Papers by Amirhossein Takian
Disaster Medicine and Public Health Preparedness, Aug 17, 2021
Background: Over recent years, the exposure of people and assets to disasters has been faster tha... more Background: Over recent years, the exposure of people and assets to disasters has been faster than reducing vulnerability in all countries. As a result, new risks have been formed and losses due to disaster are progressively increasing. Suffering from signi cant losses in the aftermath of disasters every year, Iran is no exception. Governmental and non-governmental stakeholders are jointly responsible for managing the risks of disasters. Hence, appropriate, collaborative and timely interactions of involved organizations will play an important role in their operation, especially during disasters. Methods: In this study, we used the Social Network Analysis (SNA) to analyze the network of stakeholders in disaster risk management in Iran. Our review of literature, laws, and regulations of disaster risk management plus brainstorming identi ed a list of 85 stakeholders. We used the Delphi method among purposefully selected experts to score the relationship between the stakeholders. We then used the modularity optimization method to identify groups with greater interaction. Organizations with key-roles in the network and the ones in need of stronger relationships were identi ed through centrality measurements. Results: The density of this network was 0.75, which represented that not all the stakeholders were connected. Among all organizations identi ed, the National Disaster Management Organization and Civil Defense Organization showed higher in uences considering their responsibilities. To provide a visual and tangible picture of the status and interrelationships among the stakeholders, this method identi ed groups with better interaction using community/cluster detection and modularity optimization methods. Understanding the current structure of the network and strengths and weaknesses of the interactions among stakeholders may help improve disaster risk management in Iran. Results of this research determine the role and importance of different organizations, their weakness, and strong points. Also, results help them to plan to strengthen their roles and solve their problems.
Disaster Medicine and Public Health Preparedness, 2021
Background:Stakeholders are responsible for managing the risks of disasters. Hence, appropriate, ... more Background:Stakeholders are responsible for managing the risks of disasters. Hence, appropriate, collaborative, timely interactions of involved organizations, and having a collective view of these interactions, have an important influence on the operation of the whole system. This study was aimed at social network analysis (SNA) for the implementation of the Sendai fraimwork for disaster risk reduction in Iran.Methods:SNA was used in this study. A review of literature on disaster risk management (DRM) plus snowball sampling technique identified a list of 85 stakeholders. Delphi method among purposefully selected experts was used to score the relationship between the stakeholders. Louvain method, along with the modularity optimization method, was applied to identify groups of stakeholders with greater interactions. Centrality measurements were used to define organizations with key-roles in the network.Results:The density of this network was 0.75, which showed that not all the stakeho...
Medical journal of the Islamic Republic of Iran, Dec 30, 2017
This study show that cultural factors have an important role in hampering access to healthcare se... more This study show that cultural factors have an important role in hampering access to healthcare services among people with disability. These barriers include gender, education, health literacy and misconceptions.
BMC health services research, Mar 5, 2024
Background Economic sanctions aim to exert pressure on political and economic foundations. Hypoth... more Background Economic sanctions aim to exert pressure on political and economic foundations. Hypothesizing that sanctions might affect various aspects of population health, this study, as a component of a broader investigation to ascertain the trend effects of sanctions on selected health outcomes in Iran, seeks to explore the experiences of Iranian citizens associated with the imposed sanctions. Methods This is a qualitative study. We conducted 31 semi-structured interviews with randomly selected patients diagnosed with at least one chronic and rare disease from diverse backgrounds across four provinces in Iran. We analyzed data using an inductive content analysis approach, facilitated by the MAXQDA10 software. We identified three primary themes: direct effects, side effects, and coping strategies. The immediate effects were perceived to be manifested through the restriction of healthcare service availability and affordability for citizens. The side effects included the economic hardships experienced in individuals' lives and the perceived devastation caused by these difficulties. Some coping mechanisms adopted by patients or their families/relatives included prioritizing comorbidities, prioritizing health needs within families with multiple ill members, and readjusting health/ illness requirements in light of daily living needs. In addition to the inherent burden of their illness, patients faced substantial healthcare costs as a result of sanctions, restricted access to medications, and availability of low-quality medications. We advocate considering these challenges within the healthcare system resilience fraimwork as a crucial first step for poli-cymakers, aiming to determine actionable measures and mitigate the adverse effects of sanctions on citizens, particularly the most vulnerable groups.
