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Non-communicable diseases represent 71% of all deaths worldwide. In 2015, Sustainable Development Goals, including target 3.4 of SDGs, were seated on the world agenda; “By 2030, reduce premature mortality from NCDs by one-third. More than half of the world’s countries are not on track to reach SDG 3.4, and the COVID-19 crisis has hampered the delivery of essential NCD services globally, which means the premature death of millions of people and indicates the need for capacity building for health systems. We designed a tool to measure the capacity of the National Center for Non-Communicable Disease and then presented the proposed policy package to enhance the national center’s organizational capacity. The data for this explanatory sequential mixed method study was collected using quantitative and qualitative approaches between February 2020 and December 2021. The tool for assessing organizational capacity for NCDs was developed, and its validity and reliability were measured. The developed tool assessed the organizational capacity by evaluating NCNCD’s managers and experts. Following the quantitative phase, a qualitative phase focused on the low-capacity points revealed by the tool. The causes of low capacity were investigated, as well as potential interventions to improve capacity. The developed tool comprises six main domains and eighteen subdomains, including (Governance, Organizational Management, Human Resources Management, Financial Management, Program Management, and Relations Management) which verified validity and reliability. In seven separate National Center for Non-Communicable Disease units, the organizational capacity was measured using the designed tool. (Cardiovascular disease and hypertension; diabetes; chronic respiratory disease; obesity and physical activity; tobacco and alcohol; nutrition; and cancers). The organizational management dimensions and the sub-dimensions of the organizational structure of the Ministry of Health and Medical Education and units affiliated with the national center, in all cases, were almost one of the main challenges that affected the country’s capacity to fight against NCDs. However, all units had a relatively good situation in terms of governance (mission statement, vision, and written strategic plan). The content analysis of experts’ opinions on the low-capacity subdomains highlighted challenges and recommended capacity-building interventions. Transparency in methods and processes is necessary to allocate funding among various health programs and evaluate their effects through cost-effectiveness indicators. This study identified weak points or areas where capacity building is required. The root causes of low capacity and interventions to build capacity are listed in each dimension of the tool. Some of the proposed interventions, such as strengthening organizational structures, have the potential to impact other domains. Improving organizational capacity for NCDs can assist countries to achieve national and global goals with greater efficiency.

Background Social determinants have a significant impact on children’s development and their abilities and capacities, especially in early childhood. They can bring about inequity in living conditions of children and, as a result, lead to differences in various dimensions of development including the social, psychological, cognitive and emotional aspects. We aimed to identify and analyze the social determinants of Early Childhood Development (ECD) in Iran and provide policy implications to improve this social context. Methods In a qualitative study, data were collected through semi-structured interviews with 40 experts from October 2017 to June 2018. Based on Leichter’s (1979) framework and using the deductive approach, two independent researchers conducted the data analysis. We used MAXQDA.11 software for data management. Results We identified challenges related to ECD context in the form of 8 themes and 22 subthemes in 4 analytical categories relevant to the social determinants of ECD including: Structural factors (economic factors: 6 subthemes, political factors: 2 subthemes), Socio-cultural factors (the socio-cultural setting of society: 6 subthemes, the socio-cultural setting of family: 4 subthemes), Environmental or International factors (the role of international organizations: 1 subtheme, political sanctions: 1 subtheme), and Situational factors (genetic factors: 1 subtheme, the phenomenon of air pollution: 1 subtheme). We could identify 24 policy recommendations to improve the existing ECD context from the interviews and literature. Conclusion With regard to the challenges related to the social determinants of ECD, such as increasing social harms, decreasing social capital, lack of public awareness, increasing socio-economic inequities, economic instability, which can lead to the abuse and neglect of children or unfair differences in their growth and development, the following policy-making options are proposed: focusing on equity from early years in policies and programs, creating integration between policies and programs from different sectors, prioritizing children in the welfare umbrella, empowering families, raising community awareness, and expanding services and support for families, specially the deprived families subject to special subsidies.

