Developing an organizational capacity assessment tool and capacity-building package for the National Center for Prevention and Control of Noncommunicable Diseases in Iran

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.

[1]  R. Majdzadeh,et al.  Intersectoral collaboration in the management of non-communicable disease’s risk factors in Iran: stakeholders and social network analysis , 2022, BMC Public Health.

[2]  B. Larijani,et al.  The Effect of the COVID-19 Pandemic on Non-Communicable Disease Prevention and Management Services in the Primary Health Care System of Iran , 2021, Medical journal of the Islamic Republic of Iran.

[3]  E. Strumpf,et al.  Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada , 2020, Canadian Journal of Public Health.

[4]  R. Majdzadeh,et al.  Assessment and prioritization of the WHO “best buys” and other recommended interventions for the prevention and control of non-communicable diseases in Iran , 2020, BMC Public Health.

[5]  A. Heidari,et al.  Implementation of integrated management of non-communicable disease prevention and control in Iran: A proposal , 2020, Health Monitor Journal of the Iranian Institute for Health Sciences Research.

[6]  David D. Kim,et al.  Prevention of non-communicable disease: best buys, wasted buys, and contestable buys , 2020, BMJ.

[7]  A. Mosadeghrad,et al.  Health system governance in Iran: A comparative study , 2019 .

[8]  L. Allen,et al.  Implementation of non-communicable disease policies: a geopolitical analysis of 151 countries , 2019, The Lancet. Global health.

[9]  P. Delobelle Big Tobacco, Alcohol, and Food and NCDs in LMICs: An Inconvenient Truth and Call to Action , 2019, International journal of health policy and management.

[10]  D. Magraw,et al.  Addressing NCDs: Protecting Health From Trade and Investment Law , 2019, International journal of health policy and management.

[11]  F. Farzadfar,et al.  Trend and projection of mortality rate due to non-communicable diseases in Iran: A modeling study , 2019, PloS one.

[12]  Orana Chandrasiri,et al.  Addressing NCDs: Challenges From Industry Market Promotion and Interferences , 2019, International Journal of Health Policy and Management.

[13]  T. K. Young,et al.  The north is not all the same: comparing health system performance in 18 northern regions of Canada , 2019, International journal of circumpolar health.

[14]  A. Vaidya Capacity building: A missing piece in Nepal’s plan for prevention and control of non-communicable diseases , 2018, Journal of Kathmandu Medical College.

[15]  Gretchen A. Stevens,et al.  NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4 , 2018, The Lancet.

[16]  G. Asiki,et al.  Multi-sectoral action in non-communicable disease prevention policy development in five African countries , 2018, BMC Public Health.

[17]  R. Malekzadeh,et al.  Scientometric Study on Non-communicable Diseases in Iran: A Review Article , 2018, Iranian journal of public health.

[18]  S. Nishtar,et al.  Time to deliver: report of the WHO Independent High-Level Commission on NCDs , 2018, The Lancet.

[19]  S. Yazdani,et al.  Multi-sectoral Requirements of Non-Communicable Diseases Stewardship in Iran , 2018 .

[20]  N. Roberts,et al.  Evaluation of research on interventions aligned to WHO ‘Best Buys’ for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015 , 2018, BMJ Global Health.

[21]  Tabaré Vázquez,et al.  Beating NCDs can help deliver universal health coverage , 2017, The Lancet.

[22]  T. Vos,et al.  Global, regional, and national incidence and prevalence, and years lived with disability for 328 diseases and injuries in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 , 2017 .

[23]  Melinda D. Sawyer,et al.  Towards high-reliability organising in healthcare: a strategy for building organisational capacity , 2017, BMJ Quality & Safety.

[24]  Sally E. Green,et al.  Sustainability in Health care by Allocating Resources Effectively (SHARE) 5: developing a model for evidence-driven resource allocation in a local healthcare setting , 2017, BMC Health Services Research.

[25]  N. Roberts,et al.  Are WHO "best buys" for non-communicable diseases effective in low-income and lower-middle-income countries? A systematic review , 2017 .

[26]  R. Malekzadeh,et al.  National action plan for non-communicable diseases prevention and control in Iran; a response to emerging epidemic , 2017, Journal of Diabetes & Metabolic Disorders.

[27]  A. Heidari,et al.  A Challenges in Implementing Package of Essential Noncommunicable Diseases Interventions in Iran’s Healthcare System , 2016 .

[28]  Dan J Stein,et al.  Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 , 2015, BDJ.

[29]  R. Magnusson,et al.  How Can We Strengthen Governance of Non-Communicable Diseases in Pacific Island Countries and Territories? , 2015 .

[30]  N. Abu-Rmeileh,et al.  Research capacity and training needs for non-communicable diseases in the public health arena in Turkey , 2014, BMC Health Services Research.

[31]  Xiaoming Shi,et al.  [Assessment on the capacity for programs regarding chronic non-communicable diseases prevention and control, in China]. , 2014, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[32]  Hoang Van Minh,et al.  Describing the primary care system capacity for the prevention and management of non-communicable diseases in rural Vietnam. , 2014, The International journal of health planning and management.

[33]  Meredith Davis,et al.  Defining organizational capacity for public health services and systems research. , 2012, Journal of public health management and practice : JPHMP.

[34]  N. Awofeso Organisational Capacity Building in Health Systems , 2012 .

[35]  A. Srivastava,et al.  Framework Analysis: A Qualitative Methodology for Applied Policy Research , 2009 .

[36]  I. Bourgeois,et al.  Informing Evaluation Capacity Building Through Profiling Organizational Capacity for Evaluation: An Empirical Examination of four Canadian Federal Government Organizations , 2009, Canadian Journal of Program Evaluation.

[37]  A. Lalonde,et al.  Methodology for assessment and development of organization capacity. , 2008, Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC.

[38]  A. Handler,et al.  A conceptual framework to measure performance of the public health system. , 2001, American journal of public health.

[39]  C. H. Lawshe A QUANTITATIVE APPROACH TO CONTENT VALIDITY , 1975 .

[40]  Political declaration of the third high-level meeting of the General Assembly on the prevention and control of noncommunicable diseases , 2021 .

[41]  Charlotte Taylor Westfall Got Inclusion? How Inclusive is your Organization? Assessing Inclusion through the iCAT: Inclusion Capacity Assessment Tool for Organizational Capacity , 2016 .

[42]  Daniel R Hogan,et al.  Health in 2015: From MDGs Millennium Development Goals to SDGs Sustainable Development Goals. , 2015 .

[43]  M. Motlagh,et al.  TREND AND GEOGRAPHICAL INEQUALITY PATTERN OF MAIN HEALTH INDICATORS IN RURAL POPULATION OF IRAN , 2008 .

[44]  N. P. Napalkov,et al.  for the prevention and control of noncommunicable diseases , 1999 .