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Showing 8 results for Universal Health Coverage

Bahareh Yazdizadeh, Farideh Mohtasham,
Volume 32, Issue 1 (2-2018)
Abstract

    Background: Universal health coverage (UHC) is the desired goal of achieving universal access to health services without having to endure pain and financial difficulties. Multiple factors can help steer countries toward UHC. One of the most important factors is the production of valid quality evidence that can be achieved through research. The present study aimed at outlining the status of research systems in UHC–related organizations and identifying the barriers faced by research.
   Methods: The key individuals and organizations that could provide rich, relevant, and diverse data in response to the research question were purposively selected for the interviews. Thematic analysis was used to analyze the interviews. Categories and subcategories were deductively extracted from the text based on research system performance as follows: resource provision, production and utilization of knowledge, existing resources, and stewardship. Then, the themes were inductively extracted from the interviews.
   Results: Many barriers existed for performing research in UHC–related organizations. The stewardship barrier seemed to play a key role such that structural changes in organizations affected the production & utilization of evidence. Limited financial and human resources were evident in most of the organizations. Research questions were not comprehensively identified. The conducted studies either were not designed to answer the relevant questions and/or were not appropriately reported to policy makers. As a result, their implementation in decision- making did not reach the ideal status.
   Conclusion: Research utilization aimed at achieving UHC will come to realize only when and if research is conducted to produce evidence required for decision–making and implementation. Therefore, in addition to the interventions recommended by the World Health Organization, we should design and implement interventions tailored to the local barriers and needs of UHC–related organizations.
 


Elham Ehsani-Chimeh, Haniye Sadat Sajadi, Reza Majdzadeh,
Volume 32, Issue 1 (2-2018)
Abstract

Summary:
Given the key role of adequate, skilled, well-trained, and motivated Human Resources for Health (HRH) in achieving Universal Health Coverage (UHC), this manuscript investigates the current situation of Iran HRH after the implementation of the recent Health Transformation Plan (HTP) in accordance with UHC analytical framework and by using four domains of availability, accessibility, acceptability and quality. We conclude that, Conflicts of interest and multiple interventions from different sectors have controversial and sometimes negative effects on the health workforce. In order to achieve the objectives of UHC from the perspective of human resources, Iran needs unified governance and comprehensive planning in this criterion. Also the effects of health system interventions on health workforce before implementation should be assessing.

Sahand Riazi-Isfahani, Maziar Moradi-Lakeh, Shiva Mafimoradi, Reza Majdzadeh,
Volume 32, Issue 1 (2-2018)
Abstract

The majority of modifiable health outcomes are attributable to factors that are outside the direct reach of the health systems and can only be reached through intersectoral actions. In recent years, Iran implemented a series of reforms in the health sector called Health Transformation Plan (HTP). This paper  aimed to review health-related intersectoral actions in Iran that have focused on interventions conducted after HTP implementation and to compare the interventions against the recommendations by World Health Organization (WHO) Commission on Social Determinants of Health. Findings showed that intersectoral governance interventions are the strongest points and have the most compatibility with the recommendations, while intersectoral environmental interventions are the weakest points. Also, many of the interventions have not yet been completely implemented. Moreover, continuity and sustainability of the policies and programs are still a concern.
Haniye Sadat Sajadi, Elham Ehsani-Chimeh, Reza Majdzadeh,
Volume 33, Issue 1 (2-2019)
Abstract

Over the last 4 decades, many initiatives have been implemented to accomplish equitable accessible health care for all Iranian citizens. The latest reform to address universal health coverage (UHC) is Health Transformation Plan (HTP), which resulted in significant improvements in health outcomes. Nevertheless, several challenges in the fields of sustainability of resources, service delivery, and health governance continued to exist. These challenges should be addressed in next steps to achieve the defined goals. To tackle these challenges, a number of practical solutions can be proposed, including making health financing more resilient, defining and implementing cost control policies and cost-effective package of services, changing the current method of providers’ payment, and ensuring good governance in the health system.
Zhaleh Abdi, Bahareh Yazdizadeh, Elham Ahmadnezhad, Mahboubeh Rahimi, Reza Majdzadeh,
Volume 33, Issue 1 (2-2019)
Abstract

Achieving universal health coverage (UHC), which means ensuring access to high quality and equitable services by all without financial hardship, requires local evidence. To find interventions appropriate to local needs, local knowledge and evidence are required in addition to global evidence. Thus, every country should have its own plan for research production and utilization and strengthening researchers’ capacities to achieve UHC. To accomplish the goals of UHC, the research system should be able to determine the research priorities and agenda, collect resources, improve the capacity for evidence generation, and maximally utilize the country’s capacity for finding local solutions by establishing research networks. In this study, inputs for UHC research priority setting in Iran and its challenges have been discussed.
Behzad Karami Matin, Mohammad Kamali, Heather J Williamson, Fardin Moradi, Shahin Solatni,
Volume 33, Issue 1 (2-2019)
Abstract