Background Providing an equitable Universal Health Coverage (UHC) is key for progressing towards the sustainable development goals in the health systems. To help policymakers make hypertension services more equitable with existing (limited) resources in Iran, we examined the inequality of the prevalence, awareness, treatment, and control (PATC) of hypertension as the four indicators of hypertension UHC in Iran.  Methods This research was a cross-sectional study of inequality of PATC of hypertension using a representative sample of Iranians aged ≥ 25 years from the Iran 2016 STEP wise approach to Surveillance study (STEPS). Outcome variables consisted of PATC of hypertension. Covariates were demographic (age, sex, and marital status) and living standard (area of residence, wealth status, education, and health insurance) indicators. We drew concentration curves (CC) and estimated concentration indices (C). We also conducted normalized Erreygers decomposition analysis for binary outcomes to identify covariates that explain the wealth-related inequality in the outcomes. Analysis was conducted in STATA 14.1. Results The normalized concentration index of hypertension prevalence and control was -0.066 ( p  < .001) and 0.082 ( p  < .001), respectively. The C of awareness and treatment showed nonsignificant difference between the richest and poorest. Inequality in the hypertension prevalence of females was significantly higher than males (C = -0.103 vs. male C = -0.023, p  < .001). Our analyses explained 33% of variation in the C of hypertension prevalence and 99.7% of variation in the C of control. Education, wealth index, and complementary insurance explained most inequality in the prevalence. Area of residence, education, wealth status, and complementary insurance had the largest contribution to C of control by 30%, 28%, 26%, and 21%, respectively. Conclusions This study showed a pro-rich inequality in the prevalence and control of hypertension in Iran. We call for expanding the coverage of complementary insurance to reduce inequality of hypertension prevalence and control as compared with other factors it can be manipulated in short run. We furthermore advocate for interventions to reduce the inequality of hypertension control between rural and urban areas.

ObjectivesTo assess nutrition-related knowledge, attitudes and practices among pregnant women, and identify socioeconomic and healthcare determinants.DesignA cross-sectional study on maternal nutrition during pregnancy.SettingPregnant women attending primary healthcare centres in the south of Tehran from December 2022 to March 2024.Participants1535 pregnant women of all ages living in the south of Tehran (both Iranian and non-Iranian).MeasuresPregnant women were systematically selected from primary healthcare centres. Data were collected via validated questionnaires and electronic health records. Statistical analyses included multivariate logistic regression (adjusted ORs (aORs) with 95% CIs) and generalised linear mixed models.ResultsThe findings revealed that a majority of pregnant women (83.3%; 95% CI 81.2% to 85.3%) exhibited low levels of nutritional knowledge (scores below 12), whereas 14% demonstrated moderate knowledge (scores between 12 and 17), and only 2.7% (95% CI 1.9% to 3.8%) possessed high nutritional knowledge (scores above 18). In terms of attitudes, 36.9% of respondents expressed positive views toward nutrition, with higher education significantly associated with positive attitudes (aOR=1.8; 95% CI 1.3 to 2.5, comparing higher vs lower education levels). Dietary variety was consistently reported by 65.4% of participants, while 8.5% lacked dietary variety. Statistically significant associations were observed between educational attainment, socioeconomic status and nutrition-related practices (p<0.05). Women with a university-level education achieved knowledge scores 3.2 times greater (95% CI 2.1 to 4.9) than those with only primary education. Moreover, individuals in the highest wealth quintile demonstrated practices that were 2.1 times superior (95% CI 1.5 to 3.0) to those in the lowest quintile. Nutritional counselling by professionals was positively correlated with improved attitudes (aOR=2.4; 95% CI 1.7 to 3.4).ConclusionAs a cross-sectional study, these findings highlight substantial gaps in nutrition knowledge among pregnant women in Tehran, with socioeconomic status and education playing crucial roles in shaping dietary behaviours. Improving nutritional education through healthcare interventions is essential for enhancing maternal and fetal health outcomes.

