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Table 3 Themes, sub-themes, and suggested quotes

From: Physical rehabilitation in Iran after international sanctions: explored findings from a qualitative study

Themes

Sub-themes

Quotes

Socio-economic challenges

Inadequate funding

“Much of the [Iranian] health and welfare system’s budget comes from oil and petrochemical sales. In recent years, government revenues have fallen sharply...” (Health policy-maker 3)

Rising inflation rate

“So our costs have increased. We have to cover essential health services and not include any services like physiotherapy.” (Health policy-maker 6)

High unemployment rate

“Our insurance funds are really in trouble. After the sanctions, many have become unemployed. They don’t even pay a premium!” (Health policy-maker 1)

Catastrophic expenditures

“After the sanctions, prostheses have become really expensive. How can an amputee who often has no income pay around 120 million Rials [Iranian currency] for a below-knee prosthesis?” (Practitioner 9)

Inappropriate employment status of practitioners

“Rental rates for a clinic have gone up. Many of my colleagues have closed down. Not really economical. The inflation of sanctions has destroyed us.” (Practitioner 10)

“We have no job opportunities in other countries … But if there is some kind of international cooperation right now, the credibility of our degree will increase.” (Practitioner 4)

Education challenges

Decreasing the international collaboration

“Because of the sanctions, our department’s collaboration with other universities around the world has diminished. We used to exchange doctoral students. The students had very good experiences that were very valuable for the development of the field [occupational therapy].” (Faculty member 8)

Shortage of training devices and materials

“After the sanctions, we do not have many advanced training tools” (Faculty member 3)

International challenges

Rising challenges for patients from neighborhood countries

“Many amputees came here from Afghanistan and received prostheses. But now that our raw materials are reduced, we can’t provide them with services.” (Rehabilitation expert 2)

Service delivery challenges

Shortage of raw materials for producing the orthoses and prostheses

“Although we work in a non-governmental organization, after the U.S. sanctions, there are not many devices. We used artificial foot, produced by a German company named Ottobock for below-knee amputees, the patients were very happy, but now we have to use Chinese low-quality feet. After a few days, the foot will break!” (Practitioner 4)

Hardening of the importing the needed equipment

“We needed some devices like Shock wave therapy, but we couldn’t import them. Interestingly, some equipment is only available in large cities.” (Practitioner 9)

Inappropriate infrastructures

“The rehabilitation infrastructures are really worn out, especially in the government sector. The facilities of the State Welfare Organization were from twenty to thirty years ago. Many facilities and features have not been updated. These sanctions have greatly restricted our works.” (Rehabilitation expert 4)

“Many of our tools are outdated. For example, we were not given the technology of new orthoses. We are still building an orthosis that has been around for the past twenty years.” (Practitioner 8)

 

Impossibility to use external assistance

“Many international organizations, such as the World Health Organization, the United Nations, and others, allocate large funds annually for the services of disadvantaged groups such as the disabled and the elderly, but because we are sanctioned, these resources are not allocated to us …” (Rehabilitation expert 5)

“We tried to use the services of international accreditation agencies to improve the quality of services, but they said that you are sanctioned and we are not going to cooperate with you ...” (Rehabilitation expert 1)