**Building a More Resilient Health System through Strengthening the Health Surveillance System in Iran**

#### **Azam Raoofi1,2 and Amirhossein Takian1,2,3**

1Department of Health Management, Policy & Economics, School of Public Health; Tehran University of Medical Sciences, Tehran, Iran 2Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran 3Professor & Head of Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

The risk of microbial threats to global health has increased due to globalization. The Center for Disease Control and Prevention (CDC) in Iran is responsible for preventing, controlling, monitoring and responding to microbial threats, including emerging and re-emerging infectious diseases, zoonosis, vector-borne diseases. Nevertheless, COVID-19 revealed insufficient efficiency of CDC in Iran to respond to the health threats. Our research aims to strengthen the CDC and health surveillance system in Iran using the health system strengthening (HSS) good governance approach. This is an ongoing qualitative study based on both deductive and inductive approaches. First, using systematic document content analysis and through the lenses of the health policy triangle and the stage heuristic model, policies related to microbial threats in Iran (Nov 2016–Oct 2021) were analyzed. We conducted five semi-structured interviews, which will continue until saturation, and identified a list of relevant actors for stakeholder network analysis. Using the Health Policymaking Governance Guidance Tool, we explored good governance in the policy formulation process to respond to the microbial threats and identify policy options to strengthen CDC governance in Iran. The next step will be policy option prioritization through policy dialogue and the VIKOR method. Finally, we will develop and validate a practical model for strengthening CDC and health surveillance systems in Iran using the Walker & Avant method. Through documents content analysis, we classified policies into eight main themes, including vaccination, policy and research priorities, financing, monitoring and evaluation, accountability and responsibility, information sharing, economic support, and vulnerable groups. Findings on COVID-19 policies led to the identification of 6 themes and 33 sub-themes in the content, 5 themes and 30 sub-themes in the context, and 6 themes and 19 sub-themes in the process categories. The analysis of positions and powers of the 33 identified actors showed that the supreme leader of Iran has the most power and provides the most support to these policies. Our findings might serve as a roadmap to facilitate evidence-based policymaking with a whole-government, whole-society approach, meanwhile increasing multi-sectoral collaboration and strengthening the governance of health surveillance systems in Iran and similar settings.


Azam Raoofi1,2 and Amirhossein Takian1,2,3

1 Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2 Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran 3 Professor & Head of Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran


We would like to express our sincere appreciation to all interviewees and experts who gave us advice to conduct this study.