Background While evidence of efficacy, safety, and technical feasibility is crucial when introducing a vaccine, it is equally important to consider the psychological, social, and political factors influencing vaccine acceptance. This study aims to identify the factors contributing to COVID-19 vaccine hesitancy among adults in Tehran, Iran. Methods The study employed a descriptive and analytical cross-sectional design carried out from 2021 to 2022. It involved 260 eligible individuals residing in the catchment areas of Tehran and Shahid Beheshti Universities of Medical Sciences who declined to receive the COVID-19 vaccine, selected through systematic sampling. Data collection was accomplished through a researcher-developed questionnaire and analyzed using SPSS 26 software. The analysis utilized descriptive statistics and non-parametric tests including Mann-Whitney U, Kruskal-Wallis, and Multiple Linear Regression, to examine the relationships between variables. Results The average scores (SD) across dimensions were as follows: the individual’s health status and perceived risk, 15.53 (1.70); contextual and social effects, 17.68 (2.53); awareness, 14.81 (2.34); and beliefs and concerns. 14.91 (2.64), indicating a concerning situation regarding contextual and social impacts and a moderate status as to other areas. The primary reasons for vaccine refusal included fear, lack of belief in the vaccine, concerns about its reliability, illness, and lack of access or time. Acceptance of the vaccine was associated with education, occupation, marital status, number of children at home, and income reduction due to COVID-19. Conclusion The findings indicate that fear, lack of belief in the vaccine, concerns regarding its reliability, illness, and lack of access or time were the most important factors influencing reluctance to receive the vaccine. Health organizations should consider these factors when encouraging the population to receive the COVID-19 vaccine.

This study aimed to identify the reasons for inadequate use of PHC services to mitigate the barriers to utilization of PHC services in Saudi Arabia, Oman, Türkiye, Pakistan, Iraq, Thailand, China, India, Egypt, and Iran. This is a systematic review that synthesized the findings of original studies focused on the barriers to the utilization of PHC services. We searched the MEDLINE, Scopus, and Google Scholar databases from February 1, 2000, to December 29, 2023, in English. We conducted content analysis facilitated by MAXQDA-10 software drawn upon Levesque's framework. The screening of articles was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The initial search retrieved 1,613 results, of which we included 29 studies. In terms of methodology, 17 studies used quantitative methods, eight had qualitative approaches, and the remaining studies utilized mixed or other methods. Among the five groups of identified barriers, ability to perceive, ability to reach, and ability to pay were found to be noteworthy barriers that should be considered by health policymakers. Although the main barriers to inadequate use of PHC are related to people, raising awareness about the need for PHC, improving literacy through understandable training, and establishing mobile facilities in remote areas are appropriate strategies for increasing the use of PHC services.

Introduction The Sustainable Development Goals (SDGs) emphasize the critical need to reduce maternal and infant mortality and improve maternal health, which necessitates access to high-quality reproductive health (RH) services. By developing a comprehensive list of indicators, this study aims to support evidence-based decision-making and policy adjustments that respond to national and international reproductive health needs. Methods This is a scoping review from 2000 until 2020 in the international databases including PubMed/Medline, Scopus, Cochrane, WHO website, and ProQuest. We included studies that had abstracts, English language, and involved indicators related to reproductive health indicators. The selected articles were reviewed by two members of the team and then approved by the corresponding author. After collecting the primary indicators and removing duplications, the thematic classification of indicators was done. Results We found 2026 studies from three databases and excluded 301 duplicates. After reviewing the abstract, 250 and by reading the full text, 23 studies were included. Most studies were about reproductive health indicators that are indirectly practical in the measurement of reproductive health policies. Most of the studies were systematic reviews. The most frequent indicator among the included studies was the total fertility rate. Conclusion Effective monitoring of childbearing encouragement programs and reproductive health policies requires a multi-level approach, encompassing indicators that can be applied from health-center to national levels. This review has categorized existing indicators to provide a structured framework for evaluating population policies. The selected indicators from this review can serve as a guideline for policymakers to create customized monitoring systems that address the specific needs of their countries.

