scholarly journals Seven Decades of Primary Healthcare during Various Development Plans in Iran: A Historical Review

2020 ◽  
Vol 23 (5) ◽  
pp. 338-352 ◽  
Author(s):  
Leila Doshmangir ◽  
Esmaeil Moshiri ◽  
Farshad Farzadfar
Keyword(s):  
Health System ◽  
Primary Healthcare ◽  
Health Sector ◽  
Historical Review ◽  
The People ◽  
Before And After ◽  
History Of ◽  
Development Plans ◽  
Using Data ◽  
Iranian Health System

Objective: To explore historically primary healthcare (PHC) development in Iran in the light of development plans before and after the Islamic Revolution. The results of this study can be used to outline the future of PHC in the Iranian health system. Methods: We conducted a retrospective analysis of the PHC development in the Iranian health system using data from relevant published and unpublished policy documents. The literature was retrieved and reviewed on the basis of predetermined inclusion criteria with no language or date restriction. The data were integrated and analyzed using content analysis. Results: During various upstream development plans, the attitude of the policy makers to PHC has been very different, resulting in fundamental differences in addressing such an important issue and the consequent outcomes. In the aftermath of Iran’s revolution, due to more understanding of PHC services importance and the principal slogans of the revolution to pay attention to villagers and vulnerable people, health policymakers paid more attention to PHC, which was not evident in previous periods. Conclusions: Despite considerable achievements in PHC, the history of PHC in Iran indicates frequent changes in planning and health provision structure. This suggests that the challenges facing the health sector today, the evolving needs and demands of the people, and population changes necessitate reinforcement and reform in the structure of the current PHC network as the main mission of Iran’s Ministry of Health.

scholarly journals Building collective power in citizen-led initiatives for health accountability in Guatemala: The role of networks

2019 ◽  
Author(s):  
Alison Hernandez ◽  
Anna-Karin Hurtig ◽  
Isabel Goicolea ◽  
Miguel San Sebastian ◽  
Fernando Jerez ◽  
...  
Keyword(s):  
Collective Action ◽  
Health System ◽  
System Failures ◽  
Marginalized Communities ◽  
The People ◽  
Network Building ◽  
History Of ◽  
Relational Qualities ◽  
Base Of Support ◽  
Network Mapping

Abstract Background Citizen-led accountability initiatives are a critical strategy for redressing the causes of health inequalities and promoting better health system governance. A growing body of evidence points to the need for putting power relations at the forefront of understanding and operationalizing citizen-led accountability, rather than technical tools and best practices. In this study, we apply a network lens to the question of how initiatives build collective power to redress health system failures affecting marginalized communities in three municipalities in Guatemala. Methods Network mapping and interpretive discussions were used to examine relational qualities of citizen-led initiatives’ networks and explore the resources they offer for mobilizing action and influencing health accountability. Participants in the municipal-level initiatives responded to a social network analysis questionnaire focused on their ties of communication and collaboration with other initiative participants and their interactions with authorities regarding health system problems. Discussions with participants about the maps generated enriched our view of what the ties represented and their history of collective action and also provided space for planning action to strengthen their networks. Results Our findings indicate that network qualities like cohesiveness and centralization reflected the initiative participants’ agency in adapting to their sociopolitical context, and participants’ social positions were a key resource in providing connection to a broad base of support for mobilizing collective action to document health service deficiencies and advocate for solutions. Their legitimacy as “representatives of the people” enabled them to engage with authorities from a bolstered position of power, and their iterative interactions with authorities further contributed to develop their advocacy capabilities and resulted in accountability gains. Conclusions Our study provided evidence to counter the tendency to underestimate the assets and capabilities that marginalized citizens have for building power, and affirmed the idea that best-fit, with-the-grain approaches are well-suited for highly unequal settings characterized by weak governance. Efforts to support and understand change processes in citizen-led initiatives should include focus on adaptive network building to enable contextually-embedded approaches that leverage the collective power of the users of health services and grassroots leaders on the frontlines of accountability.

