Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran.
Iranian Health Economics Association, Tehran, Iran.
Health Res Policy Syst. 2024 Aug 19;22(1):110. doi: 10.1186/s12961-024-01207-6.
Setting and implementing evidence-informed health service packages (HSPs) is crucial for improving health and demonstrating the effective use of evidence in real-world settings. Despite extensive training for large groups on evidence generation and utilization and establishing structures such as evidence-generation entities in many countries, the institutionalization of setting and implementing evidence-informed HSPs remains unachieved. This study aims to review the actions taken to set the HSP in Iran and to identify the challenges of institutionalizing the evidence-informed priority-setting process.
Relevant documents were obtained through website search, Google queries, expert consultations and library manual search. Subsequently, we conducted nine qualitative semi-structured interviews with stakeholders. The participants were purposively sampled to represent diverse backgrounds relevant to health policymaking and financing. These interviews were meticulously audio-recorded, transcribed and reviewed. We employed the framework analysis approach, guided by the Kuchenmüller et al. framework, to interpret data.
Efforts to incorporate evidence-informed process in setting HSP in Iran began in the 1970s in the pilot project of primary health care. These initiatives continued through the Health Transformation Plan in 2015 and targeted disease-specific efforts in 2019 in recent years. However, full institutionalization remains a challenge. The principal challenges encompass legal gaps, methodological diversity, fragile partnerships, leadership changeovers, inadequate financial backing of HSP and the dearth of an accountability culture. These factors impede the seamless integration and enduring sustainability of evidence-informed practices, hindering collaborative decision-making and optimal resource allocation.
Technical aspects of using evidence for policymaking alone will not ensure sustainability unless it achieves the necessary requirements for institutionalization. While addressing all challenges is crucial, the primary focus should be on required transparency and accountability, public participation with an intersectionality lens and making this process resilience to shocks. It is imperative to establish a robust legal framework and a strong and sustainable political commitment to embrace and drive change, ensuring sustainable progress.
在真实环境中设置和实施基于证据的卫生服务包（HSP）对于改善健康和展示证据的有效利用至关重要。尽管许多国家已经对大量人群进行了广泛的证据生成和利用培训，并建立了证据生成实体等结构，但设置和实施基于证据的 HSP 的制度化仍未实现。本研究旨在回顾伊朗设置 HSP 所采取的行动，并确定将基于证据的重点制定过程制度化所面临的挑战。
通过网站搜索、谷歌查询、专家咨询和图书馆手动搜索获取相关文件。随后，我们对利益相关者进行了九次定性半结构式访谈。参与者是根据与卫生政策制定和融资相关的不同背景进行有针对性抽样的。这些访谈被精心录制、转录和审查。我们采用了框架分析方法，以 Kuchenmüller 等人的框架为指导，对数据进行解释。
伊朗在 HSP 中纳入基于证据的过程的努力始于 20 世纪 70 年代的初级卫生保健试点项目。这些举措通过 2015 年的卫生转型计划和近年来 2019 年针对特定疾病的努力得以延续。然而，全面的制度化仍然是一个挑战。主要挑战包括法律空白、方法多样性、脆弱的伙伴关系、领导层更替、HSP 的资金支持不足以及问责文化的缺乏。这些因素阻碍了基于证据的实践的无缝整合和持久可持续性，阻碍了协作决策和最佳资源分配。
仅使用证据进行决策的技术方面不会确保可持续性，除非它满足制度化的必要要求。虽然解决所有挑战至关重要，但重点应该放在所需的透明度和问责制、具有交叉性视角的公众参与以及使这一过程具有抵御冲击的能力上。建立一个强大的法律框架和强有力的、可持续的政治承诺对于接受和推动变革、确保可持续进展至关重要。
