مجله تصویر سلامت
سال سیزدهم شماره 1 (بهار 1401)

In the face of the global coronavirus disease 2019 (COVID-19) pandemic, governments worldwide have taken on the immense responsibility of implementing public health interventions to curb the spread of the virus. These interventions, ranging from social distancing to widespread diagnostic testing and vaccination, have played a pivotal role in safeguarding public health and mitigating the impact of this unprecedented crisis.Government intervention in controlling the spread of COVID-19 has been critical. In this respect, governments have showed their commitment to protecting citizens, promoting community well-being, and minimizing the strain on healthcare systems through implementing various measures. These interventions not only have saved many lives but also provided a sense of security and stability during the uncertain pandemic times, considering the unprecedented and invasive waves of infodemics and conspiracies. Various policies and approaches to fight the virus have been adopted in different countries based on cultural, social, economic, and health system conditions. (1,2) The most common and important government actions include public awareness campaigns, (3) prevention measures, (4) contact tracing, (5) diagnostic and treatment interventions, vaccination, and specialized care. In the context of Iran, despite the extensive and severe global sanctions imposed on the country, multifaceted interventions were carried out in the framework of Iran's primary healthcare system within a very short period after the onset of the global COVID-19 pandemic. The documentation and dissemination of these interventions can serve as valuable lessons for the present and future health systems. Some of these interventions included educating the community, promoting social distancing, establishing verbal screening structures, contact tracing, identifying and breaking the chain of disease transmission, engaging the public and community in disease control efforts, establishing specialized COVID-19 diagnostic laboratories, expanding nationwide diagnostic testing, setting up designated COVID-19 centers to accept referrals from public and private sectors at the primary level, developing and reviewing diagnostic and treatment protocols for COVID-19, establishing quarantine centers, and implementing general vaccination programs through prioritizing vulnerable and at-risk groups. Despite the remarkable success of the interventions undertaken to combat COVID-19, numerous challenges persist. Public concerns, fueled by the prevalence of infodemics and various rumors, act as a flood that threatens to dismantle the structures, dams of prevention, and public health interventions, eroding trust in healthcare authorities. Moreover, the emergence of different and novel virus strains further exacerbates people's anxieties, demanding increased efforts within the healthcare system. Therefore, it is necessary to enhance communication strategies to ensure public understanding and compliance with preventive measures. Considering the role of scientific research journals in promoting participatory decision-making and disseminating evidence-based information, these journals play a vital role in fostering trust between the public and the healthcare system.(6) Accordingly, the role of local scientific research journals in non-English language speaking countries is vital in the distribution of evidence-based data, clarification of national programs to battle the pandemic, as well as correcting misinformation and rumors among the general public. Considering the mentioned issues, the Depiction of Health journal, as a journal published in Persian language by the Health Services Management Research Center of Tabriz University of Medical Sciences, decided to release a special issue in collaboration with the Deputy Minister of Health, Ministry of Health and Medical Education (MOHE), and the Director of Iran's Primary Healthcare Management Network. This special issue covers policies, executive and preventive measures related to COVID-19 in the primary healthcare system based on evidence, government documents, field studies, and performance data conducted in primary healthcare systems during the time frame of 2019-2021. All articles in this special issue have undergone a rigorous peer review process in accordance with the standards set by the journal under the supervision of the journal's editor-in-chief.

