Haniye Sadat Sajadi

Prolonged economic sanctions—often framed as non-military tools—have increasingly harmed health systems, especially where institutional and policy capacities are fragmented. Despite the growing debate on sanctions, documented analyses of health system responses remain scarce. This study examines Iran to assess how prolonged sanctions shaped its health policy architecture and resilience capacity, with attention to compounded crises such as COVID-19. Phase one synthesized seven empirical studies conducted by the authors—including document reviews, interviews, Delphi, and policy analyses—to assess how resilience principles were embedded across the four stages of the health policy cycle: agenda-setting, policy formulation, implementation, and evaluation. These findings formed the foundation for Phase two, which applied an expanded Theory of Change (ToC) framework to reconstruct policy logics, surface implicit assumptions, and identify institutional breakpoints. After modelling the ToC, a panel of experts reviewed and validated the findings, ensuring methodological rigour and contextual accuracy in mapping resilience under sanctions. The findings indicate that while Iranian health authorities implemented adaptive measures, responses were shaped by fragmented coordination, untested assumptions, and limited structured learning systems. Resilience limitations emerged during implementation and were embedded in early design phases, not fully anticipated or addressed, given the complex and uncertain policy environment. This study offers an analytical framework for mapping resilience in policy systems under long-term constraints. Building on identified governance and design weaknesses, we recommend strengthening international legal safeguards; establishing protected humanitarian corridors; institutionalizing risk-informed planning; routine scenario-based resilience testing; and feedback-driven learning mechanisms within national policy systems. These capacities are essential to absorb shocks and enable adaptive, inclusive, sustainable responses. By clarifying structural domains where resilience can be embedded in advance, the analysis offers guidance for countries under comparable pressures to target strategies in governance, planning, and resource protection. This provides a transferable blueprint for strengthening justice-oriented health systems under long-term constraints.

Despite the prevalence of mental disorders, the treatment rate remains low due to various barriers, including trust issues. Trust impacts the patient-provi

Aging is often accompanied by physical and cognitive decline, increasing the need for assistive technologies (ATs) to support daily living. Despite the clear benefits of ATs, access remains a significant barrier, particularly in low- and middle-income countries. This study explores access to ATs among older adults in Iran, using data from the 2022 Rapid Assistive Technology Assessment (rATA) Survey. This secondary analysis was based on cross-sectional data drawn from a subsample of 2888 participants aged 60 years and older, obtained from the 2022 Iran rATA survey. Descriptive and comparative statistics were used to examine self-reported functional difficulties and access to ATs, with group differences tested using chi-square and t tests or nonparametric equivalents as appropriate. Overall, 1979 participants (68.58%) reported experiencing at least 1 functional difficulty. Among them, 1527 (76.23%) used at least 1 AT. The use of AT varied significantly by location, with urban residents reporting greater access than their rural counterparts. Most ATs were provided by the private sector (965, 65.47%) and primarily funded out-of-pocket (951, 64.52%). Additionally, 1230 users (83.45%) expressed satisfaction with their devices. The findings underscore the need for targeted policies to strengthen governance and reduce financial and geographic barriers to ATs for older adults. Strengthening public provision, improving affordability, and integrating ATs into health systems are key priorities for equitable aging.

Health system resilience in the context of economic sanctions (ES) is an underexplored area. We used data from recent studies on the impact of ES on the health systems to cross-reference and assess the applicability of the conceptual framework of health system resilience (CFHSR). Reviewing the interventions implemented under ES and aligning them with the CFHSR and COVID-19 responses, we found that the CFHSR domains encompass most strategies from the ES and COVID-19 studies. However, CFHSR does not cover several strategies related to equity and teamwork. Additionally, monitoring the consequences is missing from the experiences of COVID-19 and ES. The CFHSR appears to be reasonably effective in categorizing strategies for both COVID19 and ES. Nonetheless, its domains can be further refined. Specifically, incorporating an intersectional equity lens could enhance this conceptual framework. The next step is to develop a practical guide to apply CFHSR to strengthen health system resilience.

