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Introduction: The prevention and control of noncommunicable diseases (NCDs) are one of the main challenges of healthcare systems around the world. In addition to the technical level, it requires political negotiations and solutions, such as global health diplomacy (GHD), which involves the participation of a wide range of actors and stakeholders and innovative international health partnerships. This review aimed to draw lessons for strengthening linkages with a wide range of actors and stakeholders from the GHD literature for NCDs, and how policymakers and political leaders can effectively use international health partnerships to beat NCDs. Methods: This research was a systematic review of the literature on GHD for NCDs. All relevant articles published in English were identified by searching PubMed, Web of Science, Scopus, and Embase databases, Google and Google Scholar search engines, and the reference lists of identified articles as well as a number of special journals. 30 articles that met the inclusion criteria were analyzed using content analysis in MAXQDA 10. The Global Health Diplomacy Pyramid and Blouin and Dubé's (2010) analytical framework for examining negotiations were used to classify the data. Findings: 30 articles have been published on GHD for NCDs. Five key themes, i.e. the specific problem requiring global collective action, key actors, their interests in the problem, potential negotiation process, and potential scenarios for collective action and 46 sub-themes were identified. Moreover, given the importance of collaboration on NCDs in the international arena, actors were categorized into three groups based on the GHD Pyramid: (1) core diplomacy, (2) multi-stakeholder diplomacy, and (3) informal diplomacy. Conclusion: Development and adoption of a global policy to tackle the rise in NCDs in developed and developing countries require policymakers and political leaders that participate in GHD. Successful developments in global health policy depend on the performance of and respectful relationships among the stakeholders, and global health diplomats need to understand the complexities of the institutional structures and functional relationships of the international institutions involved in health. © 2020 The Author(s).

Abstract Background and aim Understanding the characteristics of global policy actors and the political context in which they address diplomatic issues in the field of NCDs can play an important role in advancing NCD-related goals. The purpose of this study was to identify and analyze the network of global health actors in the field of NCDs in Iran. Methods This study was conducted in 2020 using a qualitative methodology and framework analysis. In-depth semi-structured interviews were conducted with subject-matter experts from all levels of diplomacy, including global, regional, and national, who had managerial, administrative, and academic experience. Findings A total of 21 interviews were conducted with individuals who met the inclusion criteria. Following the framework of the World Health Network, the findings were divided into three general areas: the features of the network and the actors; the policy environment; and the characteristics of the issue. Conclusion A successful and sustainable program to combat NCDs requires the participation of multiple actors from governments, the private sector, and civil society at international, national, and local levels. The Global Network for Prevention and Control of NCDs should enhance the effectiveness of NCDs policies by highlighting the need to simultaneously improve the internal factors of the network, including relationships among the actors; external factors, including the policy environment; and the complex nature of NCDs.

Background: Inadequate financing is one of the major barriers in securing equitable access to high-quality physical rehabilitation services, without imposing financial hardship. Despite this, no sufficient attention has been paid to physical rehabilitation services and no specific financial resources have been allocated to such services in many countries including Iran. Owing to the fact that effective decision- and policy-making requires identifying possible stakeholders and actors and their characteristics, in the current study a stakeholder analysis and also a social network analysis (SNA) was conducted to identify the potential stakeholders and also their characteristics involved in physical rehabilitation financing (PRF)-related policies in Iran. Methods: The present study was performed in two phases. Firstly, semi-structured interviews and relevant document review were conducted to identify the stakeholders. Then, the position, power, interest, and influence of each stakeholder were determined using a web-based questionnaire. Secondly, SNA approach was utilized to map and visualize the interactions among stakeholders. Results: The findings showed that there are different stakeholders in PRF-related decision- and policy-making processes in Iran. In addition, the position, power, interest, and influence level of the identified stakeholders were varied. Moreover, although some stakeholders, like the Ministry of Health and the parliament have the highest level of power and position, they lack sufficient interest to participate in PRF-policies. Furthermore, SNA demonstrated that social network density was low, which indicates the lack of proper collaboration and interaction among the stakeholders. Conclusion: As many powerful and influential stakeholders had low interest levels to warrant participate in the FPR-related decision- and policy-making processes in Iran, employing careful and effective strategies, that is ongoing negotiations, receiving advocacy, and making senior managers and policy-makers aware can be helpful. © 2020 The Author(s).

BACKGROUND: The steady rise in noncommunicable diseases (NCDs) worldwide has been a key global health challenge. Governments have the primary responsibility for taking action to prevent and control NCDs. Given the growing importance of globalization of healthcare as well as the increasing use of soft power, governments need to identify challenges and opportunities to enhance global health diplomacy (GHD) for NCD prevention and control. The purpose of this qualitative research was to explain the challenges and opportunities of GHD for NCDs in Iran. METHODS: This study was conducted in 2020 using a qualitative approach and through in-depth, semi-structured interviews with 21 experts and specialists in related fields such as health policy, healthcare management, epidemiology and other related specialties. The participants were selected from all levels of diplomacy, including global, regional and national levels, with at least 3 years of experience in managerial, executive and scientific activities. Data analysis was performed by content analysis with an inductive approach. Data were analysed using inductive content analysis. RESULTS: The identified challenges were categorized into five main themes, including content challenges, structural challenges, process challenges, governance challenges and cultural challenges. Opportunities extracted from the interviews were also categorized into four main themes, including strong political will, utilizing the capacity of nongovernmental organizations (NGOs), multisectoral collaborations and a well-developed health system. CONCLUSIONS: NCD prevention and control requires a multilateral collaboration-based solution. Recognition of the challenges and opportunities in GHD can help draw significant lessons for building the necessary capacities and implementing more effective policies to prevent and control NCDs.

