Raoofi Azam, Takian Amirhossein, Akbari Sari Ali, Yunesian Masud
Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of).
Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of).
BMJ Open. 2025 Jan 4;15(1):e087868. doi: 10.1136/bmjopen-2024-087868.
Microbial threats pose a growing concern worldwide. This paper reports the analysis of Iran's policy process against microbial threats.
This is a qualitative study.
We interviewed 16 purposefully identified key informants selected through snowball sampling.
Through the lens of stages heuristic framework, we analysed the interviews by using thematic content analysis. We used MAXQDA V.2020 software for data analysis, identified key themes and subthemes and discussed our findings to validate the results.
We extracted four main categories in accordance with the stages heuristic domains. Through content analysis of the agenda-setting process, we identified three main themes: magnitude of the problem, actors' power and priorities. Participants highlighted the significant impact of microbial threats, the influence of powerful stakeholders and the underprioritisation of infectious diseases based on perceived urgency and resources. In the process of policy formulation, we explored three main themes, related to governance, coherence and integration of policies and barriers to effective policy formulation. Governance issues included transparency, engagement with stakeholders, conflict of interest and use of evidence, while coherence and integration of policies focused on insufficient coherence and integration of plans as well as temporary and defensive policymaking. Barriers to effective policy formulation encompassed delay in policymaking, policy gap in response to public needs, weakness in policy feasibility, risk assessment and management. For policy implementation, we extracted governance and coordination, and health system capacity. Effective implementation of policies was hindered by fragmented governance, inadequate communication and accountability and systemic barriers, while health system capacity was limited in terms of infrastructure and human resources. Finally, content analysis of monitoring and evaluation (M&E) resulted in identification of two main themes: discrepancies in M&E and barriers to effective M&E. The discrepancies in M&E varied, with some programmes having regular evaluations and others lacking compliance with international standards. Barriers to effective M&E included inadequate data access, limited information-sharing and inefficiencies in the M&E system.
Iran needs to prioritise infectious diseases, invest in preventive measures, improve governance and coordination, strengthen health system capacity, enhance M&E and so on, to combat microbial threats effectively. Learning from successful experiences of other countries can help Iran develop more effective strategies to address microbial threats and strengthen global public health in the country.
微生物威胁在全球范围内引发了越来越多的关注。本文报告了对伊朗应对微生物威胁政策过程的分析。
这是一项定性研究。
我们采访了16名通过滚雪球抽样有目的地确定的关键信息提供者。
通过阶段启发式框架的视角，我们使用主题内容分析法对访谈进行了分析。我们使用MAXQDA V.2020软件进行数据分析，确定关键主题和子主题，并讨论我们的发现以验证结果。
我们根据阶段启发式领域提取了四个主要类别。通过对议程设置过程的内容分析，我们确定了三个主要主题：问题的严重程度、行为者的权力和优先事项。参与者强调了微生物威胁的重大影响、强大利益相关者的影响以及基于感知到的紧迫性和资源对传染病的优先重视不足。在政策制定过程中，我们探讨了三个主要主题，与治理、政策的连贯性和整合以及有效政策制定的障碍有关。治理问题包括透明度、与利益相关者的互动、利益冲突和证据的使用，而政策的连贯性和整合侧重于计划的连贯性和整合不足以及临时和防御性的政策制定。有效政策制定的障碍包括政策制定延迟、应对公众需求的政策差距、政策可行性薄弱、风险评估和管理。对于政策实施，我们提取了治理与协调以及卫生系统能力。政策的有效实施受到治理分散、沟通和问责不足以及系统性障碍的阻碍，而卫生系统能力在基础设施和人力资源方面有限。最后，对监测与评价（M&E）的内容分析确定了两个主要主题：监测与评价中的差异以及有效监测与评价的障碍。监测与评价中的差异各不相同，一些项目有定期评估，而另一些项目则不符合国际标准。有效监测与评价的障碍包括数据获取不足、信息共享有限以及监测与评价系统效率低下。
伊朗需要优先考虑传染病，投资于预防措施，改善治理与协调，加强卫生系统能力，加强监测与评价等，以有效应对微生物威胁。借鉴其他国家的成功经验可以帮助伊朗制定更有效的战略来应对微生物威胁并加强该国的全球公共卫生。
