This study highlighted specific strengths in the technical and functional aspects of DHIS2 and also drew attention to particular challenges and concerns. These results provide a sound evidence base for decision makers and policymakers to enable them to make more accurate decisions about whether or not to use the DHIS2 in the health system of their country.

Background: Outsourcing is considered as one of the tools for organizational development and promotion of productivity by managers. In recent years, outsourcing of healthcare services has become significant. The aim of this study was to identify the most important factors influencing the decision making of outsourcing healthcare services. Methods: This study is a combined study. First, the literature was examined to identify the factors influencing decision making for outsourcing. Then, with the aim of consensus on the most important factors affecting the decision making of outsourcing in health services, the panel of experts and Delphi technique were used. Sampling was purposeful. Results: In the selected articles, a total of 180 factors were extracted. The members of the panel of experts from these 180 factors selected 29 sub-factors in the form of six main factors: strategy, quality, management, technology, performance feature, and economy, as the most important factors affecting the outsourcing of services. Finally, the results of Delphi showed that 22 sub-factors were more important in outsourcing decision making at healthcare services. Conclusion: The study showed that the decision making to outsource health services is a complex and multi-criteria decision. Therefore, when deciding to outsource healthcare services, attention should be paid to various factors, such as strategy, quality, management, technology, and economics.

BackgroundSufficient and sustainable financing of the health system is essential for improving the health of the community. The health systems financing of the EMR countries is facing the challenge. Assessment and ranking of healthcare financing can help identify and resolve some challenges of health systems. So, the aim of this study is to evaluate and rank the condition of the health sector financing in the EMR countries.MethodsThis study was a cross-sectional study. The data was of secondary type, extracted from the official WHO and World Bank data. The six healthcare financing indicators in a 10-year interval (2005–2014) in 19 EMR countries analyzed using Grey Relation Analysis and Shannon Entropy.ResultsOn average, the countries in the EMR region spent 4.87% of their GDP on the health sector. Jordan and Qatar allocated the highest (8.313) and the lowest (2.293) percentages of their GDP to the health sector, respectively. The results showed That Qatar was in a better condition than other EMR countries during 2005–2014 in terms of the health system financing and earned the first rank. After that, the UAE and Kuwait were ranked second and third.ConclusionsThere is a lot of inequality among the EMR countries in terms of health financing. However, our findings confirmed that only increasing the total health expenditure in a country would not improve its financing status compared to other countries, but it also depends on financing methods.Electronic supplementary materialThe online version of this article (10.1186/s12962-018-0151-6) contains supplementary material, which is available to authorized users.

Background: The hospital is a significant part of health systems that presents a complex and vital services. Therefore, performance management of hospitals should be considered especially. BSC model is so helpful and popular for performance management. In using BSC, cause and effect relations is very important, since it helps to apply non-financial to forecast financial performance. Objectives: This study aims to analysis systematic relations between key indicators of hospital performance evaluation, identifying causal relations and prioritizing indicators. Methods: Based on the 4 perspectives described by the balanced scorecard (BSC), the evaluation indicators of hospital performance and key performance indicators (KPIs) were adopted from the related literature and selected by experts' panel, respectively. Then, the decision making trial and evaluation laboratory (DEMATEL) method was employed for the determination of the cause-and-effect relationships between the indicators, differentiation of the effective and significant factors, and construction of the strategy map to ameliorate hospital performance. Results: According to the BSC perspectives, 21 KPIs were selected for evaluation of hospital performance. The highest relationship was found between bed occupancy having the largest R + D value and other indicators, thus illustrating its fundamental role among the indicators. Clinical errors with the greatest value of R-D showed the strongest impacts on the other indicators and was thus named as the "main cause factor" among the indicators. In contrast, the percentage of patient satisfaction with the smallest R-D value was most strongly influenced by the other indicators and therefore, it was known as the "main effect factor" among the indicators. Conclusions: Assessment and improvement of the hospital performance is a complex and multi-dimensional activity. In order to have a powerful assessment system and success in improving hospital performance, instead of a single-dimension, it should be paying attention to all dimensions of performance.

Background: Social issues have short- or long-term as well as positive or negative effects on health systems. Identifying and analyzing events and trends help managers to make the vision and strategic planning. The purpose of this study is to identify the social trends and their impacts on the future of the Iranian health system. Methods: Focus group discussion (FGD) was used to collect the data in 2017--18. The participants were selected through purposive sampling and the snowball method. The discussions were all written and recorded with the consent of the participants. A qualitative content analysis was used to analyze the data. Results: The participants believed that the most important social trends affecting future of health system in Iran are increase health literacy, demographic transition, nutritional pattern, migration and urbanization, marginal settlement, rising unemployment, and increased usage of personal cars. Conclusions: The increase in health problems, healthcare costs, and mortality because of social behaviors and trends are considered as threats to the health system. Therefore, policymakers should reduce their negative effects by taking into account and focusing on these trends and making appropriate plans.