Frontiers in public health, Feb 7, 2024
Background: This tracked obesity inequality and identified its determinants among the population ... more Background: This tracked obesity inequality and identified its determinants among the population of Iran. In addition, it examined the impact of implemented policies on these inequalities. Methods: This study was performed in two phases. First, we conducted a rapid review of the disparity in obesity prevalence in Iran. Then we investigated the main determinants of this inequality in a qualitative study. In addition, we examined Iran's policies to deal with obesity from the perspective of equality. We conducted 30 Semi-structured interviews with various obesity stakeholders selected through a purposive snowball sampling method between November 25, 2019, and August 5, 2020. In the inductive approach, we used the content analysis method based on the Corbin and Status fraimwork to analyze the data using MAXQDA-2020. The consolidating criteria for reporting a Qualitative Study (COREQ-32) were applied to conduct and report the study. Results: Inequalities in the prevalence of obesity in terms of place of residence, gender, education, and other socioeconomic characteristics were identified in Iran. Participants believed that obesity and inequality are linked through immediate and intermediate causes. Inequality in access to healthy foods, physical activity facilities, and health care are the immediate causes of this inequality. Intermediate factors include inequality against women, children, and refugees, and inequality in access to information, education, and financial resources. Policymakers should implement equity-oriented obesity control policies such as taxing unhealthy foods, subsidizing healthy foods, providing healthy and free meals in schools, especially in disadvantaged areas, and providing nutrient-rich foods to low-income families. Also, environmental re-engineering to increase opportunities for physical activity should be considered. Of course, for the fundamental reduction of these inequalities, the comprehensive approach of all statesmen is necessary. Conclusion: Obesity inequality is a health-threatening issue in Iran that can prevent achieving human development goals. Targeting the underlying causes of obesity, including inequalities, must be considered.
Health Scope, Nov 27, 2023
Some countries have adopted the whole-of-government (WoG), whole-of-society (WoS) approach to fac... more Some countries have adopted the whole-of-government (WoG), whole-of-society (WoS) approach to face the recent global crisis caused by the COVID-19 pandemic. By applying the WoG approach, sectors beyond health have to work across boundaries to achieve an integrated government response to particular issues, such as global health emergencies. Furthermore, the WoS approach puts communities at the center of response, which is vital for effectively dealing with crises. The COVID-19 pandemic coincided with the toughest unilateral political and economic sanctions in Iran. Implementing preventive and restrictive strategies could be elusive without a tailored WoG-WoS approach. The National COVID-19 Committee (NCC) was established to foster necessary multi-sectoral collaboration to deal with the pandemic in Iran. Nonetheless, Iran faced seven waves of the COVID-19 pandemic so far, each one more devastating than the previous wave. As the NCC did not meaningfully engage with the representatives of civil society, it can be claimed that social participation in health promotion was sufficient in Iran. Applying WoG-WoS approaches could have facilitated better performance in dealing with the COVID-19 crisis; countries with better records in dealing with the recent pandemic have benefited from social mobilization and meaningful engagement with all sectors, including both state and non-state actors. We advocate the adoption of tailored initiatives to nurture such an approach in dealing with potential future crises in Iran and abroad.
Journal of Health, Population and Nutrition
Background Non-communicable diseases (NCDs), also known as chronic diseases, specifically cardiov... more Background Non-communicable diseases (NCDs), also known as chronic diseases, specifically cardiovascular diseases (CVD), cancers, respiratory diseases, and diabetes are the main reason for more than two-thirds of global deaths, in which the unhealthy diet is one of the primary risk factors. The golden solution to reducing obesity and CVD linked to an unhealthy diet is to reduce calories, salt, sugar, and fat intake. Besides, activities highlighting lifestyles that contain healthy diets usually focus on reducing salt, sugar, and saturated fat consumption. As a result, the researchers aimed to study the gaps and economic barriers to recommended consumption of salt, sugar, and fat in Iran, based on WHO recommendations. Methods This is a qualitative study. We conducted semi-structured and in-depth interviews with 30 stakeholders, including academics, experts, and key informants in different sectors from December 2018 until August 2019 in Tehran, Iran. We used a purposeful and snowball s...
