مجله تصویر سلامت
سال سیزدهم شماره 1 (بهار 1401)

The Health System (HS) in the Islamic Republic of Iran is designed in three levels: the first level (Primary Health Care (PHC) system), second level (specialized polyclinics/clinics, general and specialized hospitals), and the third level including sub-specialized hospitals. Iran's HS has passed evolutionary and progressive stages since 1984, thus becoming a comprehensive, people-centered, responsive, and low-cost system, based on the available evidence.

COVID-19 pandemic caused by the newly emerged Coronavirus was first detected in China in December 2019 and rapidly spread throughout the world. With the rapid spread of the disease, all countries involved in accordance with their capacities took necessary measures to identify and manage the disease. The first patient was diagnosed with COVID-19 in Iran in February 2020. Considering the significant role of the laboratory services in detection and management of the disease, planning and programming to provide access to these services was considered as a top priority for healthcare system in Iran. Adopting all existing laboratory capacities and providing necessary infrastructures for expanding COVID-19 laboratory diagnostics, resulted in establishment of a nationwide network of COVID-19 molecular diagnostic laboratories within the shortest possible time. In addition to expanding the capacity of laboratory services, improving the laboratory network’s performance have been taken into serious consideration. In spite of the strict sanctions, the COVID-19 molecular diagnostic laboratories scaled up to more than 430 laboratories currently (September 2021), mostly are operating in the private sector. With considerable efforts, COVID-19 molecular laboratory network was established to provide nationwide diagnostic services. Taking into account the capacity for performing SARS CoV-2 Rapid Antigen testing, at the moment, we are able to provide more than 100,000 COVID-19 diagnostic tests per day. However, due to continuation of the pandemic and in accordance with the needs of the health system, it is necessary to plan and carry out more activities for diagnostic testing of COVID-19. The purpose of this paper is to introduce the process of establishing the COVID-19 laboratory diagnostic network to manage the COVID-19 pandemic in Iran.

From the start of the COVID-19 pandemic in February 2019 in Iran, the Iranian health system, following its mission, began planning with the goal of pandemic prevention and control. Various steps were taken, and the program of National Mobilization against COVID-19 was devised to provide services for individuals in the community, mainly the sick and vulnerable, and promote people's knowledge and skills regarding the crisis. Given the role of Community Health Workers (Behvarzes and Moragheb-e-Salamats) in preventing and controlling infectious diseases, this study was carried out to investigate their role in the COVID-19 pandemic.

The present study is a descriptive cross-sectional study. The census method was used to study 30034 Behvarzes and 22573 Moragheb-e-Salamats working in medical universities. The required data were extracted using the integrated health system and the portal of the Ministry of Health and Medical Education's Primary Health Network Management Center and were analyzed using descriptive and analytical statistical methods.

More than 78 million people were screened during the first step of the national mobilization against COVID-19, more than 42 million during the second step, and more than 59 million during the third step. In addition, by the end of the fourth step of the national mobilization, 4,278,899 people who had come into close contact were screened. According to the health system's report, these community health workers had injected 28,073,777 vaccines since the implementation of the fifth step (until 04.09.2021).

Considering the facilities and capabilities of primary health care networks in providing prevention, diagnostic, and treatment services, the activity of the primary health network management center and all affiliated units in the implementation of the National Mobilization against COVID-19 program has been significant since the beginning of this pandemic. Inadequacies in healthcare human resources, financial resources, and training planning should all be considered.

In order to respond the people in the COVID-19 crisis, a number of comprehensive urban health centers in the primary health care system converted to the selected COVID-19 centers in 2020. Considering the importance of evaluating the performance of the mentioned centers and ensuring the continuity of the services provided in accordance with the rules and instructions, the performance evaluation of the mentioned units began from July 2020 to march 2021 in three levels: self-evaluation (first level evaluation), university evaluation (second level evaluation) and the evaluation of the experts of the Ministry of Health and Medical Education (third level evaluation).

A cross-sectional descriptive-analytical study was conducted in all selected COVID-19 centers including 978 in all 63 universities / medical schools across the country in 2020. The sample was selected by census sampling method and includes a total of 978 centers. In this study, 28 main criteria in the fields of education and information, staff and client safety by observing social distance and using personal protective equipment, supplying manpower, equipment, disinfection and work processes and 91 sub-criteria were determined by using Delphi Technique.