Background: In developing countries, people with disabilities (PWD) are more likely to have unequitable access to health care services than their counterparts without disabilities. Access to health care is a multidimensional concept and PWD experience various barriers to use health care.  This quantitative study explored the predictors and determents of access to health care for PWD in an Iranian context.
   Methods: Data were collected from a cross sectional study conducted in Tehran in 2017. A total of 403 adults with physical and/or intellectual disabilities were selected using census method. The data on PWD were collected from 14 rehabilitation centers affiliated to Welfare Organization and Red Crescent Organization. The self–report World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to collect data on disability status. T test, ANOVA, and multiple linear regressions were used to determine factors influencing access to health care for PWD. Significance level was set at 5%. Also, SPSS software version 20.0 was used for data analysis.
   Results: The mean of access to health care among people with intellectual disabilities (mean: 61.77, 95% confidence interval (CI):59.20, 64.35) was significantly lower than their counterparts with physical disabilities (Mean: 67.97, 95% CI: 65.26, 70.69). The results of multiple linear regression analysis showed that in the affordability dimension, type of disability, marital status, and supplemental health insurance could predict access to health services for PWD. In availability dimension, only location predicted the outcome variable significantly. Also, location and type of disability were considered to be potential predictors of access to health services in acceptability dimension.
   Conclusion: The results indicate that various factors can limit access to health services for PWD. To achieve universal health coverage, vulnerable groups and their needs should be identified to increase equitable access to health care services. Also, the health care system should pay more attention to demographic differences when planning and providing affordable and acceptable health care for PWD. Finally, the role of the government as the heath stewardship is vital to promote health care access for PWD in Iran. 
 
Hassan Joulaei, Mozhgan Fardid, Kamran Bagheri Lankarani,
Volume 33, Issue 1 (2-2019)
Abstract

We appreciate the authors for analyzing Health Transformation Plan (HTP) and its challenges toward Universal Health Coverage (UHC). Although the authors made all their efforts to put forward the background of Iran’s health system before HTP implementation and the challenges it faces during its progress, we think some major issues are not expressed precisely.
HTP.
In conclusion, we do believe that HTP aimed to reduce the inequality of utilization, increase the financial protection and improve the quality of care. However, not paying proper attention to existed health system especially HNS, improper prioritization of the intervention package, insufficient attention to the prerequisites of such a plan including sustainable financial resources and lack of real support from all stakeholders were the main errors of implementing HTP. We also would like to add the importance of upgrading the managerial skills of health system at national level as a major precondition due to its momentous role in all reforms.    
Haniye Sadat Sajadi, Elham Ehsani-Chimeh, Reza Majdzadeh,
Volume 33, Issue 1 (2-2019)
Abstract

We thank Joulaei et al (1) for their insightful comments on our paper on Universal Health Coverage in Iran (2). They criticized some parts of Iran's Health Transformation Plan (HTP), and we do not disagree with some of their comments on HTP. However, we think that an evidence-based approach is needed for an in-depth analysis of HTP, which is beyond our correspondence and Joulaei et al.’s comments. Therefore, we only focus on the criticisms made to our correspondence which was related to the starting point of HTP as to whether public hospitals were an appropriate starting point or whether the primary health care (PHC) should have been the starting point for HTP. 
While we believe that strengthening PHC is a strategic approach and vital to achieve Universal Health Coverage (UHC), at the same time, starting HTP from hospital services was a tactically correct decision, as public policymakers were looking for a showcase of using targeted subsidies funds to do something sensible for people in social welfare. The inpatient services were an urgent challenge which caused extreme public dissatisfaction. Much earlier, the first measure taken in the health transformation plan of Turkey was prohibition of holding the corpse hostage in hospitals due to unpaid hospital costs. While this was not a significant intervention for strengthening the health system, it softened the ugly face of the system and had tangible results for people. The second reason was the ease of implementing interventions in hospital services; 70% of outpatient services are provided by the private sector in Iran, which is not well-manageable by the government. In contrast, the public sector is the largest provider of inpatient services, providing inpatient care to almost 80% of the population. As a result, intervention in public hospitals, compared to outpatient services, has been more feasible. The third reason was the chance of achieving the desired results in a shorter time. The impacts of promotive and preventive measures appear in the long-term, while curative affair measures have short-term impacts.
In sum, we entirely agree that reform is useful when it addresses the most fundamental challenges of the health system. However, the progressive realization of UHC is a crucial principle, meaning that the reform should be a long-term plan which must gradually be evolved (3). Starting HTP from the public hospital should not be considered as a disadvantage since, in reality, it has attracted enough attention and support; however, HTP should have not ended up in the hospital, and it had to address other aspects that were essential for a fundamental transformation such as PHC.
 

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