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Health Care System Management
Original Article
Mass Testing and Verbal Screening to Control COVID-19 Pandemic: The Second Phase of National Mobilization Plan against COVID-19
Elaheh Kazemi
1 
, Alireza Raeisi
2 , Nima Akhtardanesh
1, Parisa Rezanejad Asl
1 , Zahra Shirzadi
1, Saeedeh Aghamohamadi
1 , Babak Farrokhi
1 , Siamak Mirab Samiee
3 , Saeid Ghalehei
1, Jafar Sadegh Tabrizi
4* 1 Network Management Centre, Deputy for Public Health, Iranian Ministry of Health and Medical Education, Tehran, Iran
2 Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
3 Reference Health Laboratory, Iranian Ministry of Health and Medical Education, Tehran, Iran
4 Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract
Background. 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 healthcare system can better manage and control this pandemic. The Ministry of Health and Medical Education, and the Deputy Minister of Public Health executive branch, played an influential role in controlling the epidemic with community-based and network-based interventions in the National Mobilization Plan against COVID-19.
Methods. This cross-sectional descriptive study aimed to assess the second step of the National Mobilization Plan (NMP) against COVID-19. The data were extracted from the portal of the 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 from April 11 to August 10, 2020, and was analyzed using Statistical Package for the Social Sciences (SPSS) software.
Results. During the second phase, healthcare providers screened more than 42 million people. About 98.4% of this population were diagnosed with no symptoms, and 0.4% were referred to the selected COVID-19 comprehensive health centers for examination and medical procedures. 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, 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 tests were positive. By the end of the second step of the NMP against COVID-19, this rate had increased to 25%.
Conclusion. In times of crisis and epidemic conditions, the health network system, and the primary healthcare 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.
Extended Abstract
Background
COVID-19 was discovered in December 2019 in Wuhan Province, China. Iran officially announced the outbreak on February 20. It quickly spread throughout the country, with all provinces becoming involved in this epidemic in the first half of March. The Iranian Ministry of Health and Medical Education (MOHME) and the Deputy for Public Health were responsible for managing and controlling the epidemic and established the National Corona Headquarters. In the Islamic Republic of Iran, five stages of the National Mobilization Plan (NMP) against COVID-19 have been conducted until September 2021. This study aimed to introduce the second step of the NMP against COVID-19 as an effective experience in screening, controlling, and managing the epidemic through public health.
Methods
The present study is a cross-sectional descriptive study. The information related to the second step of the NMP against COVID-19 was collected from the four digital systems of the public health system (Sib, Sina, Nab, and Parsa). The second phase of the NMP against COVID-19 lasted for four months (April 11, 2020, to August 10, 2020), during which time data was collected from 63 medical science and health service universities across the country. Data regarding COVID-19 diagnostic tests in the first two months of the second phase of the NMP against COVID-19 were collected from the portal of the Network Management Center, the Centers for Disease Control and Prevention (CDC), and the CLIS system (COVID-19 Laboratory Information System) of the Ministry of Health and Medical Education (MOHME). We refined the collected data and presented the final reports using descriptive statistics (frequency, percentage, average). Also, Statistical Package for the Social Sciences (SPSS) version 16 (IBM SPSS Statistics version 16) was used to analyze the data.
Results
In the second NMP, approximately 42 million Iranians were screened by healthcare providers in rural and urban areas. About 98.4% of this population were diagnosed with no symptoms, and 0.4% were referred to the selected COVID-19 comprehensive health centers for examination and medical procedures. 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, 3.6% needed to be referred to a hospital, and 3.3% received outpatient care (chloroquine administration). At the beginning of the second step of the NMP against COVID-19, the ratio of positive PCR tests to all samples was 11% on April 23. Following that, the ratios were 13% on May 23, 39% on June 23, 23% on July 23, and 25% at the completion of the second stage on August 23.
Conclusion
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. Primary health care improves the performance of health systems in cases of crisis and epidemic by lowering overall health care expenditure. We should strengthen primary health care to achieve full health coverage and reforms. Therefore, primary healthcare is essential, and like hospitals, it should be seriously considered by health system policymakers.
Practical Implications of Research
In general, according to the present study results, primary healthcare and the use of the network system in healthcare significantly affect disease prevention, control, and management during the epidemic and have reduced the burden of hospitalization. Therefore, it is suggested that the primary healthcare network system be supported and prioritized by health system policymakers.
Ethical Considerations
This study used secondary data and aggregate reports, and no intervention was made.
Conflict of Interest
The authors declare that this study results from an independent study and has no conflict of interest with other organizations and individuals.
Acknowledgment
Researchers need to express their gratitude to all the people who participated in implementing this project and developing related documents. We also appreciate the efforts of the managers and experts of the Deputy Minister for Public Health - MOHME and the Deputies for Public Health of the universities in managing and controlling the disease during the pandemic. The present study summarizes the measures taken by the Deputy Minister for Health for the COVID-19 epidemic, which results from the effective measures taken by healthcare providers.