Abstract P183: Minimal Impact of JAMA 2014 Guidelines on Blood Pressure Control in a Large Health System

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Alex R Chang ◽  
J E Hartle ◽  
Lawrence Appel ◽  
Morgan Grams
Keyword(s):  
Blood Pressure ◽  
Health System ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Mixed Effects Models ◽  
System Level ◽  
Minimal Impact ◽  
Before And After ◽  
Patients With Diabetes ◽  
Using Data

Background: JAMA 2014 blood pressure (BP) guidelines raised BP goals for adults older than 60 years (from <140/90 to <150/90) and adults with chronic kidney disease (CKD) or diabetes (from < 130/80 to <140/90). It is unknown whether there were changes in BP control at the health system level after guideline publication. Methods: Using data from 288,962 adults receiving primary care in the Geisinger Health System, we compared blood pressure control over 1-year time periods before and after the February 2014 publication of the JAMA 2014 BP guidelines (i.e. Aug 2012-July 2013 vs Aug 2014-July 2015). Mixed effects models were used, allowing intercepts to vary by individual, adjusted for age, gender, and race. Results: Mean age was 49.2 ± 18.3 y, 56.7% were female, and 2.5% were black. Prevalence of diagnoses for hypertension, diabetes, and CKD were 40.0%, 15.1%, and 11.4%, respectively. Overall, distributions of systolic BP were similar before and after JAMA 2014 BP guidelines (Figure). BP control <140/90 was also similar between the two periods for adults 18-59 y (90.9% vs. 90.3%; OR 1.01, 95% CI: 0.99-1.02; p=0.3), adults ≥ 60 y (81.8% vs 82.2%; OR 1.01, 95% CI: 1.00-1.03; p=0.05), and adults with diabetes (83.2% vs. 82.7%; OR 1.00, 95% CI: 0.99-1.02; p=0.7) whereas BP control <140/90 improved slightly for adults with CKD (81.7% vs. 82.1%; OR 1.06, 95% CI: 1.04-1.08; p<0.001). BP control <130/80 was marginally worse after JAMA 2014 BP guidelines in patients with diabetes (53.5% vs. 51.8%; OR 0.98, 95% CI: 0.96-0.99; p=0.01). Trends were similar in analyses only including patients with hypertension diagnoses (overall 78.6% vs. 78.2%, OR 1.00, 95% CI: 0.99-1.02; p=0.5), and when using a goal of < 130/80 for patients with CKD (53.3% vs. 53.5%; OR 1.06, 95% CI: 1.04-1.08; p<0.001). Conclusion: There was little change in blood pressure control in a large integrated health system after publication of the JAMA 2014 BP guidelines. These findings are reassuring given recent findings from the SPRINT trial supporting lower BP goals.

Progression of cognitive decline before and after incident stroke

Neurology ◽  
2019 ◽  
Vol 93 (1) ◽  
pp. e20-e28 ◽  
Author(s):  
Fanfan Zheng ◽  
Li Yan ◽  
Baoliang Zhong ◽  
Zhenchun Yang ◽  
Wuxiang Xie
Keyword(s):  
Cognitive Decline ◽  
Repeated Measures ◽  
Temporal Orientation ◽  
Stroke Survivors ◽  
Semantic Fluency ◽  
Before And After ◽  
History Of ◽  
Global Cognition ◽  
Using Data ◽  
Acute Changes

