Hepatitis C virus-related policy-making in Iran: a stakeholder and social network analysis

Abstract

Background Hepatitis C virus (HCV) infection is a major public health challenge worldwide. Implementing policies to cope with this challenge requires commitment from all stakeholders at various levels, and all necessary resources should be mobilised. Support for various HCV-related stakeholders can reduce the challenges and obstacles that can be encountered during the programme implementation. The present study aims to identify all stakeholders involved with HCV-related policy-making in Iran at different steps (policy development, implementation and evaluation) and to characterise them in terms of interest, position, power and influence, in order to provide valuable information for appropriate decision-making and design. The present study can also serve as a case study for healthcare systems in other countries. Method An approach based on social network analysis was utilised. Data collected included relevant document searches and in-depth interviews to a sample of 18 key informants. Results Various stakeholders were found to be involved with HCV-related policies in Iran. The extent of their participation and support in policy-making varied. Specifically, international agencies had a high interest for HCV-related policy-making, whereas media and members of the private sector were characterised by a medium interest and governmental and non-governmental bodies by a highly variable interest, ranging from low to high, depending on the specific organism. Moreover, media and members of the private sector, non-governmental institutions and international agencies were rated low in terms of position, whereas governmental actors were rated low to high. Media were rated medium in terms of power, whereas international agencies and members of the private sector were respectively rated low to medium and low. Non-governmental actors were rated low, whilst governmental bodies were rated low to high. Finally, media, members of the private sector and international agencies were rated medium in terms of influence, whereas non-governmental and governmental actors were respectively rated low to medium and low to high. Conclusion Policy-making involves trust, negotiation and integration of the different views of all stakeholders. Social network analysis was critical for identifying stakeholders and showing that, in Iran, involvement in HCV-related policy-making is generally low. This information is of practical implication for policy- and decision-makers regarding the adoption of more favourable and effective strategies.

A systematic review and meta-analysis of the prevalence of hepatitis C virus infection in people who inject drugs in Iran

“…According to a recently published systematic review and meta-analysis, the prevalence of HCV in Iran is about 0.6% [14]. Despite the fact that this rate is lower compared to many neighboring countries in the area, the rate among high-risk groups such as PWID has considerably increased and this is a serious warning for Iranian health policy-and decision-makers [15]. Neighborhood with countries like Afghanistan is one of the major causes of this increase, and the Iranian government has been trying to mobilize all its resources to cope with this challenge [13].…”

Financing of physical rehabilitation services in Iran: a stakeholder and social network analysis

“…According to the theoretical framework adopted in previous studies [25], four items (namely position, power, interest, and influence) were chosen to analysis the identified stakeholders. Subsequently, an online web-based questionnaire was designed in which stakeholders were ranked with respect to position, power, interest, and influence in PRF-related policies and plans.…”

“…Indeed, this network analysis can be a distinctive approach to recognize the structure of decision-and policy-making processes and also interaction between potential actors [29]. Therefore, using SNA can facilitate the identification of the relevant parts that need to be negotiated and addressed, with the aim of improving the health related policy-making processes and obtaining appropriate interactions among the involved stakeholders [25,30]. SNA uses several metrics to describe the network, which can be categorized into two groups including overall structure (e.g.…”

“…Effective decision-and policy-making requires identifying potential stakeholders and actors and their characteristics [23]. Stakeholders are actors (organizations or individuals) that may affect a policy [24], and stakeholder analysis is a process of identifying and understanding the characteristics of such actors by evaluating their position, power, interest, and influence on policy-making [25]. Based on the current literature, there are a variety of stakeholders in the health care physical rehabilitation sectors in Iran, who can affect physical rehabilitation financing (PRF)-related policies [15,21].…”

The challenges of hepatitis C management in Iran: A qualitative study with patients

“…We decided to focus on Iranian HCV patients, in that, despite the relatively low prevalence of HCV among the general Iranian population with respect to the neighboring countries, the burden generated by HCV is on the rise. hepatitis C virus is, indeed, expected to become the major cause of viral hepatitis‐related mortality .…”