BACKGROUND: Inadequate financing is one of the major barriers in securing equitable access to high-quality physical rehabilitation services, without imposing financial hardship. Despite this, no sufficient attention has been paid to physical rehabilitation services and no specific financial resources have been allocated to such services in many countries including Iran. Owing to the fact that effective decision- and policy-making requires identifying possible stakeholders and actors and their characteristics, in the current study a stakeholder analysis and also a social network analysis (SNA) was conducted to identify the potential stakeholders and also their characteristics involved in physical rehabilitation financing (PRF)-related policies in Iran. METHODS: The present study was performed in two phases. Firstly, semi-structured interviews and relevant document review were conducted to identify the stakeholders. Then, the position, power, interest, and influence of each stakeholder were determined using a web-based questionnaire. Secondly, SNA approach was utilized to map and visualize the interactions among stakeholders. RESULTS: The findings showed that there are different stakeholders in PRF-related decision- and policy-making processes in Iran. In addition, the position, power, interest, and influence level of the identified stakeholders were varied. Moreover, although some stakeholders, like the Ministry of Health and the parliament have the highest level of power and position, they lack sufficient interest to participate in PRF-policies. Furthermore, SNA demonstrated that social network density was low, which indicates the lack of proper collaboration and interaction among the stakeholders. CONCLUSION: As many powerful and influential stakeholders had low interest levels to warrant participate in the FPR-related decision- and policy-making processes in Iran, employing careful and effective strategies, that is ongoing negotiations, receiving advocacy, and making senior managers and policy-makers aware can ...

BACKGROUND: Adequate financing is a crucial function, securing that physical rehabilitation services (i.e., physiotherapy, occupational therapy, prosthetics and orthotics) are available with no financial hardship. Like many other countries, despite the adoption of various policies and strategies in recent decades, Iran enjoys no desirable physical rehabilitation financing (PRF). Accordingly, this qualitative study aimed to explore the PRF-related strategies and issues as well as their impacts on relevant policies in Iran. METHODS: An analysis of PRF-related policies was conducted in Iran using semi-structured interviews and policy documents review. Purposive and snowball sampling techniques were employed to select key informants, including health-policy makers, civil society, rehabilitation-policy makers, university professors, and practitioners. Thematic analysis was used to analyze the collected data. The analysis was framed within Kingdon's multiple streams. RESULTS: The hindering factors for desirable financing were weak insurance coverage, lack of sustainable financial resources, fragmented financing, lack of split between provider and financer, high-cost of physical rehabilitation services, low engagement of relevant experts in policy-making processes, and corrupt activities. In the policy stream, the following factors were highlighted: involvement of sustainable financial resources, the use of external revenue sources, allocated resources' earmarking, the integration of the current funds to have better pooling, the use of incentive and timely payment mechanisms, the implementation of strategic purchasing principals, and the employment of effective rationing strategies. Moreover, parliament support, changes in administrations, international effects, pressures from interest campaigns and NGOs, and international sanctions were found as factors affecting the politics stream. CONCLUSION: The study findings revealed that a variety of national and international factors affect PRF-related issues in Iran. The ...

BACKGROUND: Although the main aims of sanctions are the political and economic pressures on governments, literature has demonstrated the harsh effects of sanctions on the general public, especially on the patients, poor and disabled people. Since the international sanctions regime negatively affected almost all dimensions of Iran's health sector, this qualitative study was conducted to investigate the situation of the physical rehabilitation sector after these sanctions. METHODS: This qualitative study was conducted from January 2019 to June 2019 in Iran using Skype, telephone, and face-to-face in-depth semi-structured interviews. Purposive and snowball sampling approaches were used to identify the participants. Also, framework analysis approach was applied to analyze the collected data. RESULTS: In total, 38 individuals including health policy-maker, faculty member, rehabilitation expert, Physiotherapist, Occupational therapist, and Orthotist/Prosthetist, were involved in the study. Based on our findings, a number of challenges facing the Iranian physical rehabilitation sector during the international sanctions period included: 1) socioeconomic challenges (inadequate funding, rising inflation rate, high unemployment rate, catastrophic expenditures, and inappropriate employment status of practitioners); 2) education challenges (decreased international collaboration and shortage of training devices and materials); 3) international challenges (rising issues in accessing services for patients from neighborhood countries); and 4) service delivery challenges (shortage of raw materials for producing the orthoses and prostheses, hardening of the importing the needed equipment, inappropriate infrastructures, and impossibility to use external assistance). CONCLUSION: After international sanctions, the Iranian physical rehabilitation sector has faced considerable multifaceted challenges. Therefore, the international community must be aware of the situation and be concerned about the irreparable consequences.