ObjectiveTo determine the trajectory of cognitive decline before and after incident stroke.MethodsBy using data from the English Longitudinal Study of Ageing, we studied 9,278 participants without dementia with no history of stroke who underwent cognitive assessment at baseline (wave 1) and at least 1 other time point (waves 2–7). We used linear mixed models to analyze repeated measures and longitudinal data.ResultsAmong the 9,278 participants (56.8% women, mean age 63.1 ± 10.3 years), 471 (5.1%) incident stroke events were identified. Compared with stroke-free participants, multivariable-adjusted rates of prestroke cognitive decline in global cognition, memory, semantic fluency, and temporal orientation of participants who later experienced an incident stroke were increased by −0.029 , −0.016, −0.022, and −0.024 SD/y, respectively. Among the 471 stroke survivors, the multivariable-adjusted acute changes in the 4 cognitive domains were −0.257, −0.150, −0.121, and −0.272 SD, respectively. In the years after stroke, global cognition declined over time and was steeper than its prestroke slope, that is, by −0.064 SD/y after multivariable adjustment. The rates of memory, semantic fluency, and temporal orientation decline were −0.046, −0.033, and −0.037 SD/y, respectively.ConclusionsAccelerated prestroke cognitive decline and poststroke cognitive decline were associated with incident stroke over a follow-up period of 12 years. Attention should be paid to the long-term cognitive problems of stroke survivors, and intervention and management of major vascular risk factors should start from early life or midlife to reduce the risk of cerebrovascular disease and the associated cognitive impairment.

scholarly journals Enhancing Leadership, Management, And Governance Competencies For Performance Improvements At Primary Health Care Entities In Ethiopia: A Before And After Study

2021 ◽  
Author(s):  
Binyam Fekadu Desta ◽  
Sualiha Abdlkader Muktar ◽  
Wondwosen Shiferaw Abera ◽  
Heran Demissie ◽  
Mesele Damte Argaw
Keyword(s):  
Primary Healthcare ◽  
Health Workers ◽  
Health Sector ◽  
Work Climate ◽  
Management Systems ◽  
Performance Improvements ◽  
Leadership Management ◽  
Before And After ◽  
Post Test ◽  
Before And After Study

Abstract ObjectivesLeadership, management, and governance (LMG) interventions play a significant role in improving management systems, enhancing work climate, and creating responsive health systems. This study aimed to determine the change that occur in the performance of primary healthcare entities and compare the outputs of block and segmented LMG trainings and the intervention as a whole after implementation for one full year.ResultsTwo hundred and ninety-three LMG trained and 333 non-trained health workers participated with a response rate of 100 percent and 87 percent, respectively. Of those who attended the didactics sessions, 235 (80.9%) scored 70% or more on post-test exams. In addition, the assessment on the practical exercises after implementing the leadership projects revealed that the majority, 252 (86%) scored 80% or more on their desired measurable results. As a result of the LMG trainings, management systems, work climate, and responsiveness of the health system to new challenges were significantly improved (p<0.001). Owing to the leadership projects, within the 136 health facilities, an additional 2,290.3 units of health service coverage was gained. A comparison of the trainees revealed that more block (79.1%), than segmented I (65.02%) and segmented II (62.0%) LMG trainings were successfully completed. Therefore, providing block LMG trainings for more health workers and managers working at primary healthcare entities is 53 recommended as it willaccelera te the implementation of prioritized health sector interventions.

scholarly journals Genre searches in ukrainian playwrights’ plays about hybrid war

2020 ◽  
pp. 19-25
Author(s):  
Yevhenii Vasyliev
Keyword(s):  
Performing Arts ◽  
The Other ◽  
Modern History ◽  
Dramatic Works ◽  
The People ◽  
Before And After ◽  
History Of ◽  
The Subject ◽  
The Creation ◽  
Hybrid War

