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Depiction of Health. 2022;13(Suppl 1): 75-87.
doi: 10.34172/doh.2022.18
  Abstract View: 27
  PDF Download: 9

Health Care System Management

Original Article

Provision of Disrupted Essential Health Services during COVID-19 Pandemic in the Islamic Republic of Iran; the Third Phase of National Mobilization against COVID-19

Jafar Sadegh Tabrizi 1 ORCID logo, Ardeshir Khosravi 2 ORCID logo, Alireza Raeisi 3 ORCID logo, Amin Ataey 2 ORCID logo, Azizolah Atefi 4 ORCID logo, Babak Farrokhi 2 ORCID logo, Hossein Kazemeini 2 ORCID logo, Elahe Kousha 2 ORCID logo, Azadeh Dormiani, Elham Rashidian 2* ORCID logo

1 Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
2 Center for Primary Health Care Network Management, Deputy for Public Health, Iranian Ministry of Health and Medical Education, Tehran, Iran
3 School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
4 Deputy for Public Health, Iranian Ministry of Health and Medical Education
*Corresponding Author: Email: elirashidian@yahoo.com

Abstract

Background. COVID-19 is a global pandemic and has plagued many countries with unprecedented management problems. The rapid spread of COVID-19 around the world has reduced the ability of countries to address and respond to essential health services. Most countries have taken steps to prevent the spread of COVID-19 and improve essential services. The National Mobilization Plan against COVID-19 in Iran’s healthcare system was implemented in 5 stages until the September of 2021. This study aimed to assess and review medical universities' performance in the third step of management and control of COVID-19 to provide documents and reports to be used in similar experiences.

Methods. This research is a cross-sectional descriptive study. Data were obtained from electronic records at the primary health care facilities. Data were analyzed and reported using descriptive statistical methods, including comparative tables and graphs. In order to prepare the report, Excel 2016 software was used. The third step of the National Mobilization Plan against COVID-19 was implemented from August 10, 2020, to November 10, 2020. In this step, while re-emphasizing the importance and necessity of verbal and laboratory screening of COVID-19, essential health services provision was highlighted as "in person and remote services" for the covered population.

Results. In the third step of national mobilization, 59,109,413 people were screened for COVID-19. During the third step, non-COVID essential services increased compared to the previous three months, with the most significant increase in middle-aged care.

Conclusion. After implementing the third step of National Mobilization Plan against COVID-19 in Iran, the number of delivered services in all target groups has increased. This indicates the effectiveness of the third step in the fight against COVID-19 and has increased the provision of Essential Health Services.

Keywords: COVID_19, Comprehensive Health Service Center, Essential Health Services

Extended Abstract

Background

COVID-19 is a global pandemic and has plagued many countries with unprecedented management problems. Management of the prevention and treatment of COVID-19 is directly related to people’s quality of life. The rapid spread of COVID-19 around the world has reduced the ability of countries to address and respond to Essential Health Services (EHS). Most countries have taken steps to prevent the spread of COVID-19 and improve essential services. The National Mobilization Plan (NMP) against COVID-19 in Iran’s healthcare system was implemented in 5 stages until the spring of 2021. This study aimed to carry out an assessment and review of the performance of medical universities across the country in the third step of NMP against COVID-19 to provide documentation and report to be used in similar experiences.

Methods

This cross-sectional descriptive study examines the third step in the NMP against COVID-19 at the national and subnational levels from August 10, 2020, to November 10, 2020. In this step, while re-emphasizing the importance and necessity of screening the third stage of COVID-19, we emphasized the provision of EHS specified as “in person services and remore services” for the covered population.The data were obtained from the electronic records at the primary health care facilities. Data were analyzed and reported using descriptive statistical methods, including comparative tables and graphs. Excel 2016 software was used to prepare the report. Only three electronic file systems were active in Iran when implementing the third step. Sina system for Mashhad University of Medical Sciences, Nab system for Golestan University of Medical Sciences, and Sib system for other universities / medical schools across the country.This article reviewed in-person services, remote services, screening of the covered population by a health care provider or health worker, doctor visits, and care in selected comprehensive health centers of COVID-19 (16 or 24 hours).In-person services include child and infant care, diabetics, hypertensive patients, pregnant women, and vaccinations. Remote essential services that are provided by phone include adolescent, youth, and middle-aged care, pre-pregnancy, childbirth, mental health and nutrition counseling.

Results

In the third step, 59,109,413 people were screened for COVID-19 disease, including 5,081,924 elderly people, 5,485,091 people with diabetes, 2,913,053 people with high blood pressure, 32,114 people with body mass index greater than 40, 541,315 pregnant women, 2,291,764 foreign nationals and 46,739,695 other people. In this step, compared to the previous three months, the number of people hired and the number of EHS provided in all age groups increased. The only exception was the numbers of children (0-5 years old) and adolescent services (5-18 years old), which were decreased by 4.4 and 13.4 percent, respectively.The highest increase was related to middle-aged services (30 to 60 years) in both the number of services (57.4%) and the number of people (38.9%), followed by the number of young people (50.4%). Comparison of the number of people employed and the number of EHS in the third step and comparison with the previous year on the same date showed that except for the middle-aged and elderly group in other groups, the number of people and the number of services in adolescent services (32.1%) and then child services (28.2%) have decreased compared to last year. About 47.8% of the people who visited the selected COVID-19 centers had no problems. 45.2% of the people who visited the selected COVID-19 centers needed to be tested. 3.1% of people visited in the selected centers received outpatient drug treatment. Almost 4% of people visited in the selected centers were referred to selected hospitals, and 26.7% of those were admitted.Around 1.5% of people screened by a health care provider had at least one suspected symptom. Of the total screened population, 0.18% of those screened by a health care provider were referred to a physician.About 541,315 pregnant women were screened by a non-physician (health worker), 3.5% (19048) were found pregnant, of whom 2.7% (15108) were referred to a physician, and 0.5% (2897 people) were hospitalized.

Conclusion

Based on the planning done in the third step, besides providing COVID-19 services, other health services were also provided in person or remotely ( by telephone or online consultation) on a priority basis. Remote services included adolescents' care and care for young and middle-aged groups. Our study showed that three months after implementing the third step, the number of people receiving EHS in all three groups increased. In the face-to-face service, if people did not show up, they were called by phone to make an appointment and receive the service, including care of mother and child. Three months after implementing the third step, delivering health services increased for pregnant women and children.

Practical Implications of Research

Given the vastness of the health care network system throughout the country, primary health care can be available for everyone. To quickly respond to problems, it is necessary to strengthen primary health services by allocating human resources and physical equipment.

Ethical Considerations

Since this article is prepared based on aggregated data in different systems, there was no need to obtain informed consent or approval from the ethics committee.In this study, the data extracted from the systems of the Ministry of Health have been used only for the purposes of the study.

Conflict of Interest

The authors hereby declare that this work results from an independent study and has no conflict of interest with other organizations and individuals.

Aknowledgment

We would like to thank the deputy for public health and all the staff of medical sciences universities across the country, who played a crucial role in compiling the data for this report.


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Submitted: 12 Sep 2021
Revision: 31 Oct 2021
Accepted: 31 Oct 2021
ePublished: 09 Apr 2022
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