Afshar Hosseinabadi Zahra, Shaarbafchizadeh Nasrin, Amini-Rarani Mostafa
Organizational Development and Administrative Transformation Department, Kerman University of Medical Sciences, Kerman, Iran.
Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
Glob Health Action. 2025 Dec;18(1):2491199. doi: 10.1080/16549716.2025.2491199. Epub 2025 May 29.
Emerging infectious respiratory diseases present significant challenges to public health systems worldwide. The recent COVID-19 pandemic has revealed critical weaknesses in Iran's healthcare infrastructure, particularly regarding surveillance and testing capabilities. During the pandemic, Iran faced severe consequences, including a high death toll and overwhelming demands on its healthcare system. This situation highlights the urgent need for a stronger public health system in the country.
This study identifies interventions implemented in Iran's public health system during respiratory disease pandemics, their context, mechanisms and outcome.
A qualitative realist study was conducted using semi-structured interviews with 21 public health experts across various sectors. Data were analyzed through content-directed analysis using the CIMO (Context-Intervention-Mechanism-Outcome) approach and the SPRP (Strategic Preparedness and Response Plan) framework. Data collection occurred from March to June 2024.
Analysis revealed that factors such as individual behaviors, social capital, institutional settings, and political pressures significantly influenced intervention outcomes. Key interventions included enhanced risk communication strategies and the establishment of specialized respiratory disease centers. However, bureaucratic inefficiencies and resource limitations hindered effective responses. Additionally, continued investment in local diagnostic production is essential for maintaining national laboratory and vaccination capabilities.
The findings underscore the necessity for systemic reforms in Iran's public health framework to enhance preparedness for future pandemics. The realist approach provided insights into the complexities of intervention effectiveness, emphasizing the importance of context in shaping health outcomes. Strengthening primary healthcare and fostering inter-sectoral collaboration are essential for building a more resilient public health system capable of addressing emerging respiratory diseases effectively.
新发传染性呼吸道疾病给全球公共卫生系统带来了重大挑战。近期的新冠疫情暴露了伊朗医疗基础设施的严重弱点，尤其是在监测和检测能力方面。在疫情期间，伊朗面临了严重后果，包括高死亡率以及对其医疗系统的巨大需求。这种情况凸显了该国迫切需要一个更强大的公共卫生系统。
本研究确定伊朗公共卫生系统在呼吸道疾病大流行期间实施的干预措施、其背景、机制和结果。
采用定性现实主义研究方法，对21名来自不同部门的公共卫生专家进行了半结构化访谈。通过使用CIMO（背景-干预-机制-结果）方法和SPRP（战略防范和应对计划）框架的内容导向分析对数据进行了分析。数据收集于2024年3月至6月进行。
分析表明，个人行为、社会资本、机构设置和政治压力等因素对干预结果产生了重大影响。关键干预措施包括加强风险沟通策略以及建立专门的呼吸道疾病中心。然而，官僚主义低效和资源限制阻碍了有效应对。此外，持续投资于本地诊断产品生产对于维持国家实验室和疫苗接种能力至关重要。
研究结果强调了伊朗公共卫生框架进行系统性改革以增强对未来大流行的防范能力的必要性。现实主义方法提供了对干预效果复杂性的见解，强调了背景在塑造健康结果方面的重要性。加强初级医疗保健并促进部门间合作对于建立一个更具弹性、能够有效应对新发呼吸道疾病的公共卫生系统至关重要。