Background: Monitoring and evaluation are crucial in ensuring the effective implementation of health priorities. This descriptive study examined the progress towards implementing Iran’s General Health Policies (IGHP) to illustrate how countries can effectively monitor and evaluate their national plans. Additionally, the study sought to identify factors that impede the full implementation of these policies. Methods: Available data sources, formal reports, and studies were examined to gather data on selected indicators. Then, documentary analysis and 21 semi-structured interviews were conducted to identify measures taken to materialize IGHP and factors that hindered the full implementation of IGHP. Data were analyzed using the content analysis method. Results: The results showed that several indicators improved during these years, while there was no data for some indicators. There are some barriers to implementing the IGHP, including lack of full understanding of the policies, absence of necessary mechanisms and infrastructures, lack of coherency and alignment of national health plans and policies, absence of monitoring and evaluation framework, and lack of transparency and accountability in the health system. As countries continue to develop their health plans and policies, lack of clarity regarding the progress of these plans remains a concern. Conclusion: Countries need to strengthen their health planning systems and expedite the implementation of accountability mechanisms within the health system. Enhancing capacity building is essential to establish a comprehensive monitoring and evaluation framework. By fortifying these systems, countries will be better equipped to measure and track progress toward achieving their health objectives.

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Background and Aim: The health system's responsiveness to provision of health services displays the ability of the system to meet the non-medical needs of people. The present study aimed to assess Iran's health system responsiveness in providing rehabilitation for people with disabilities (PWD). Materials and Methods: This population-based cross-sectional study ...

Background: Sanctions have direct and indirect impacts on people’s lives. Therefore, the health systems of countries targeted by sanctions must respond effectively. This study proposes a set of mitigating measures and response strategies to improve the health systems of countries under sanctions. Methods: This three-stage study was conducted in Iran within the 2020–2021 period, in which a rapid review of evidence was carried out to identify the measures implemented or proposed to make the health system resilient in confronting sanctions. A qualitative approach was then adopted to determine how the health system could be improved to response to sanctions from the perspectives of 10 key experts. Semi-structured interviews and document analysis were conducted for data collection. Finally, a two-round Delphi technique was employed to help eleven experts reach a consensus on a set of mitigating measures, which were then prioritized. Results: In this research, 62 proposed or implemented mitigating measures were extracted from 13 eligible studies to improve the health system performance in confronting sanctions. Moreover, 18 measures were identified in interviews for a better health system response to sanctions. They were then classified as five categories: sustained financing, good governance, integrated and updated health information systems, qualified workforce, and efficient and equitable service delivery. In the first Delphi round, 28 mitigating measures were discovered. Nine measures were identified as more effective and feasible in both short and long runs. They were introduced as below: conducting proactive inventory control, developing the nationally essential list of medicines, providing additional clarification that oil revenues can be freely used for medicines procurement, defining tailored health service packages for vulnerable populations, establishing and enhancing an efficient surveillance system, reducing prices of imported medicines, developing dual policies of equity and priority for vulnerable groups, institutionalizing fair and effective resource allocations, and providing clinical guidelines. Conclusions: According to the findings, the most critical areas for the resilience of a health system in confronting sanctions include strengthening particular components of governance, improving efficiency, and caring for vulnerable populations. The experts collectively emphasized investment in domestic capacities, public participation, and health diplomacy. Despite the proposed measures, it is unclear how effective these are and, especially whether they can significantly affect the harsh impacts of sanctions on health. Moreover, intensive and long-term sanctions have significant irreversible outcomes that cannot be reversed easily or quickly.

The Evidence-Informed Deliberative Processes (EDPs) guide provides a practical framework for fair priority setting of the Health Benefits Package (HBP) that countries can reasonably use. The steps presented in the EDPs are applicable for prioritising health services in designing HBP and are consistent with practical experience in countries. However, institutionalisation must be considered an element of fairness in the priority-setting process if the aim is to reach broader goals of a health system, such as universal health coverage (UHC). Otherwise, the EDPs for priority setting might not be integrated into the formal health system or impactful, resulting in a waste of time and resources, which is unfair. Institutionalisation means formalising the desired change as an embedded and integrated system so that the change lasts over time. For the institutionalisation of EPDs, four stages are suggested, which are (1) establishing a supportive legal framework, (2) designating governance and institutional structure, (3) stipulating the EDPs processes and (4) individual and institutional capacity building.