The Islamic Republic of Iran's health system is divided into three levels: the first level is the Primary Health Care (PHC) system, the second level includes specialized polyclinics/clinics, general and specialized hospitals, and the third level is the sub-specialized hospitals. Based on the available evidence, Iran's HS has evolved and progressed since 1984, becoming a comprehensive, public-centered, responsive, and cost-effective system, (Figure 1) (1,2).  
During the COVID-19 pandemic, countries reacted differently based on their HS infrastructure and structure, available primary resources (financial and human resources), and the severity of the disease spread. Evidence reveals that most countries relied on their hospitals and health systems to combat the COVID-19 epidemic. However, the health system’s response was slightly different in the Islamic Republic of Iran. Since the early days of identifying cases and preparing hospitals for admission and treatment of COVID-19 patients, the PHC system initiated a comprehensive reaction to combat the COVID-19 pandemic as the first line and the first point of the HS's contact with the community. In this regard, the PHC system determined the principal policies for combating COVID-19 as follows (3):- General vaccination based on the priorities in the national document Provision of active and essential healthcare and services (in-person/remotely)
- Early identification of COVID-19 cases and tracing their close contacts (family/workplace)
- Protection and isolation of vulnerable populations (reverse quarantine
- Ensuring compliance with isolation and quarantine rules (hotel quarantine and house quarantine)
- Development and improvement of outpatient COVID-19 treatment
Different solutions and strategies have been devised to implement and fulfill the determined policies, which can be divided into three general categories:a) Modifying the structure of service delivery
b) Modifying the programs and procedures
c) Improving the methods of service provision
Strategy 1: The first strategy is to make structural changes in the PHC system (Figure 2), which occurred in the first week of the outbreak in the Iran’s PHC system. Through alterations in structure, human resources, duties, and function, 1200 comprehensive urban (1099) and rural (111) health centers were designated as COVID -19 centers for suspected COVID-19 outpatients from rural health houses, urban health posts, rural/urban comprehensive health service centers, and other private centers.

The COVID-19 pandemic caused by the newly emerged coronavirus was first detected in China in December 2019 and rapidly spread worldwide. The rapid spread of the disease urged all countries involved, in accordance with their capacities, take the necessary measures to diagnose and manage the disease. The first patient was diagnosed with COVID-19 in Iran in February 2020. Considering the significant role of the laboratory services in detection and management of the disease, planning and programming to provide access to these services was considered as a top priority for healthcare system in Iran. Adopting all existing laboratory capacities and providing necessary infrastructures for expanding COVID-19 laboratory diagnostics, resulted in the establishment of a nationwide network of COVID-19 molecular diagnostic laboratories within the shortest possible time. In addition to expanding the capacity of laboratory services, improving the laboratory network’s performance have been taken into serious consideration. Despite the strict sanctions, the COVID-19 molecular diagnostic laboratories scaled up to more than 430 laboratories currently (September 2021), mostly are operating in the private sector. With considerable efforts, COVID-19 molecular laboratory network was established to provide nationwide diagnostic services. Considering the capacity for the SARS-CoV-2 Rapid Antigen test, we can now perform more than 100,000 COVID-19 diagnostic tests per day. However, due to the ongoing pandemic and in accordance with the requirements of the health system, it is necessary to plan and carry out more COVID-19 diagnostic tests. This study aimed to introduce the process of establishing the COVID-19 laboratory diagnostic network to manage the COVID-19 pandemic in Iran.

The outbreak of COVID-19 in Iran in February 2019 prompted the Iran’s health system to plan for pandemic prevention and control. The national mobilization program (NMP) against COVID-19 was devised to support the sick and vulnerable and promote community awareness and skills regarding the crisis. This study aimed to investigate the role of community health workers (CHWs) in preventing and controlling the COVID-19 pandemic.

The present study is a descriptive cross-sectional study. The census method was used to study 30,034 rural health workers (RHW) and 22,573 urban health workers (UHW) working in medical universities. The required data were extracted using the integrated health system and the portal of the Ministry of Health and Medical Education's Primary Health Network Management Center and were analyzed using descriptive and analytical statistical methods.

More than 78 million people were screened during the first phase of the NMP , more than 42 million during the second phase, and more than 59 million during the third phase. In addition, by the end of the fourth phase of the NMP, 4,278,899 highly vulnerable individuals were screened. According to the health system's report, CHWs administered 28,073,777 vaccines since the implementation of the fifth step (until 04.09.2021)

Considering the facilities and capabilities of primary health care networks in providing prevention, diagnostic, and treatment services, the activity of the primary health network management center and all affiliated units in the implementation of the NMP has been significant since the beginning of this pandemic. Inadequacies in human resources, financial resources, and training planning should all be considered.

