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Table 4 The mitigating measures for the resilience of Iran’s health system

From: Health system to response to economic sanctions: global evidence and lesson learned from Iran

Code

Mitigating measures

Health System Function towards resilience

Source of data

Delphi

1

Proactive inventory control

Efficient and equitable service delivery

Review

Accepted

2

Developing the list of nationally essential medicines

Efficient and equitable service delivery

Review

Accepted

3

Providing additional clarification that Iranian oil revenues can be freely used for medicine procurement without reservations

Sustained financing

Review

Accepted

4

Using the capacity of some international intermediate organizations and certain companies and financial institutions to facilitate purchasing medical items

Good governance

Review

Accepted

5

Defining tailored health service packages for vulnerable populations

Efficient and equitable service delivery

Interview and gray literature

Accepted

6

Establishing and improving a strong surveillance system

Integrated and updated health information system

Review & Interview and gray literature

Accepted

7

Price reduction of imported medicines through public resources

Sustained financing

Review

Accepted

8

Developing dual policies of equity and priority for vulnerable groups

Good governance

Review

Accepted

9

Institutionalizing fair and effective resource allocations

Sustained financing

Interview and gray literature

Accepted

10

Considering collateral pathways for procurement of required medical items

Good governance

Review & Interview and gray literature

Accepted

11

Extra financial protection for special, incurable, and chronic patients and for allocation of the additional budget to over-compensate unaffordable pharmaceutical products

Sustained financing

Review

Accepted

12

Providing clinical guidelines for rational prescribing

Efficient and equitable service delivery

Review

Accepted

13

Establishing an appropriate organizational structure to deal with the sanction

Good governance

Review & Interview and gray literature

Accepted

14

Having constant collaboration and active social networks at both national and global levels

Good governance

Review & Interview and gray literature

Accepted

15

Prioritizing health among public policies

Sustained financing

Review

Accepted

16

Strengthening evidence-informed policymaking

Good governance

Review & Interview and gray literature

Accepted

17

Preventing third parties, black market dealers, pharmacies, and health facilities that provide unsafe medicines as well as smugglers

Good governance

 

Accepted

18

Facilitating immediate release of medicines from the customs with minimum financial documents

Service delivery

Review

Accepted

19

Adapting exportation laws based on domestic needs

Good governance

Review

Accepted

20

Conducting Health Impact Assessments (HIAs) that identify the effects of sanctions on healthcare

Good governance

Review

Accepted

21

Founding for health via sustained sources

Sustained financing

Interview and gray literature

Accepted

22

Investing in domestic production

Sustained financing

Review & Interview and gray literature

Accepted

23

Empowering the community and increasing their participation

Good governance

Review & Interview and gray literature

Accepted

24

Strengthening the global health diplomacy

Good governance

Review & Interview and gray literature

Accepted

25

Establishing support mechanisms to prevent and control the social harms of the economic outcomes of sanctions (e.g., the protection of working children)

Efficient and equitable service delivery

Review

Accepted

26

Improving the system for fair and effective allocation of resources between health plans and relevant executive bodies in health

Sustained financing

Review & Interview and gray literature

Accepted

27

Institutionalizing economic evaluation of medicines, medical devices and equipment, and health services

Sustained financing

Review & Interview and gray literature

Accepted

28

Optimizing the use of human resources (by improving competencies and making appropriate use of job descriptions, e.g., avoiding specialization in basic services)

Qualified workforces

Interview and gray literature

Accepted

29

Preparedness and planning for sanction

Good governance

Interview and gray literature

Rejected

30

Strong leadership and management

Good governance

Review & Interview and gray literature

Rejected

31

Optimizing the domestic market

Sustained financing

Review

Rejected

32

Strengthening the insurance system

Sustained financing

Review

Rejected

33

Strengthening of inter-sectoral cooperation

Good governance

Review

Rejected

34

Paying more attention to mass media

Good governance

Review

Rejected

35

Management and development of health tourism

Good governance

Review

Rejected

36

Electronic health record

Integrated and updated health information system

Review

Rejected

37

Electronic prescription

Integrated and updated health information system

Review

Rejected

38

Proper implementation of the referral system

Efficient and equitable service delivery

Review

Rejected

39

Medication tracking

Efficient and equitable service delivery

Review

Rejected

40

Consumer–patient collaboration

Efficient and equitable service delivery

Review

Rejected