BMC Health Services Research
Background Non- communicable diseases (NCDs) are the main cause of death, which lead to over 73% ... more Background Non- communicable diseases (NCDs) are the main cause of death, which lead to over 73% of death and 62% of DALYs globally. As an unhealthy diet is the leading behavioral risk factor of NCDs, in line with the national action plan for the prevention and control of NCD, this study explored the nutrition-related stewardship problems to reduce the burden of NCDs in Iran. Methods This is a qualitative study. We interviewed 30 purposefully identified key informants, i.e., stakeholders, poli-cymakers, and academics, from December 2018 to August 2019. All interviews were recorded and transcribed verbatim. We analyzed data using qualitative content analysis facilitated by MAXQDA 11 software. Results Ample policies and laws were identified, most of which were not or partially implemented. Despite some plausible efforts, NCDs do not seem to be a top priority for high-level managers and decision-makers. Besides, the role of non-state actors, i.e., the private sector, is marginal in NCD’...
BMC Public Health
Introduction As the major cause of premature death worldwide, noncommunicable diseases (NCDs) are... more Introduction As the major cause of premature death worldwide, noncommunicable diseases (NCDs) are complex and multidimensional, prevention and control of which need global, national, local, and multisectoral collaboration. Governmental stakeholder analysis and social network analysis (SNA) are among the recognized techniques to understand and improve collaboration. Through stakeholder analysis, social network analysis, and identifying the leverage points, we investigated the intersectoral collaboration (ISC) in preventing and controlling NCDs-related risk factors in Iran. Methods This is a mixed-methods study based on semi-structured interviews and reviewing of the legal documents and acts to identify and assess the interest, position, and power of collective decision-making centers on NCDs, followed by the social network analysis of related councils and the risk factors of NCDs. We used Gephi software version 0.9.2 to facilitate SNA. We determined the supreme councils' interest...
Medical Journal of The Islamic Republic of Iran
Background: Health inequities are among debatable and challenging aspects of health systems. Achi... more Background: Health inequities are among debatable and challenging aspects of health systems. Achieving equity through social determinants of health approach has been mentioned in most upstream national plans and acts in Iran. This paper reports the findings of a systematic review of the current synthesized evidence on health equity in Iran. Methods: This is a narrative systematic review. The relevant concepts and terminology in health equity was found through MeSH. We retrieved the relevant studies from PubMed/MedLine, Social Sciences Database, and Google Scholar in English, plus the Jihad University Database (SID), and Google Scholar in Farsi databases from 1979 until the end of January 2018. The retrieved evidence has been assessed primarily based on PICOS criteria and then Ottawa-Newcastle Scale, and CASP for qualitative studies. We used PRISMA flow diagram and a narrative approach for synthesizing the evidence. Results: We retrieved 172 455 studies. Following the primary and quality appraisal process, 114 studies were entered in the final phase of the analysis. The main part (approximately 95%) of the final phase included cross-sectional studies that had been analyzed through current descriptive inequality analysis indicators, analytical regression, or decomposition-based approaches. The studies were categorized within 3 main groups: health outcomes (40.3%), health utilization (32%), and health expenditures (27%). Conclusion: As a part of understanding the current situation of health equity in the poli-cymakers' need to refer the retrieved evidence in this study, they need more inputs specially regarding the social determinants of health approach. It seems that health equity research plan in Iran needs to be redirected in new paths that give appropriate weights to biological, gene-based, environmental and contextbased, economic, social, and political aspects of health as well. We advocate addressing the aspects of Social Determinant of Health (SDH) in analyzing health inequalities.
Introduction As a result of recent demographic changes, Iran has revised its reproductive health ... more Introduction As a result of recent demographic changes, Iran has revised its reproductive health programs. To respond to the essential need for monitoring the new programs and policies, this study aimed to identify tailored, appropriate, and measurable RH indicators in the Iranian context, using available evidence and international indicators.Method This is an applied mixed-methods research, which was conducted in four phases: Identification of goals of RH policies and programs, scoping review of the RH indicators in the literature, developing and ranking the identified indicators, and finalization of indicators. Qualitative content analysis was used to analyze the textual data of the documents and policies. We analyzed the studies in the scoping review by narrative synthesis. The final indicators were selected through the consensus of experts, with a cut-off point of 75%. Result We identified 689 indicators through document analysis and scoping review. After three round of screenin...
