This cross-sectional study was conducted in 2016 - 2017. An active sampling approach was carried out in urban and rural areas of Kurdistan province. Data were collected by a researcher-made questionnaire. Reliability and validity of the questionnaire were calculated. Overall, 410 cases were recruited. Data analysis was performed using SPSS V. 22 software. 32.4% of the victims were immediately killed after landmine explosions and 67.6% of the survivors were living with injuries and various disabilities. The most prevalent injury was the amputation of at least one upper or lower limb with the rate of 63.5%. The prevalence rates of complete blindness and deafness were 9.8% and 1.5%, respectively. In order to prevent and mitigate the consequences, it is recommended to detect, enclose, and clear the landmine contaminated areas and implement educational programs for people and communities at risk of landmine explosions. It is also necessary for provincial planners and policymakers to implement rehabilitation and treatment programs for landmine survivors in Kurdistan.
Keywords: Landmine; Explosion; Health Impacts; Kurdistan
Please cite this article as follows:Fathollahi S, Fatemi F, Ardalan A, Bidarpoor F, Esmaeilnasab N.Yari Arezoo Assessing health-related consequences of land mine explosions in Kurdistan province during the last 37 years: 1980-2017. Hakim Health Sys Res 2018; 21(3): 200- 210.

There are various models and processes for commercialization in the pharmaceutical biotechnology industry. All these processes comprise three phases of scientific explorations, clinical experiments, and manufacturing, marketing, and sale. In the field of pharmaceutical biotechnology, this process is limited to opportunity identification, clinical experiments, and manufacturing, marketing, and sale. This restriction, because of existing a scientific background, provides a good opportunity for biosimilars for production. The aim of this research was to present an evaluation pattern to be used in the commercialization process of research outcomes by focusing on the pharmaceutical biotechnology industry. In this descriptive-analytical research, a mixed-method exploratory approach was adopted. The statistical population included the community of experts in the pharmaceutical biotechnology industry and academic and research centers. This research used a dynamic programming model. Mathematical equations and analyzing the process network showed that among 126 sub-indices influencing the process of commercialization of R&D in pharmaceutical biotechnology, 44 factors had higher values. These factors can be considered in this process by policymakers, manufacturers, and other stakeholders in the field of pharmaceutical biotechnology.

Strategic thinking is an approach in the organization that refers to using different mental frameworks to examine, analyze, and ultimately decide on the strategic situation of the organization. The aim of the study was to determine the status of strategic thinking in education and research managers of Tabriz University of Medical Sciences, as well as its related factors, in 2016. This is a descriptive - analytical study. The study population comprised all senior and middle managers in the fields of education and research of Tabriz University of Medical Sciences (n = 79). The employed instrument was a standard strategic thinking questionnaire, with the dimensions of future imagination and focusing on it, intelligent opportunism with systematic perspective, understanding the situation based on learning and cognitive concepts, decision-making based on hypothesis driving (creativity and diverse subjective patterns), and the ability to create organizational infrastructures. Data entered in the SPSS software version 23 and the Shapiro-Wilk test, Independent t-test, Mann-Whitney test, one-way ANOVA test, and Kruskal-Wallis test were used for data analysis. The results showed that most of the senior and middle managers in the fields of education (88.2%) and research (89.5%) had poor strategic thinking. The highest score of the dimensions of strategic thinking was related to the “future imagination and focusing on it” for education managers (28.9 out of 32) and “decision-making based on hypothesis driving” for research managers (28.8 out of 36). It was also observed that there was a significant relationship between the status of strategic thinking and work experience as a demographic variable (P = 0.03). Based on the results, it is necessary to take serious measures to improve the status of strategic thinking by providing university managers with training the relevant skills and paying attention to the skills as a criterion for managers’ selection and evaluation processes.

The provision of services in our primary care system defined for adolescents focuses more on physical aspects and less attention is paid to psychological and social concerns to prevent high-risk behaviors. This study was conducted to determine the physical and psychological health needs of adolescents and provision resources from the viewpoints of various health providers and adolescents. This qualitative study was carried out through in-depth interviews with young people aged 15 - 24 years and other people involved in the service delivery process. Nine group discussions and 30 individual interviews were done in Tehran. Data collection continued until data saturation was reached. The analysis was performed simultaneously with sampling. Four criteria of Lincoln-Guba were used to assess the validity and quality of the study. In this study, two main ideas “adolescents’ health concerns” and “information resources” were emerged. Adolescents’ health concerns included physical, psychological, and social needs. The most important reason for referring to health centers was the physical illness. Communication with the opposite sex and the fear of divulging secrets were the most important reasons for psychological worries. The theme of information resources consisted of two categories of accepted and common resources. Service providers as accepted resources were important in the physical dimension. The Internet was a common method to resolve psychological and social concerns. Since receiving health-related services is easily possible and acceptable, this channel can be a suitable way to evaluate the serious psychological problems of adolescents. Then, it prevents the use of virtual resources and reduces high-risk behaviors.

Many health problems and the slow progress of development plans root in the absence of indicators to measure and monitor the achievement of the goals. This study aimed to identify the categorized indicators for monitoring and assessment of goal achievement in the Sixth Development Plan in the health sector. This qualitative applied study was conducted in the following stages: Identifying the goals of the Sixth Development Plan in the health sector; identifying the inputs and outputs of the programs; initial compilation of indicators; evaluation of the indicators, and designing a conceptual model for health policy assessment. During the implementation of the study, the qualitative methods including high-level documents examination, literature review, and expert consensus were used. After being analyzed, the content of the development plan was divided into 12 topics. Then, a set of indicators were determined for each topic, which led to the emergence of 80 indicators after the final analysis. The highest score was related to the maternal and child health indicators (giving the scores of more than 63 out of 70). Concerning its generalities and details, the progress evaluation of the sixth development plan can be done using small to large-scale indicators. The optimal mode is to compile indicators for each level individually and professionally.