Tab. III.
The challenges of the Iranian health system in fighting COVID-19; resources.
| Themes | Line-managers | Staff-managers | Sub-themes and related codes | |
|---|---|---|---|---|
| Financial resources | ✓ | Financing | Lack of finical support for research and hygiene | |
| ✓ | ✓ | Lack of necessary budget and credit | ||
| ✓ | Lack of transparency in funding some of the actions taken and the problem of paying for them | |||
| ✓ | Consequences of quarantine such as economic problems | |||
| ✓ | Inadequacy payment benefits and support for medical staff | |||
| ✓ | ✓ | Income and cost | Decreased revenue of hospitals and the consequent problems | |
| ✓ | ✓ | Increase costs per case | ||
| Human resources | ✓ | ✓ | Education | The problems in the area of education (training) or continuing it during the pandemic |
| ✓ | The professors’ unpreparedness for virtual education | |||
| ✓ | ✓ | Inefficiency of the education provided for the personnel to fight the critical and emergency conditions | ||
| ✓ | ✓ | Lack of up-to-dated and inadequate education about infectious and respiratory diseases and how to care for the patients | ||
| ✓ | Acceptance and mental preparation | Lack of proper insight to the disease | ||
| ✓ | ✓ | The personnel’s (the nurses and specialists) fear and anxiety of being infected by this virus and transferring that to their family | ||
| ✓ | ✓ | Lack of acceptance and willingness to face the disease in the personnel | ||
| ✓ | ✓ | Inadequate mental preparedness in the personnel and the consequent mental problems | ||
| ✓ | ✓ | Fatigue and burnout of medical staff / manpower | ||
| ✓ | Needs and expectations | The personnel’s expectation for supplying personal protective equipment | ||
| ✓ | Providing proper welfare and nutrition facilities for the corona ward personnel | |||
| ✓ | Number and distribution of human forces | The absence of some of the employees from their workplace | ||
| ✓ | ✓ | Increased work load and numerous responsibilities of the personnel | ||
| ✓ | ✓ | The employees’ personal problems such as pregnancy, having underlying diseases, and high risk conditions | ||
| ✓ | ✓ | Lack of manpower | ||
| ✓ | ✓ | Lack of specialist and trained manpower | ||
| ✓ | Inappropriate distribution of manpower and employing them in inappropriate positions | |||
| ✓ | ✓ | Infection or death of health workers | ||
| ✓ | Weaknesses in professional skills | The personnel’s inability to management the disease load | ||
| ✓ | Negligence and not taking seriously in infection control by some of the specialists | |||
| ✓ | Challenges in the relationship between the personnel and patients | |||
| Drugs and medical equipment | ✓ | ✓ | Consumables and personal protective equipment | Lack of personal protective equipment such as the ordinary masks, n95 masks, gloves, clothes, shield, glasses, head cover, shoe cover, etc. |
| ✓ | ✓ | Low quality of some of the personal protective equipment | ||
| ✓ | ✓ | Lack of disinfectants | ||
| ✓ | ✓ | The need to supply a lot of personal protective equipment and disinfectant in the early stages of the pandemic | ||
| ✓ | ✓ | High price and hoarding of the personal protective and consumables equipment | ||
| ✓ | ✓ | Diagnostic equipment | Lack of kit and diagnostic equipment | |
| ✓ | High price of coronavirus diagnosis kits | |||
| ✓ | ✓ | Low accuracy of the diagnosis kits | ||
| ✓ | Time-consuming process of diagnosis | |||
| ✓ | ✓ | Medical equipment | Lack of medical equipment (ct scan, oxygen generator, respiratory aids, laser thermometer, and pulse oximeter) and updated laboratory and diagnostic facilities | |
| ✓ | Shortage of hospital beds, especially icu beds | |||
| ✓ | ✓ | Depreciated facilities and equipment | ||
| ✓ | Lack of biobank | |||
| ✓ | Impossibility of supplying medical equipment from foreign countries | |||
| ✓ | Drugs | Shortage of useful and effective drug for the disease in the early stages of the pandemic | ||
| ✓ | High price of drugs | |||
| Physical space and facilities | ✓ | ✓ | Shortage of physical space in hospitals for reception of respiratory patients such as coronavirus cases | |
| ✓ | Observance of infection control protocols in allocation of physical space to coronavirus wards | |||
| ✓ | Inobservance of standards in temporary treatment centers and their low popularity | |||
| ✓ | Shortage of laboratory space | |||
| ✓ | Lack of infectious (biological) ward, negative pressure ventilation system, and standard isolation room in some of the hospitals | |||
| ✓ | Lack of specialized biological (infectious) hospital in the country | |||
| ✓ | Inappropriate ventilation in some units | |||
| ✓ | Density of personnel in some units | |||