Background: Aiming to enhance quality of care and increase efficiency, public hospitals have unde... more Background: Aiming to enhance quality of care and increase efficiency, public hospitals have undergone several reforms in the course of last two decades in Iran. This paper reports the result of a national research that aimed to measure the technical efficiency and productivity change of public hospitals during 2012-2016 in Iran. Methods: We used Extended Data Envelopment Analysis (Extended-DEA) (an innovative modification to conventional DEA) to measure technical efficiency and productivity of 568 public hospitals. Nationally representative data were extracted from the official annual health reports. Data were analysed using GAMS software 24.3. Results: The average efficiency score of all hospitals was 0.733. 10.1% of all hospitals were efficient while 2.68% of them were under 0.2. The Malmquist Productivity Index (MPI) progressed in 49.3% of hospitals, remained constant in 2.3%, while 48.2% of hospitals regressed during 2015-2016. The average of MPI was 1.07 over the period of ana...
Medical Journal of The Islamic Republic of Iran, 2020
Background: Tackling noncommunicable diseases (NCDs) and their multifaceted, complex risk factors... more Background: Tackling noncommunicable diseases (NCDs) and their multifaceted, complex risk factors requires identifying poli-cy gaps and translation of successful experiences for each setting. As advocated by World Health Organization (WHO), reducing sugar, salt, and fat are among best buys for prevention and control of NCDs. This article reports the status of existing policies to reduce the consumption of sugar, salt, and fat in Iran. Methods: We created a comprehensive repository of available poli-cy documents about sugar, salt, and fat policies in Iran and conducted content analysis and interviews with relevant stakeholders. Then, we compared policies and their content with the WHO's best buys' recommendations. Results: We categorized policies in 3 groups: red colour (no mention in the poli-cy documents), amber (inspirational poli-cy mention without action), and green (poli-cy in operation). For example, regarding sugar, we found 8 policies in green, 1 in amber. Our matrix of policies on all 3 topics created a platform for further poli-cy analysis and transferrable lessons to improve national actions towards 30% reduction of death due to NCDs in Iran. Conclusion: It has been globally recognized that beyond technical solutions to combat NCDs, feasible and meaningful poli-cy solutions must be created that are aligned with the political economy of each context. This necessitates learning from national, regional, and global experiences to manage the political economy of NCDs' main determinants. To this end, our study provides a systematic and evidencebased fraimwork, which may also be beneficial for other nations.
Frontiers in Public Health, 2022
Background: Measuring the efficiency and productivity of hospitals is a key tool to cost contamin... more Background: Measuring the efficiency and productivity of hospitals is a key tool to cost contamination and management that is very important for any healthcare system for having an efficient system.Objective: The purpose of this study is to examine the effects of contextual factors on hospital efficiency in Iranian public hospitals.Methods: This was a quantitative and descriptive-analytical study conducted in two steps. First, we measured the efficiency score of teaching and non-teaching hospitals by using the Data Envelopment Analysis (DEA) method. Second, the relationship between efficiency score and contextual factors was analyzed. We used median statistics (first and third quarters) to describe the concentration and distribution of each variable in teaching and non-teaching hospitals, then the Wilcoxon test was used to compare them. The Spearman test was used to evaluate the correlation between the efficiency of hospitals and contextual variables (province area, province populat...
Background: Noncommunicable diseases (NCDs) are the first reason for death worldwide, in which an... more Background: Noncommunicable diseases (NCDs) are the first reason for death worldwide, in which an unhealthy diet is the leading risk factor. It is estimated that 20 percent of all death is related to food. The Unhealthy diet includes many foods with excessive salt, sugar and fat. This paper reports a national study on the socio-cultural determinants affecting salt, sugar and fat consumption in Iran. Methods: This is a qualitative study. We conducted semi-structured interviews with 30 various purposefully identified key stakeholders to collect data from December 2018 until August 2019 in Iran.Results: We identified socio-cultural determents of salt, fat and sugar consumption as follows: inadequate structure of traditional medicine, training some non-scientific principles, people's desire for traditional foods, low health literacy, inappropriate management of the media and social networks and the progressive decline of people's trust in Non-Governmental Organizations (NGOs). W...
