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

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Extended Abstract
Background
The pandemic of COVID-19 has caused unprecedented challenges in the management of health care in several countries throughout the world. 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 the provision of 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 conduct 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 examined 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 in the third stage of COVID-19, we emphasized the provision of EHS, such as “in-person and remote services,” for the covered population.The data were obtained from the electronic databases of the primary healthcare facilities. Data were analyzed and reported using descriptive statistical methods, including comparative tables and graphs. Microsoft Excel version 2016 was used to prepare the report. Only three electronic file systems were active in Iran during the implementation of 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 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 elderlies, 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 healthcare staff and EHS provided in all age groups increased. However, the number of services provided for children (0-5 years old) and adolescents (5-18 years old), declined by 4.4 and 13.4 %, 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. Also, 3.1% of those who visited the selected centers received outpatient drug treatment. Almost 4% of people who visited the selected centers were referred to selected hospitals, and 26.7% were admitted.Around 1.5% of people screened by a healthcare provider had at least one suspected symptom. Of the total screened population, 0.18% of those screened by a healthcare 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% (2,897 people) were hospitalized.
Conclusion
Based on the planning in the third step, besides providing COVID-19 services, other health services were 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 the number of people receiving EHS in all three groups increased three months after implementing the third step. 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, delivery of 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. Immediate response to problems necessitates enhancing 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 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.
Acknowledgment
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.