This study highlighted specific strengths in the technical and functional aspects of DHIS2 and also drew attention to particular challenges and concerns. These results provide a sound evidence base for decision makers and policymakers to enable them to make more accurate decisions about whether or not to use the DHIS2 in the health system of their country.

Background: The World Health Organization (WHO) aims to promote strategies that ensure efficacy, safety, suitability, and cost-effectiveness of medicine prescription. Health systems should design effective mechanisms to monitor prescription and rational use of medicines at all healthcare settings. This study aimed to determine and analyze prescription patterns of general practitioners and specialists in Kerman/Iran from 2005 to 2015. Methods: This is an explanatory mixed method study. Data were gathered during two phases. At the first phase, prescriptions issued by physicians during 2005-2015 were reviewed to extract information required to develop eight main prescription indicators. In the second phase, the indicators trends were presented to experts participating in expert panel to have their opinions and analyses on the data obtained in the first phase. Experts were selected based on their experience and expertise in medicine and/or health policy and/or experience in implementation of polices to promote rational use of medicines. Some experts attending the panel were a sample of physicians whose prescriptions were included in the first phase. Results: Findings revealed that two indicators of the average price of prescriptions and the maximum number of medicines in each prescription had an increasing trend over the study period. Reasons including unprecedented devaluation of the Iranian Rial and willingness of young physicians to prescribe more medications were proposed as the primary contributors to the observed increasing trends. However, other indicators including types of prescribed medicines, average number of medicines per prescription, the percentage of prescriptions with more than four medications, a percentage of encounters with a corticosteroid prescribed, a percentage of encounters with an antibiotic prescribed, and a percentage of encounters with an injection prescribed decreased in the study period. Reasons of controlling initiatives adopted by the Ministry of Health, the higher responsibility of physicians, adoption of continued medical education (CME) programs, and improved knowledge of pharmacists, physicians, and patients about irrational use of medicines were proposed by participants as the main reasons for the decreasing trend. Conclusion: Findings indicated that prescription indicators were better in Kerman than those of country average over the study period based on comparing the results of this study and others in Iran. However, they were non-desirable when compared to the international average. The number of factors contributes to the irrational use of medicines, including lack of knowledge among healthcare providers and patients, patients’ misunderstanding about the efficacy of some particular medicines, the high cost of drug development and manufacturing, and unavailability of effective medicines.

The Hospital Information system (HIS) is a comprehensive solution that offers complete data integration for different administrative levels in hospitals. To the extent that this system is close to its aim, the efficiency and quality of health care would increase in hospitals. The performance of HIS systems in 13 hospitals in Kerman province that they were evaluated based on four major criteria of ownership, location, education and software design. Seven hospitals were located in the capital city of Kerman province. According to teaching status of hospitals, four were teaching and based on their ownership three were public. The checklist of Iranian ministry of health and medical education, containing 20 indexes were used to evaluate each hospital's HIS system in three main supportive, diagnosis and clinical sectors. Spearman correlation coefficient was used to assess the association between major sectors. The highest score (mean±SD) was observed in laboratory information systems (88.19±13.69), resource management (84.47±8.94), and registration information systems (84.47±18.06); the lowest scores were for telemedicine (45.58±3.86), staff information and timing systems (40±16.64), and decision support systems (23.6±4.97). The total score of HIS software was positively correlated with all its three components. There were strong positive correlations between all three components. The three factors of decision support systems, staff information systems and telemedicine have an important role in providing solutions for non-structured management problems and for leading decision-makers to insights, improving human resource management and solving the problem of access to services. Thus, based on the survey findings, those three factors need to be improved in the Iranian hospital information system.

Background The health research system (HRS) is an important national priority that requires a systematic and functional approach. Evaluating the HRS of Iran as a developing country and identifying its challenges reveals the stewardship-related role in how the whole system is operating well. This study aims to assess the HRS in terms of stewardship functions and highlight the enhancement points. Methods This study was carried out between March 2020 and April 2021 using a systematic review and meta-synthesis of evidence to examine the Iranian HRS stewardship challenges and interview 32 stakeholders, using a critical case sampling and snowballing approach which included both semi-structured and in-depth interviews. The interviewees were selected based on criteria covering policy-makers, managers, research bodies and nongovernmental organizations (NGOs) in health research-related fields like higher education, research, technology, innovation and science. All data were analysed using content analysis to determine eight main groups of findings under three levels: macro, meso, and micro. Results Analysis of the findings identified eight main themes. The most critical challenges were the lack of an integrated leadership model and a shared vision among different HRS stakeholders. Their scope and activities were often contradictory, and their role was not clarified in a predetermined big picture. The other challenges were legislation, priority-setting, monitoring and evaluation, networking, and using evidence as a decision support base. Conclusions Stewardship functions are not appropriately performed and are considered the root causes of many other HRS challenges in Iran. Formulating a clear shared vision and a work scope for HRS actors is critical, along with integrating all efforts towards a unified strategy that assists in addressing many challenges of HRS, including developing strategic plans and future-oriented and systematic research, and evaluating performance. Policy-makers and senior managers need to embrace and use evidence, and effective networking and communication mechanisms among stakeholders need to be enhanced. An effective HRS can be achieved by redesigning the processes, regulations and rules to promote transparency and accountability within a well-organized and systematic framework.

As indicated by a worldwide common perspective about health and sustainable health systems, the health structure as a part of public health is a key theme of many societies. The future is shaped by probable future scenarios, for which dealing practically has many complications. This study is focused on the future scenarios for a comprehensive sustainable health financing model to support a superior structure for a decision and policy-making pilot for the society. This aim is followed based on multiple attribute decision making (MADM)-based scenarios using two MADM methods, step-wise weight assessment ratio analysis (SWARA) and weighted aggregated sum product assessment (WASPAS), as a hybrid model which is the first real case study of the approach. Four main probable future scenarios are identified and selected based on experts’ viewpoints about sustainable health financing models. These scenarios include membership in the World Trade Organization (WTO), dynamic basic insurance, international cooperation, and effective resources management. The process of evaluating based on the approach works as a wider picture, including all criteria and alternatives together. Sustainable medical services, empowering the private sector in both production and technology, and employing international managers took place as the top priority for considering the most applicable alternatives in the future. This structure is designed and developed in Iran’s context, and the Institute for Futures Studies in Health is the pilot of the research.