Introduction This study aimed to explore how Iranian primary health care (PHC) policies have influenced equity in Iran’s health system over the last 50 years, from the perspectives of policymakers. Methodology This qualitative research was conducted between 2019 and 2020. Following the identification, screening, and selection of the most relevant PHC policies through document analysis and expert consultation, 30 semi-structured interviews were conducted with various experts in Iran’s health system. The logical relationships among the data were analysed using the health policy triangle and thematic content analysis, facilitated by MaxQDA software. Findings Among the 28 identified PHC policies, five policy groups were recognised as the most significant in relation to health equity. These policies, particularly the PHC and District-level Health Networks (DHNs), have been instrumental in promoting social participation, intersectoral collaboration, and social equity, particularly in addressing acute and communicable diseases. The policies have also ensured equal access to basic health services, especially in rural areas, and have significantly impacted the delivery of care to the population across Iran when acute and communicable diseases were the primary health burden. However, in recent decades, the PHC and DHNs have struggled to keep pace with the dynamic societal changes, shifting disease patterns, and technological advancements. Discussion and conclusion While the policies have been successful in providing equitable care for acute and communicable diseases, improvements are required to address the rising burden of non-communicable diseases (NCDs). The integration of NCD care into Iran’s PHC and DHN requires a cultural shift towards preventive health and lifestyle changes. Political will and support from both the government and healthcare policymakers are essential to overcome barriers such as inherent conflicts of interest.

Introduction Health Equity Impact Assessment (HEIA) is a decision support tool that shows users how a new program, policy, or innovation affects health equity in different population groups . Various HEIA reporting and dissemination tools are available, nevertheless, a practical standard tool to present the results of HEIA in an appropriate period to policymakers is lacking. This work reports the development of a tool (a checklist) for HEIA reporting at the decision-making level, aiming to promote the application of HEIA evidence for improving health equity. Methods This is a mixed-method study that was carried out over four stages in 2022–2023: 1) identifying HEIA models, checklists, and reporting instruments; 2) development of the initial HEIA reporting checklist; 3) checklist validation; and 4) piloting the checklist. We also analyzed the Face, CVR, and CVI validity of the tool. Results We developed the initial checklist through analysis of 53 included studies and the opinions of experts. The final checklist comprised five sections: policy introduction (eight subsections), managing the HEIA of policy (seven subsections), scope of the affected population (three subsections), HEIA results (seven subsections), and recommendations (three subsections). Conclusion Needs assessment, monitoring during implementation, health impact assessment, and other tools such as monitoring outcome reports, appraisals, and checklists are all methods for assessing health equity impact. Other equity-focused indicators, such as the equity lens and equity appraisal, may have slightly different goals than the HEIA. Similarly, the formats for presenting and publishing HEIA reports might vary, depending on the target population and the importance of the report.

Aedes-borne diseases pose escalating public health challenges globally, influenced not only by ecological and biological factors but critically by social determinants of health (SDH). In Iran, emerging local transmission of dengue highlights these diseases as effective proxies to examine the impact of social and environmental factors on health equity. However, evidence on context-specific drivers and effective responses remains scarce. This study aimed to identify key SDH and propose prioritized interventions to inform evidence-based policymaking. This mixed-method study included a two scoping review on SDH of Aedes-Borne Diseases and SDH-focused interventions, complemented by qualitative data from in-depth interviews with 21 national and provincial health experts in Iran. Data were analyzed using an inductive content analysis approach and MAXQDA 25 software was used throughout the analysis. The identified interventions were prioritized through a multi-criteria decision analysis, incorporating expert input via an online checklist and digital platform, based on four key criteria: effectiveness, feasibility, social acceptability, and political support. Findings reveal that socioeconomic inequalities, weak community awareness, and limited health system capacity substantially drive disease risk. Notably, the local emergence and spread of dengue serve as a sensitive indicator reflecting broader social vulnerabilities affecting health outcomes. Integrated multisectoral strategies-encompassing health education, environmental management, digital surveillance, and cross-sector collaboration-are vital for effective control. Priority actions include healthcare worker training, embedding disease prevention within educational curricula, and tailored communication leveraging native languages and trusted community leaders. The study underscores that Aedes-borne diseases are not only biological threats but also reflections of underlying social and structural inequities. By framing dengue and related diseases as sentinel indicators of SDH, policymakers can better design integrated and equity-oriented strategies. Controlling Aedes-borne diseases requires a shift from disease-centric approaches toward comprehensive, SDH-informed strategies that strengthen community engagement, improve environmental and health infrastructure, and enhance cross-sector coordination. The prioritized interventions identified in this study provide a practical roadmap for strengthening preparedness and response in Iran and similar settings.