In order to address the community’s health needs during the COVID-19 crisis in 2020, several comprehensive urban health centers affiliated with the primary healthcare system were designated as COVID-19 centers. Considering the importance of evaluating the performance of the mentioned centers and ensuring the continuity of the services provided in accordance with the rules and instructions, the performance evaluation of the mentioned units was conducted from July 2020 to March 2021 in three levels: self-evaluation (first-level evaluation), university evaluation (second-level evaluation) and the evaluation of the experts of the Ministry of Health and Medical Education (third-level evaluation).

This cross-sectional descriptive-analytical study was conducted in all selected COVID-19 centers, including 978 in 63 universities / medical schools across the country in 2020. The sample was selected by census sampling method and included a total of 978 centers. In this study, 28 main criteria in the fields of education and information, safety of staff and clients by observing social distance, use of personal protective equipment, supplying manpower and equipment, disinfection, and work processes, and 91 sub-criteria were determined by using Delphi Technique.

With the criteria and sub-criteria defined in the areas of "community education and information", staff training, observance of social distance, facilities, waste management, manpower supply, supply of medical equipment and work processes, it was identified that in the self-evaluation (first level evaluation), the criterion with the lowest score was "staff training". The lowest score in the evaluation of the level of universities / medical schools (second level evaluation) was related to the observance of social distance in the centers and the highest score in both evaluation levels was related to the criterion of "providing the necessary education to patients regarding prevention and control of COVID-19".

The establishment and setting up of selected COVID-19 centers has been one of the effective measures in controlling and managing the COVID-19 epidemic, which was created as a result of changing the structure of the primary healthcare system. The continuity of service quality of selected centers requires continuous monitoring and evaluation of their performance.

COVID-19, caused by a novel beta-coronavirus known as SARS-CoV-2, was first identified in China in late December 2019. The coronavirus outbreak was officially announced in Iran on February 19, 2020. The official report of the virus spread throughout the country was announced in mid-March 2020. While expanding the coverage of the “Each Home as a Health Post” (HAHP) program, universities recruited health messengers and health volunteers and trained them with the educational content “A Guide to Live with COVID-19”.

This study is a descriptive cross-sectional study. The sampling method was the census method. The required data were extracted using the integrated health system and the portal of the Ministry of Health and Medical Education’s Primary Health Network Management Center. Data were analyzed using descriptive and analytical statistical methods.

The numbers of household health messengers and health volunteers were 11,134,290 and 280,619, respectively. The highest total number of health volunteers and health messengers, with 824803 people, were in Shahid Beheshti University, and the lowest, with 7088 people in Gerash, Iran. Households with health messengers were 11656389, covering 50.1% of Iranian households. The national average score of trained messengers in the COVID-19 training course was 79.2%. In 22 universities/colleges, 100% of the health messengers passed the COVID-19 training course.

Implementing the HAHP program has effectively controlled COVID-19 spread by increasing awareness and promoting self-care in the community. Health messengers and health volunteers were the essential elements of the HAHP program. They identified and referred patients to selected COVID-19 care centers, improving care and services such as interception and support.

In late 2019, the outbreak of COVID-19 disease, with symptoms like the common cold or severe respiratory illness, caused a global public health crisis. In order to control and manage this disease, countries and the World Health Organization (WHO) have adopted various strategies and decisions.This study aimed to describe the initial measures of the Ministry of Health and Medical Education of the Islamic Republic of Iran with a focus on the Deputy Minister of Health in the framework of the national mobilization plan to combat COVID-19.

A mixed method study, including reviewing the documents of different departments of the Deputy Minister of Health in the management and control of the COVID-19 epidemic (qualitative) and descriptive cross-sectional (quantitative) study was conducted between March 2020 and April 2020. In this study, data and information related to all 63 universities / medical schools in the country were collected from the electronic health record systems and the portal of the Network Management Center and analyzed using EXCEL software.

