Background The Astana Declaration on Primary Health Care reiterated that PHC is a cornerstone of a sustainable health system for universal health coverage (UHC) and health-related Sustainable Development Goals. It called for governments to give high priority to PHC in partnership with their public and private sector organisations and other stakeholders. Each country has a unique path towards UHC, and different models for public-private partnerships (PPPs) are possible. The goal of this paper is to examine evidence on the use of PPPs in the provision of PHC services, reported challenges and recommendations. Methods We systematically reviewed peer-reviewed studies in six databases (ScienceDirect, Ovid Medline, PubMed, Web of Science, Embase, and Scopus) and supplemented it by the search of grey literature. PRISMA reporting guidelines were followed. Results Sixty-one studies were included in the final review. Results showed that most PPPs projects were conducted to increase access and to facilitate the provision of prevention and treatment services (i.e., tuberculosis, education and health promotion, malaria, and HIV/AIDS services) for certain target groups. Most projects reported challenges of providing PHC via PPPs in the starting and implementation phases. The reported challenges and recommendations on how to overcome them related to education, management, human resources, financial resources, information, and technology systems aspects. Conclusion Despite various challenges, PPPs in PHC can facilitate access to health care services, especially in remote areas. Governments should consider long-term plans and sustainable policies to start PPPs in PHC and should not ignore local needs and context.

Background: Multiple sclerosis (MS) causes significant economic burden to the patients, families, health systems and society. This study aimed to estimate the annual economic costs incurred by patients with multiple sclerosis (pwms) at different levels of the disease. Method: This was a cross-sectional study, using the Expanded Disability Status Scale (EDSS) tool for assessing the disease level of 300 (=N) pwms in East Azerbaijan province, Iran. To estimate the cost of MS, a questionnaire with its validity and reliability (CVR 92% and CVI 87%) and pilot test (Cronbach's alpha score 0.89) was used. The data were collected by interviewing pwms and reviewing their clinical records. Multivariate linear regression was used to assess the relationship between disease levels and incurred costs. Results: The results revealed that the mean annual cost for pwms in Iran is 97,521,740 IRR (equivalent to 2321.94 USD; 1978.93 EURO) and the mean score of EDSS in pwms was 3.14. The annual cost incurred by pwms with mild, moderate and severe levels of disease were

Background This study aimed to reflect on scientific experts’ and executive stakeholders’ opinions on how charitable organizations can participate in the health care system properly and cope with problems, challenges, strategies, and executive requirements at three major levels of prevention, treatment, and rehabilitation. Methods A total number of 20 semi-structured interviews were conducted with scientific experts and executive stakeholders, selected for this qualitative study, based on an interview guide. Using the purposeful sampling method, we selected scientific experts with 5 years of experience in the health care system and executive stakeholders who had 5 years of experience in charitable activities. We applied a framework method for data analysis, and the main themes were extracted through MAXQDA software. Results Our findings revealed that charitable organizations at the major levels of the health care system, i.e., prevention, treatment, and rehabilitation, possessed the necessary capacities to provide services effectively. Nevertheless, charities encountered some problems, e.g., financial instability, non-recognition of donors’ legal status, non-involvement in policy-making, inadequate cooperation from other agencies, absence of transparent programs and goals, together with weaknesses in advertising and attracting donations. It was noted that the government should take more operational steps towards supporting such organizations, e.g., by granting special facilities and exemptions, engaging charities in policy-making and training processes, and empowering them in terms of the production of resources. Charitable organizations are also recommended to establish external communications with other bodies such as municipalities, secretaries of state, governorate offices, welfare organizations, relief committees, and medical sciences universities. Conclusions Charitable organizations have the potentials to provide health care services at prevention, treatment, and rehabilitation levels. Thus, it is of utmost importance to adopt strategies such as creating sustainable funding sources, training charity managers with a wide variety of scientific management techniques, and implementing their intellectual capacities in legislative and planning processes.

Background Multiple sclerosis (MS) causes significant economic burden to the patients, families, health systems and society. This study aimed to estimate the economic costs incurred by patients with multiple sclerosis at different levels of the disease.Method This was a cross-sectional study, using the Expanded Disability Status Scale (EDSS) tool for assessing the disease level of 300 (=N) patients in East Azerbaijan province, Iran. To estimate the cost of MS, a questionnaire with its validity and reliability (CVR 92% and CVI 87%) and pilot test (Cronbach's alpha score 0.89) was used. The data were collected by interviewing patients and reviewing their clinical records. Linear regression and ANOVA were used to assess the relationship between disease levels and incurred costs.Results The results revealed that the mean annual cost for patients is 97,521,740 IRR (equivalent to 2,321.94 USD) and the mean score of EDSS in patients was 3.14. The annual cost incurred by patients with mild, moderate and severe levels of disease were 83,918,150 IRR (998.05 USD), 137,772,660 IRR (3,280.30 USD) and 119,962,670 IRR (2,856.25 USD) respectively. Also, there was a significant relationship between total cost and disease severity in such a way that any increase in EDSS degree is led to 8,139,260 IRR (193.79 USD) added cost for patients.Conclusion The study results could be helpful for Iranian health managers to solve problems which are facing patients and their families.

Objective: This study aimed to reflect on the participation status of non-governmental organizations (NGOs) at different levels (i.e., prevention, treatment, and rehabilitation) of Iran’s health care system. Methods: This descriptive cross-sectional study was fulfilled in 2019 based on 40 charitable organizations involved in health care services delivery, which were randomly selected from the Iranian Charities Portal (ICP). Data were collected via a valid and reliable researcher-made questionnaire. SPSS software version 16.0 was used to analyze data. Results: Direct and indirect methods of service delivery were used in 63% of organizations. The most important sources of funding were associated with public donations. Furthermore, 94% of charities were evaluating the health care services with internal and external evaluation and customer satisfaction surveys. Conclusions: The NGOs could be a precious contribution to the health care system. To use this potential as a synergistic factor of the health system, adopting such strategies as creating sustainable funding sources and establishing more coordination between organizations are essential.