The tragic events of the Revolution of Dignity and the hybrid war have been reflected in various stylistics and genre parameters of dramatic works. The brightest of them were included in two recent anthologies, which were prepared and published thanks to the efforts of the Department of Drama Projects of the National Center for the Performing Arts named after Les Kurbas. The first of them, “Maidan. Before and After. Anthology of the Actual Drama” (2016), has absorbed 9 plays by the authors of different generations (Yaroslav Vereshchak, Nadiia Symchich, Oleg Mykolaychuk, Neda Nezhdana, Oleksandr Viter, Dmytro Ternovyi, etc.). The completely new second anthology “The Labyrinth of Ice and Fire” (2019) also consists of 9 plays (three of which are also part of the previous anthology), which are the reflections of the modern history of Ukraine. The texts about the hybrid war, which are included in two anthologies, are the subject of our analysis. The focus is on the genre specificity of these drama works. The genre modifications of archaic genres inherent in the Ukrainian theatrical tradition (vertep, mystery) are studied in the plays “Vertep-2015” by Nadiia Marchuk and “Maidan Inferno, or On the Other Side of Hell” by Neda Nezhdana. The functioning of the documentary and epic drama (“The Chestnut and the Lily of the Valley” by Oleg Mykolaychuk, “The People and Cyborgs” by Olena Ponomareva and Dario Fertilio) is analysed. The processes of episation and lyricization are considered. The peculiarities of intergeneric diffusion and the creation of a specific genre type — lyrico-epic drama are analysed. The actual monodramas of Neda Nezhdana “The Cat in Memory of the Darkness” and “OTVETKA@ UA” are highlighted, as well as the intermedial character of the genre transformations of Igor Yuziuk’s drama “C-sharp Sixth Octave”

scholarly journals Inputs of Iranian health system reform plan from health sector managers and policy-makers' points of view

2018 ◽  
Vol 7 (1) ◽  
pp. 126 ◽  
Author(s):  
Mahan Mohammadi ◽  
MohammadHossein Yarmohammadian ◽  
Elahe Khorasani ◽  
MohsenGhaffari Darab ◽  
Manal Etemadi
Keyword(s):  
Health System ◽  
Health Sector ◽  
System Reform ◽  
Policy Makers ◽  
Health System Reform ◽  
Reform Plan ◽  
Points Of View ◽  
Iranian Health System

Challenges In The Development Of The Health System In Surkhan Volume

2021 ◽  
Vol 03 (02) ◽  
pp. 63-67
Author(s):  
Nodira Ibragimovna Hasanova ◽  
Keyword(s):  
Health System ◽  
The People ◽  
History Of

This article discusses the history of undeveloped field of medicine where local doctors treated the people as they knew in the 20-30s of the XX century in the land of Surkhandarya. Doctors had worked tirelessly to cure patients. The medicines they used were made from local herbs in a variety of ways to treat patients.

Evaluation of Health System Responsiveness to the 2003 Bam, Iran, Earthquake

2005 ◽  
Vol 21 (1_suppl) ◽  
pp. 469-474 ◽  
Author(s):  
M. E. Akbari ◽  
M. Asadi Lari ◽  
A. Montazeri ◽  
M. R. Aflatunian ◽  
A. A. Farshad
Keyword(s):  
Health Services ◽  
Health System ◽  
Health Sector ◽  
Family Health ◽  
Disease Notification ◽  
Bam Earthquake ◽  
Notification System ◽  
Medical Assistants ◽  
Health System Responsiveness ◽  
Iranian Health System

The Bam earthquake on 26 December 2003 was one of the worst natural disasters in Iran in the last century. The Iranian health system responded immediately to the devastating earthquake in various ways including diagnosis and treatment management, providing environmental health services, setting up health facilities and field hospitals with international aid, providing health professionals and medical assistants, and establishing mental and family health services. Ten months after the disaster, temporary housing for survivors was almost completed; mental health, reproductive health, environmental and oral health services were established; offering services of quality comparable or better than what was provided prior to the earthquake. A disease notification system was established within the Primary Health Care network (PHC) to prevent contagious and non-communicable diseases. This paper evaluates the responsiveness of the health sector to the disaster and reviews the strategies employed by national disasters and health managers following the earthquake.

scholarly journals Building collective power in citizen-led initiatives for health accountability in Guatemala: The role of networks