The first step in the national mobilization against COVID-19 was to establish 1200 comprehensive health centers for COVID-19, provide self-assessment portal at salamat.gov.ir, and dedicate telephone lines (406,190, and1666) for COVID-19 distance counseling and tips. About 98% of the people registered in the electronic health record systems (78,315,029 people) were orally screened and evaluated, including 6,220,603 elderly, 262,717 people with diabetes, 3,356,131 individuals with high blood pressure, 29,201 obese people, 517,696 pregnant women and 2,722,659 foreign nationals. Another significant aspect of the implementation of the first step of the national mobilization was a significant reduction in the burden of hospitalization and management of outpatients in the first level of the health system (primary health care).

The COVID-19 epidemic caused a global health crisis, the management of which became the top of the world's health activities. The health sysntem in Iran, using the capacity of the health network system structure and service providers, developed appropriate policies for the management and control of the disease. One of these policies is the verbal screening to combat COVID-19, which has led to the optimal management of this epidemic.

As an emerging disease, COVID-19 is considered more than just a health crisis, as it socially affects communities. Therefore, community-oriented solutions via the primary healthcare system can better manage and control this pandemic. The Ministry of Health and Medical Education, and the Deputy Minister of Public Health executive branch, played an influential role in controlling the epidemic with community-based and network-based interventions in the National Mobilization Plan against COVID-19.

This cross-sectional descriptive study aimed to assess the second step of the National Mobilization Plan (NMP) against COVID-19. The data were extracted from the portal of the Network Management Center, Centers for Disease Control and Prevention (CDC), CLIS system, Reference Health Laboratory, and electronic record systems of the public health networks of all universities across the country from April 11 to August 10, 2020, and was analyzed using Statistical Package for the Social Sciences (SPSS) software.

During the second phase, healthcare providers screened more than 42 million people. About 98.4% of this population were diagnosed with no symptoms, and 0.4% were referred to the selected COVID-19 comprehensive health centers for examination and medical procedures. Of all the direct and referred patients of the selected COVID-19 comprehensive health centers, 55.3% had no problems, 37.8% needed to be tested, 3.6% needed to be referred to a hospital, and 3.3% received outpatient care. In the first days of laboratory screening, 11% of PCR tests were positive. By the end of the second step of the NMP against COVID-19, this rate had increased to 25%.

In times of crisis and epidemic conditions, the health network system, and the primary healthcare providers can effectively manage outpatients and reduce the burden of hospitalization. Only 3.6% of outpatients in the network system were referred to hospitals. The rest were cared for and followed up by the primary health care providers. Therefore, strengthening the network system structure and primary health care should be further considered.

COVID-19 is a global pandemic and has plagued many countries with unprecedented management problems. The rapid spread of COVID-19 around the world has reduced the ability of countries to address and respond to essential health services. Most countries have taken steps to prevent the spread of COVID-19 and improve essential services. The National Mobilization Plan (NMP) against COVID-19 in Iran’s healthcare system was implemented in 5 stages until September 2021. This study aimed to assess and review medical universities' performance in the third step of management and control of COVID-19 to provide documents and reports to be used in similar experiences.

This research is a cross-sectional descriptive study. Data were obtained from electronic records at the primary health care facilities and were analyzed and reported using descriptive statistical methods, including comparative tables and graphs. In order to prepare the report, Excel 2016 software was used. The third step of the NMP against COVID-19 was implemented from August 10, 2020, to November 10, 2020. In this step, while re-emphasizing the importance and necessity of verbal and laboratory screening of COVID-19, essential health services provision was highlighted as "in-person and remote services" for the covered population.

In the third step of national mobilization, 59,109,413 people were screened for COVID-19. During the third step, non-COVID essential services increased compared to the previous three months, with the most significant increase in middle-aged care.

Implementing the third step of NMP against COVID-19 in Iran increased the healthcare service delivery to all target groups, indicating the effectiveness of the third step in the fight against COVID-19 and the provision of Essential Health Services.

