A SWOT analysis of the development of health technology assessment in Iran

Abstract

Background Health systems need to prioritize their services, ensuring efficiency and equitable health provision allocation and access. Alongside, health technology assessment (HTA) seeks to systematically evaluate various aspects of health technologies to be used by policy- and decision-makers. In the present study, we aim to identify strengths, weaknesses, opportunities, and threats in developing an HTA in Iran. Method This qualitative study was conducted using 45 semi-structured interviews from September 2020 to March 2021. Participants were selected from key individuals involved in health and other health-related sectors. Based on the objectives of the study, we used purposive sampling (snowball sampling) to select individuals. The range of length of the interviews was between 45 to 75 minutes. Four authors of the present study carefully reviewed the transcripts of interviews. Meanwhile, the data were coded on the four domains of strengths, weaknesses, opportunities, and threats (SWOT). Transcribed interviews were then entered into the software and analyzed. Data management was performed using MAXQDA software, and also analyzed using directed content analysis. Results Participants identified eleven strengths for HTA in Iran, namely the establishment of an administrative unit for HTA within the Ministry of Health and Medical Education (MOHME); university-level courses and degrees for HTA; adapted approach of HTA models to the Iranian context; HTA is mentioned as a priority on the agenda in upstream documents and government strategic plans. On the other hand, sixteen weaknesses in developing HTA in Iran were identified: unavailability of a well-defined organizational position for using HTA graduates; HTA advantages and its basic concept are unfamiliar to many managers and decision-makers; weak inter-sectoral collaboration in HTA-related research and key stakeholders; and, failure to use HTA in primary health care. Also, participants identified opportunities for HTA development in Iran: support from the political side for reducing national health expenditures; commitment and planning to achieve universal health coverage (on behalf of the government and parliament); improved communication among all stakeholders engaged in the health system; decentralization and regionalization of decisions; and capacity building to use HTA in organizations outside the MOHME. High inflation and bad economic situation; poor transparency in decisions; lack of support from insurance companies; lack of sufficient data to conduct HTA research; rapid change of managers in the health system; and economic sanctions against Iran are threats to the developmental path of HTA in Iran. Conclusion HTA can be properly developed in Iran if we use its strengths and opportunities, and address its weaknesses and threats.

Situation analysis model of hospital emergency department promotion in Iran: A cross‐sectional study

“…Proper interaction and communication with the pre‐hospital emergency (EMS) (Emergency Medical System) 28,38 …”

“…Increase in the elderly population referring to the ED 30 Increasing patient expectations from emergency services 37 Increasing referrals of patients with sober conditions during the pandemic 34,37 Increasing referrals of patients with different health cultures in conditions of infection transmission 34 Technological factors Opportunities Providing remote emergency services and consultations following technological upgrades 22,28 The existence of reporting systems of emergency indicators at the hospital and national level 27 Threats Non-use of data exchange and registration standards in electronic systems 22 Environmental factors Opportunities Due to the importance of time, considering the appropriate geographical location and easy access to the ED 1 Considering the appropriate physical space and the possibility of expanding new capacities as needed 1 Effective and appropriate communication with the emergency center 38 Proper interaction and communication with the pre-hospital emergency (EMS) (Emergency Medical System) 28,38 Effective communication between medical centers for accepting emergency patients through the medical care monitoring system (MCMC) (Medical Care Monitoring Center) and the Ministry of Health's Treatment Guidance Headquarters 38 Threats Limitation of emergency beds 31 Limitation of physical space during a crisis 1 Lack of specialist staff 3 Limitation of insurance coverage 8 Lack of emergency equipment and medical supplies 3 Failure to pay insurance financial debts and delay in insurance payments to government hospitals 8,22 Failure to increase the defined budget for emergency services and failure to accept certain obligations from insurance 8,33 Failure to collect insurance funds 8,16 Stagnation of the ED following the dissatisfaction of some shareholders and beneficiaries 33 Increasing debt to pharmaceutical companies 8,16 Legal factors…”

“…The Minister of Health, the head of the vice department of treatment, the presidents of the universities of medical sciences, the head of the management of medical accidents and emergencies in the country, and the expert center in charge of emergencies 38 Ministry of Health (MOH) and related departments such as (Deputy of Medicine, Center for Management of Medical Accidents and Emergencies of the country, Deputy of Medicine of Medical Sciences Universities, Hospital ED, Department of Expert in charge of Hospital Emergency) 38 The head of the parliament and members of the parliament 8 The legislative body of the Iranian parliament in providing support laws in determining particular budgets for the ED of hospitals 8 Head of the Center for Hospital Management and Clinical Service Excellence 38 Hospital Management and Clinical Service Excellence Center (Hospital Management Office under the supervision of the Deputy Director of Treatment in the Ministry of Health) 38 1. The members of the emergency clinical team include (an emergency medicine specialist, resident specialist doctors in the hospital, a general practitioner, emergency nurse) 14,38 2.…”

“…The members of the emergency clinical team include (an emergency medicine specialist, resident specialist doctors in the hospital, a general practitioner, emergency nurse) 14,38 2. The members of the emergency clinical team include (an emergency medicine specialist, resident specialist doctors in the hospital, a general practitioner, emergency nurse) 14,38 ED Department heads of the Ministry of Health and heads of involved organizations or other managers of ministries 7,38 Strategic committee 7,8 Emergency doctor and nurse, executive director, head of the emergency nurse, head of ED 38 Hospital emergency service improvement committee 32,39 Members of the project management team led by the Ministry of Health 7 Core team 7,31 F I G U R E 1 Presenting the final situation analysis model of the emergency department.…”

Exploring the landscape of health technology assessment in Iran: perspectives from stakeholders on needs, demand and supply

“…In recent years, the healthcare system of Iran has endeavoured to establish mechanisms for incorporating HTA into evidence-based decision-making. Various initiatives have been undertaken towards this end [ 18 , 19 ]. The objective of this study is to assess the current state of Iran’s healthcare system in terms of the requisite demand, need and supply of HTA services.…”