With the criteria and sub-criteria defined in the areas of "education and information of the people", staff training, observance of social distance, facilities, waste management, manpower supply, supply of medical equipments and work processes , it was identified that in the self-evaluation ( first level evaluation), the criterion with the lowest score was "staff training". The lowest score in the evaluation of the level of universities / medical schools (second level evaluation) was related to the observance of social distance in the centers and the highest score in both evaluation levels was related to the criterion of "providing necessary education to patients regarding prevention and control of COVID-19".

Establishment and setting up of selected COVID-19 centers has been one of the effective measures in controlling and managing COVID-19, which was created as a result of changing the structure of the primary health care system. Continuity of service quality of selected centers requires continuous monitoring and evaluation of their performance.

COVID-19, caused by a new beta-coronavirus called SARS-CoV-2, started in China in late December 2019. Its outbreak was officially announced in Iran on February 19, 2020. The official report of the virus spread throughout the country was announced in mid-March 2020. While expanding the coverage of the "Each Home as a Health Post" program, universities gathered and trained health messengers and health volunteers with the educational content "A Guide to Live with COVID-19".

This study is a cross-sectional descriptive study. The sampling method was the census method. The required data were extracted using the integrated health system and the portal of the Ministry of Health and Medical Education’s Primary Health Network Management Center. They were analyzed using descriptive and analytical statistical methods.

The numbers of household health messengers and health volunteers were 11134290 and 280619, respectively. The highest total number of health volunteers and health messengers with 824803 people were in Shahid Beheshti University and the lowest with 7088 people in Gerash. Households with health messengers were 11656389, covering 50.1% of Iranian households. The national average score of trained messengers in the COVID-19 training course was 79.2%. In 22 universities/colleges, 100% of the health messengers passed the COVID-19 training course.

Implementing the "Each Home as a Health Post" program has effectively controlled COVID-19 spread by increasing awareness and promoting self-care in the community. Health messengers and health volunteers were the essential elements of the "Each Home as a Health Post" program. They identified and referred patients to selected COVID-19 centers, improving care and services such as interceptions and support.

In late 2019, the outbreak of COVID-19 disease, with symptoms similar to the common cold or severe respiratory illness, created a global public health crisis. In order to control and manage this disease, countries and the World Health Organization have adopted various strategies and decisions. This study aims to describe the initial measures of the Ministry of Health and Medical Education of the Islamic Republic of Iran with the focus on the Deputy Minister of Health in the framework of the national mobilization plan to combat COVID-19.

A mixed method study including reviewing the documents of different departments of the Deputy Minister of Health in the management and control of the COVID-19 epidemic (qualitative) and descriptive cross-sectional (quantitative) study was conducted between March 2020 and April 2020. In this study, data and information related to all 63 universities / medical schools in the country were collected from the electronic health record systems and the portal of the Network Management Center and analyzed using EXCEL software.

In the first step of the national mobilization against COVID-19, about 1200 selected comprehensive health centers of COVID-19, salamat.gov.ir self-assessment system and COVID-19 distance counseling and training telephones (406-190-1666) were launched. About 98% of the people registered in the electronic health record systems (78,315,029 people) were orally screened and evaluated, of which 6,220,603 were elderly, 262,717 had diabetes, and 3,356,131 had high blood pressure, 29,201 obease people, 517,696 pregnant mothers and 2,722,659 foreign nationals. Another important result of the implementation of the first step of the national mobilization was a significant reduction in the burden of hospitalization and management of outpatients in the first level of the health system (primary health care).

The COVID-19 epidemic created a crisis in the world, the management of which became the top of the world's health activities. The health sector of Iran, using the capacity of the health network system structure and service providers, developed appropriate policies for the management and control of this disease. One of these policies is the verbal screening to combat COVID-19, which has led to the optimal management of this epidemic.

As an emerging disease, COVID-19 is considered more than just a health crisis, as it socially affects communities. Therefore, community-oriented solutions via the primary health care system can better manage and control this pandemic. The Ministry of Health and Medical Education, and the executive branch of the Deputy Minister of Public Health, played an influential role in controlling the epidemic with the community-based and network-based interventions in the National Mobilization Plan against COVID-19.