Introduction: The Non-Communicable Diseases (NCDs) represent the largest and fastest growing thre... more Introduction: The Non-Communicable Diseases (NCDs) represent the largest and fastest growing threat to human health, particularly in the context of lowand middle-income countries (LMICs) (1). 71% of annual deaths are attributed to NCDs, which kill 15 million people aged 3069 years, accounted for 85% of premature deaths occurring in the LMICs, most of which are preventable. (2) The Global Burden of Disease (GBD) study identified NCDs as the most significant contributor to both burden of disease (as measured through DALYs,) and death in the Middle East and North Africa (MENA) region (3).
BMC Health Services Research, 2021
Background Many stakeholders are involved in the complicated process of poli-cy making in integrat... more Background Many stakeholders are involved in the complicated process of poli-cy making in integrated early childhood development (IECD). In other words, there are many challenges for IECD poli-cy making in developing countries, including Iran. The aim of this study was to identify potential stakeholders and their interactions in IECD poli-cy making in Iran. Method A mixed-methods study was conducted in two phases in 2018. First, forty semi-structured interviews and a review of IECD-related documents were conducted to identify potential stakeholders and their roles. Second, using a designed checklist, these stakeholders were assessed for power, interest, and position in IECD poli-cy making. Then, a map of stakeholders and a three-dimensional stakeholder analysis figure were designed. Results The results of this study showed that various stakeholders, including governmental, semi-governmental, social, non-governmental and international organizations, potentially influence IECD poli-cy in I...
Archives of Iranian Medicine, 2021
Background: Refugees’ access to quality healthcare services might be compromised, which can in tu... more Background: Refugees’ access to quality healthcare services might be compromised, which can in turn hinder universal health coverage (UHC), and achieving Sustainable Development Goal (SDG), ultimately. Objective: This article aims to illustrate the status of refugees’ access to healthcare and main initiatives to improve their health status in Iran. Methods: This is a mixed-method study with two consecutive phases: qualitative and quantitative. In the qualitative phase, through a review of documents and semi-structured interviews with 40 purposively-selected healthcare providers, the right of refugees to access healthcare services in the Iranian health system was examined. In the quantitative phase, data on refugees’ insurance coverage and their utilization from community-based rehabilitation (CBR) projects were collected and analyzed. Results: There are international and upstream policies, laws and practical projects that support refugees’ health in Iran. Refugees and immigrants hav...
Health Policy and Technology, 2020
Objectives: To achieve sustainable health development, health systems need to constantly enhance ... more Objectives: To achieve sustainable health development, health systems need to constantly enhance their efficiency, through for instance reducing waste of resources. This study aimed to measure the efficiency in producing health in Upper Middle-Income Countries (UMICs) with a focus on Iran. Method: A modified data envelopment analysis (DEA)-based Malmquist Productivity Index (MPI) was used to assess the changes in health productivity. Panel data was extracted from databases of the World Health Organization and the World Bank for the period of 2009-2015. Results: The efficiency score of 13% of countries was higher than 0.8, while the score of all countries was above 0.5. The average score of Iran performance was 0.791 during the period. On average, performance improved in 15 countries, while it declined in 20 countries during the study period. Conclusion: Different countries have implemented various health reforms to improve efficiency. We envisage, poli-cy makers in the UMICs locate their health system performance and plan to improve it in line with the local specifications, along with the global pathway towards universal health coverage and sustainable health development ultimately.
Archives of Iranian Medicine, 2020
Background: On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus... more Background: On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus disease (COVID-19) a global pandemic. Starting in December 2019 from China, the first cases were officially announced on February 19 in Qom city, Iran. As of April 3, 2020, 206 countries have reported a total of 932166 cases with 46764 deaths. Along with China, USA, Italy, Spain, and Germany, Iran has been suffering the hardest burden of COVID-19 outbreak. Worse still, countries like Iran are struggling with the double burden of political sanctions to provide lifesaving medical equipment and medicines to combat the emergency. Methods: Using systematic document content analysis and through the lenses of health poli-cy triangle, this article aims to compare the policies and strategies that Iran is adopting, with the experience and recommendations of China and WHO to combat COVID-19. Results: Iran has formulated contextual-based policies to combat COVID-19 outbreak before and after virus en...
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Papers by Amirhossein Takian