Iran’s Hypertension and Diabetes Mellitus Surveillance System and Its Implementation Challenges: A Case Study of Tehran Uni- versity of Medical Sciences

Yosra  Azizpour; Sarmad  Salehi; Azita  Karimi; Samaneh  Akbarpour

doi:10.18502/jbe.v11i2.20553

Yosra Azizpour Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Sarmad Salehi Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Azita Karimi Department of Health, Noncommunicable Disease Group, Tehran University of Medical Sciences, Tehran, Iran.
Samaneh Akbarpour Sleep Breathing Disorders Research Center (SBDRC), Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/jbe.v11i2.20553

Keywords: Hypertension; Diabetes; Surveillance system; Challenges; Iran

Abstract

Introduction: Surveillance systems play a vital role in managing non-communicable diseases (NCDs). This study explores thechallenges encountered in the implementation of Iran's hypertension (HTN) and diabetes surveillance system, using TehranUniversity of Medical Sciences (TUMS) as a case study.

Methods: This study employed a two-part approach, consisting of a literature review and an expert panel discussion. In the firstpart, a literature review was conducted using PubMed and Google Scholar, encompassing studies published between 2000 and2023 in both Persian and English. The objectives of this review were to: 1) investigate the history of diabetes and HTN surveillancesystem and 2) identify implementation challenges of the surveillance system for these conditions. The sources included nationalguidelines, health surveys, published reports, and academic papers. In the second part, five expert panel discussions (formalfocus groups) were conducted semi-structured with seven TUMS specialists. These sessions aimed to pinpoint the challengesin implementing diabetes and HTN surveillance in Iran. Finally, data from both parts were analyzed using conventional contentanalysis with an inductive approach and were categorized and coded using MAXQDA software to extract the key challenges inimplementing the surveillance system.

Results: The National HTN Prevention and Control Program was initiated in 1992 and later expanded its focus to includeindividuals (both males and females) aged 30 and older in rural areas. In 2004, it merged with the National diabetes Preventionand Control Program, which was established in 1991. This program primarily targeted high-risk individuals aged 15 to 39, as wellas those over 40 in selected pilot rural areas. Together, these programs now address both HTN and diabetes prevention throughthe IraPEN program, launched in 2014. The analysis identified three main categories and eleven subcategories, resulting in a totalof 78 codes. The issues have been categorized into three areas: healthcare recipients (lack of public awareness and social issues),healthcare system employees (staffing issues and inadequate training), and upper levels of the healthcare system (ineffectivepolicies, poor evaluation and monitoring, outdated facilities, weak management, insufficient data, and financial constraints).

Conclusion: The study identifies challenges within Iran's healthcare system that impede surveillance programs. To improveoutcomes, we should prioritize public education, provide better support for healthcare workers, and implement strongermanagement practices. By adopting these changes, we can enhance the surveillance systems for HTN and diabetes.