A cross-sectional descriptive study was conducted. The data from portal of Network Management Center, Centers for Disease Control and Prevention (CDC), CLIS system, Reference Health Laboratory, and electronic record systems of the public health networks of all universities across the country were used to assess the second step of the National Mobilization Plan against COVID-19. Data was collected from April 13 to August 11, 2020, and was analyzed using SPSS software.

During the second phase, more than 42 million people were screened by health care providers. About 98.4% of this population were diagnosed with no problems, and 0.4% were referred to the selected COVID-19 comprehensive health centers for examination and medical procedures by physicians. Of all the direct and referred patients of the selected COVID-19 comprehensive health centers, 55.3% had no problems, 37.8% needed to be tested, and 3.6% needed to be referred to a hospital, and 3.3% received outpatient care. In the first days of laboratory screening, 11% of PCR were positive. By the end of the second step of the National Mobilization Plan against COVID-19, this rate had increased to 25%.

In times of crisis and epidemic conditions, the health network system and the primary health care providers can effectively manage outpatients and reduce the burden of hospitalization. Only 3.6% of outpatients in the network system were referred to hospitals. The rest were cared for and followed up by the primary health care providers. Therefore, strengthening the network system structure and primary health care should be further considered.

COVID-19 is a global pandemic and has plagued many countries with unprecedented management problems. The rapid spread of COVID-19 around the world has reduced the ability of countries to address and respond to essential health services. Most countries have taken steps to prevent the spread of COVID-19 and improve essential services. The National Mobilization Plan against COVID-19 in Iran’s healthcare system was implemented in 5 stages until the September of 2021. This study aimed to assess and review medical universities' performance in the third step of management and control of COVID-19 to provide documents and reports to be used in similar experiences.

This research is a cross-sectional descriptive study. Data were obtained from electronic records at the primary health care facilities. Data were analyzed and reported using descriptive statistical methods, including comparative tables and graphs. In order to prepare the report, Excel 2016 software was used. The third step of the National Mobilization Plan against COVID-19 was implemented from August 10, 2020, to November 10, 2020. In this step, while re-emphasizing the importance and necessity of verbal and laboratory screening of COVID-19, essential health services provision was highlighted as "in person and remote services" for the covered population.

In the third step of national mobilization, 59,109,413 people were screened for COVID-19. During the third step, non-COVID essential services increased compared to the previous three months, with the most significant increase in middle-aged care.

After implementing the third step of National Mobilization Plan against COVID-19 in Iran, the number of delivered services in all target groups has increased. This indicates the effectiveness of the third step in the fight against COVID-19 and has increased the provision of Essential Health Services.

In December 2019, a new disease was reported in China that spread rapidly worldwide. This disease is called COVID-19, a viral infection of the coronavirus family. COVID-19 has caused health, social and economic problems around the world. In Iran, the first disease cases were reported in February 2020. This article aimed to describe the results of the fourth step of the National Mobilization Plan against COVID-19 pandemic.

The information used in this cross-sectional-descriptive study is based on the data recorded in the computer program (Portal) of the Network Management Center of the Ministry of Health and Medical Education.The fourth step was devised to manage and control the COVID-19 pandemic with public participation and coordination between departments. It was formed of four teams, including contact tracing, home care, supervisory, and support teams. Excel 2016 software was used to analyze the present study's data, and ArcMap software version 10.8 was applied to draw thermal maps.

In this study, there were 3.2 members per contact tracing team. This number was equal to 3.2, 2.9, and 3.8 people per team for supportive, home care, and supervisory teams, respectively. Also, on average, the contact tracing teams tracked 135.9 cases per team. This number was 518.6 visits per team for supervisory teams, 75.3 for home care teams, and 52.2 households for support teams. During the program's implementation, 3065.3 PCR tests and 3596.7 rapid tests were taken per 100,000 population, of which 15.5% were positive. The average contact tracing in people with close contact with the infected people was 4.87 per patient with a positive test.

The COVID-19 pandemic challenged all political, economic, social, and health policies and exposed the weaknesses of the governments. According to statistics and information, the measures taken to manage and control COVID-19 in Iran have been valuable and effective. Still, the continuation of this process depends on the persistence of policies and protocols by the government and people in the society.