2020 ◽  
Author(s):  
Alison Hernandez ◽  
Anna-Karin Hurtig ◽  
Isabel Goicolea ◽  
Miguel San Sebastian ◽  
Fernando Jerez ◽  
...  
Keyword(s):  
Collective Action ◽  
Health System ◽  
System Failures ◽  
Marginalized Communities ◽  
The People ◽  
Network Building ◽  
History Of ◽  
Relational Qualities ◽  
Base Of Support ◽  
Network Mapping

Abstract Background Citizen-led accountability initiatives are a critical strategy for redressing the causes of health inequalities and promoting better health system governance. A growing body of evidence points to the need for putting power relations at the forefront of understanding and operationalizing citizen-led accountability, rather than technical tools and best practices. In this study, we apply a network lens to the question of how initiatives build collective power to redress health system failures affecting marginalized communities in three municipalities in Guatemala. Methods Network mapping and interpretive discussions were used to examine relational qualities of citizen-led initiatives’ networks and explore the resources they offer for mobilizing action and influencing health accountability. Participants in the municipal-level initiatives responded to a social network analysis questionnaire focused on their ties of communication and collaboration with other initiative participants and their interactions with authorities regarding health system problems. Discussions with participants about the maps generated enriched our view of what the ties represented and their history of collective action and also provided space for planning action to strengthen their networks. Results Our findings indicate that network qualities like cohesiveness and centralization reflected the initiative participants’ agency in adapting to their sociopolitical context, and participants’ social positions were a key resource in providing connection to a broad base of support for mobilizing collective action to document health service deficiencies and advocate for solutions. Their legitimacy as “representatives of the people” enabled them to engage with authorities from a bolstered position of power, and their iterative interactions with authorities further contributed to develop their advocacy capabilities and resulted in accountability gains. Conclusions Our study provided evidence to counter the tendency to underestimate the assets and capabilities that marginalized citizens have for building power, and affirmed the idea that best-fit, with-the-grain approaches are well-suited for highly unequal settings characterized by weak governance. Efforts to support and understand change processes in citizen-led initiatives should include focus on adaptive network building to enable contextually-embedded approaches that leverage the collective power of the users of health services and grassroots leaders on the frontlines of accountability.

scholarly journals Donors' Participation in Iran's Health System: Challenges and Solutions

2021 ◽  
Author(s):  
Ali Mohammad Mosadeghrad ◽  
Maryam Tajvar ◽  
Fatemeh Ehteshami
Keyword(s):  
Health System ◽  
Health Sector ◽  
Healthcare Services ◽  
Structured Interviews ◽  
Ethical Considerations ◽  
Senior Managers ◽  
Department Of Health ◽  
The Social ◽  
The Right ◽  
Iranian Health System

Background: Philanthropic activities play an important role in health systems. Donors contribute to financing, generating resources, and providing healthcare services in Iranian health system. However, they face many challenges. This study aimed to identify barriers to donors' participation in the Iranian health system and to provide solutions. Methods: This qualitative study was performed using semi-structured interviews with 38 donors and 26 policymakers and managers in the social affairs department of health ministry and medical universities in 2018. In addition, document analysis was performed and the relevant data were extracted. Thematic analysis was used for data analysis. All ethical considerations were followed in this research. Results: Insufficient structures, poor communications, low trust, ineffective working processes, bureaucracy, insufficient senior managers’ support, weak legal support and poor monitoring were the most important challenges for donors’ participation in the Iranian health system. Effective donor participation in the health system requires the creation of an appropriate system including the right structures, processes, culture, and management. The necessary changes must be planned, led and monitored to promote donors’ participation in healthcare. A conceptual model was developed to strengthen donors’ participation in the health system. Conclusion: Iranian donors face structural, procedural, cultural, and managerial challenges when financing the health system, generating resources, and providing health services. Policymakers and managers should tackle these challenges and adopt strategies to reinforce donors' participation in the health system. Planning, organizing, leading, monitoring, evaluation, transparency, accountability, and a commitment to meet donors’ needs are necessary for successful philanthropy initiatives in the health sector.

Sign in / Sign up

Export Citation Format

Share Document