In December 2019, a new disease was reported in China that spread rapidly worldwide. This disease is called COVID-19, a viral infection of the coronavirus family. COVID-19 has caused health, social and economic problems around the world. In Iran, the first disease cases were reported in February 2020. This article aimed to describe the results of the fourth step of the National Mobilization Plan against the COVID-19 pandemic.

The information used in this cross-sectional-descriptive study is based on the data recorded in the computer program (Portal) of the Network Management Center of the Ministry of Health and Medical Education.The fourth step was devised to manage and control the COVID-19 pandemic with public participation and coordination between departments. It comprised four teams, including contact tracing, home care, supervisory, and support teams. Excel 2016 software was used to analyze the present study's data, and ArcMap software version 10.8 was applied to draw thermal maps.

In this study, every contact-tracing team consisted of 3.2 members. This number was equal to 3.2, 2.9, and 3.8 people per team for supportive, home care, and supervisory teams, respectively. Also, on average, the contact-tracing teams tracked 135.9 cases per team. This number was 518.6 visits per team for supervisory teams, 75.3 for home care teams, and 52.2 households for support teams. During the program's implementation, 3065.3 PCR tests and 3596.7 rapid tests were taken per 100,000 population, of which 15.5% were positive. The average contact tracing in people with close contact with the infected people was 4.87 per patient with a positive test.

The COVID-19 pandemic challenged all political, economic, social, and health policies and revealed the governments’ inadequencies. Statistical evidence suggests that the measures taken to manage and control COVID-19 in Iran have been valuable and effective. Still, this process depends on the persistence of policies and protocols by the government and society.

One of the most effective ways to prevent coronavirus disease 2019 (COVID-19) is to perform general vaccination and actively prevent the outbreak at the primary health care level. The present study aimed to review the measures against COVID-19 in Iran from April to September 2021.

A cross-sectional and descriptive study was conducted at the national level from April to September 2021. Data related to COVID-19 vaccination, prevention, care, and outpatient services was collected from databases, including first level electronic health record systems, the portal of Network Management Center, the portal of Infectious Diseases Management Center, and the portal of Health Observatory. The target population of the study included medical universities and schools in Iran. Using a census sampling method, all 63 medical universities and schools in the country were included in the study. The Statistical Package for the Social Sciences (SPSS) version 16 was utilized to analyze the collected data.

In the fifth step of the national mobilization program against COVID-19 epidemic, a total of 1,228 vaccination centers with 6,490 stations were established across the country from April to September 2021. In these centers, more than 47 million doses of the COVID-19 vaccines were injected. At this step, over 15 million people exposed to close contact with infected people were intercepted. A home care team was deployed at each selected health center for COVID-19, providing 532,551 home care services. At the fifth step, the monitoring teams issued 1,015,831 warnings to trading, industrial, or administrative units, which led to the sealing of 73,443 units. Also, more than six million rapid tests were performed in homes and health units. During the same period, 30,843 vulnerable households received support packages.

The national mobilization program to combat COVID-19 in Iran focused on the community and primary health care system. The program was successful in strengthening the health system to expand vaccination and actively prevent COVID-19 epidemic.

The first cases of COVID-19 disease in the world, and thus its prevalence in Iran, caused numerous public health issues and significantly hampered the provision of health services. Due to its particular geographical location, Iran is among the ten most refugee-hosting countries in the world. These populations have been living in different rural and urban areas of Iran for the last four decades. This study aimed to determine the care challenges of COVID-19 in a population of refugees and foreign immigrants.

This article is based on the reports of the rapid response teams of the Ministry of Health and Medical Education (MOH) and the visits made to the accommodations for refugees and foreign immigrants in the country's provinces.

According to studies, refugees and foreign immigrants face several challenges in receiving standard health services which are mainly related to low insurance coverage, a low level of literacy and health literacy, a reluctance to use health services, a large family size, overpopulated households, and living in poor conditions, as well as ignoring early symptoms of disease and referring to health centers in an emergency.

According to the results, organizing the housing of foreigners and immigrants and increasing insurance coverage are the leading health priorities. Regarding the common culture and language, regular planning should be done to attract these populations’ participation.