Abstract
Background. In late 2019, the outbreak of COVID-19 disease, with symptoms like the common cold or severe respiratory illness, caused a global public health crisis. In order to control and manage this disease, countries and the World Health Organization (WHO) have adopted various strategies and decisions.This study aimed to describe the initial measures of the Ministry of Health and Medical Education of the Islamic Republic of Iran with a focus on the Deputy Minister of Health in the framework of the national mobilization plan to combat COVID-19.
Methods. 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.
Results. The first step in the national mobilization against COVID-19 was to establish 1200 comprehensive health centers for COVID-19, provide self-assessment portal at salamat.gov.ir, and dedicate telephone lines (406,190, and1666) for COVID-19 distance counseling and tips. About 98% of the people registered in the electronic health record systems (78,315,029 people) were orally screened and evaluated, including 6,220,603 elderly, 262,717 people with diabetes, 3,356,131 individuals with high blood pressure, 29,201 obese people, 517,696 pregnant women and 2,722,659 foreign nationals. Another significant aspect 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).
Conclusion. The COVID-19 epidemic caused a global health crisis, the management of which became the top of the world's health activities. The health sysntem in Iran, using the capacity of the health network system structure and service providers, developed appropriate policies for the management and control of the disease. One of these policies is the verbal screening to combat COVID-19, which has led to the optimal management of this epidemic
Extended Abstract
Background
In December 2019 for the first time, a report of an epidemic of a coronavirus respiratory infection in Wuhan, China was sent to the World Health Organization (WHO). In January 30, 2020, Director General of the World Health Organization announced the emergence of a new viral disease known as COVID-19. The disease has symptoms similar to common cold and pneumonia, and 80% of patients are asymptomatic but can transmit the disease. In Iran, the Ministry of Health and Medical Education (MOHME), in cooperation with other related organizations, devised various measures and plans, including the preparation of various procedures (in the fields of hospitals and service centers, dentistry, schools, universities, environmental health, restaurants, public transportation, public centers, guilds), the formation of a crisis team, and the establishment of National Corona headquarters to manage and control this epidemic.Due to the high prevalence of COVID-19 and its impact on various aspects of society and people's lives, governments and agencies need appropriate management decisions and executive programs to control the disease, this leads to improved health, social, and economic conditions, and mental status of society.
Methods
A mixed-method (quantitative and qualitative) document review and cross-sectional descriptive study was conducted to evaluate interventions and measures and the results of the first step of the national mobilization against COVID-19. Data were collected from the databases of 63 universities / medical schools across the country registered in the first level electronic health record systems (Sib, Sina, Nab and Parsa) and in the portal of the PHC Network Management Center of the Ministry of Health and Medical Education for the period of March 2020 and April 2020.The collected data were analyzed using EXCEL software. Documents related to the initial measures in the management and control of the COVID-19 epidemic were extracted from the databases of various departments of the MOHME and the Automation System and were analyzed.
Results
Following the outbreak of COVID-19, the deputy for public health of the MOHME published WHO guidelines for the prevention and treatment of COVID-19. In addition, in-person training of health workers, midwives, nurses, physicians, and other health professionals was provided to improve their knowledge and skills in preparing for the epidemic. Also, COVID-19 diagnosis and treatment training courses were developed based on the latest international evidence and uploaded in the electronic health system. After identifying the first case of COVID-19 in Iran, the MOHME implemented the "National Mobilization against COVID-19" project, which includes five key steps. One of the main measures in the first days of the outbreak was organizing the plans of the MOHME by the Deputy Minister of Health, including setting up policy committees at national and university levels and executive committees at national, university, and district levels and operational teams in the comprehensive health centers with specific task descriptions.
A. Key terms in the service delivery method:
Establishment of 1,200 selected COVID-19 comprehensive health centers (16 and 24 hours) that provide services including screening, medical visits, diagnostic tests, and outpatient treatment in accordance with COVID-19 national service guidelines seven days a week. Over 10,000 new phone lines (190, 1666, and 4030) dedicated to answering questions about COVID-19 prevention and treatment and providing general and specialized counseling in the field of nutrition and mental health.Launching salamat.gov.ir system for screening, self-assessment, and self-care of people at home. Establishing telephone communication between health workers with suspicious people and referring them to the nearest selected COVID-19 comprehensive health center according to the instructions. This system is connected to the electronic health file.
B. Formation of national mobilization teams against COVID-19
In order to optimally manage the COVID-19 pandemic, the national mobilization executive teams were quickly organized:
1) Care teams (two to three people: Community Health workers and Basij forces).
2) Environmental health intervention teams (three to five people: environmental / occupational health experts, Basij forces and other volunteers).
3) Basij teams of departments and companies (two to four people: Basij forces, volunteers).
4) Cities entrance control teams (four people: Red Crescent, police, Basij forces, and pre-hospital emergency).
C. National mobilization to inform and raise public awareness about COVID-19
The MOHME, with the aim of promoting health literacy regarding COVID-19, organized the “COVID-19 National Information Mobilization".During the first one and a half month of the COVID-19 outbreak, various educational products were produced and offered for the general education, including 61 motion graphic items, 17 motion posters, 104 short films and several educational pamphlets. From the beginning of the program on March 28, 2020 until the end of the first step of the national mobilization against COVID-19, 78,315,029 people (98% of people registered in electronic health record systems) were evaluated and orally screened by health workers and health care providers across the country. About 1.4% (approximately 833,121 people) of the screened population in the first step were symptomatic, of which about 0.2% (143,769 people) were referred to the selected COVID-19 comprehensive health centers and 98% had no problems and the rest (1.2%) needed isolation at home.
Conclusion
Some essential aspects of the plan include optimal use of the healthcare system and available resources including manpower, administrative and technical facilities in other sectors outside the MOHME, applying the fastest executive procedures in preventing the spread of disease and reducing complications and disease-related death. Also, implementing the program in compliance with safety principles will safegaurd service providers and people from unwanted complications caused by interventions. In addition, providing the necessary arrangements and timely resources to implement and carry out operations based on scientific principles considering the executive capabilities and resources available in PHC are important principles of running this program. One of the most important results of this plan is to reduce the burden of hospitalization and optimal management of outpatients in the health network system throughout the country.
Practical Implications of Research
In general, according to the results of this study, it can be said that timely intervention and rapid response to the COVID-19 epidemic in the framework of the National COVID-19 mobilization plan as soon as the first patient is observed in the country increases public awareness and compliance with protocols, preventing the high prevalence of this disease. One of the important consequences of implementing the first step of this plan is to reduce unnecessary visits to hospitals, prevent the congestion in and disruption in public service.
Ethical Considerations
In this study, secondary data and aggregate reports were used and no intervention was made.
Conflict of Interest
The authors hereby declare that this study is the result of 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 somehow participated in implementing of this project and developing related documents. We also thank all the managers and experts of the Deputy for Public Health of the MOHME and the Deputies for Public Health of the universities who did not spare any effort to manage and control the COVID-19 epidemic.