Urban policies for in-house vaccination of vulnerable people during COVID-۱۹ based on critical systems learning

KGROUND AND OBJECTIVES: Urban managers and local authorities tried to provide public health services to vulnerable groups and establish urban justice during the COVID-۱۹ pandemic. This research aims to evaluate the vaccination services of vulnerable groups at their houses in Tehran during the COVID-۱۹ pandemic through critical rethinking. Then it provides policies for developing an in-house healthcare services system for vulnerable groups.METHODS: This study applies a multi-methodology and multi-paradigm exploratory approach to design a systemic intervention by using qualitative and quantitative methods. For this purpose, the activists involved in the vaccination services of vulnerable groups in Tehran are primarily interviewed based on Critical Systems Heuristics methodology, and then the responses to the boundary questions in four basic areas, including motivation, control, knowledge, and legitimacy, have been analyzed. Afterward, the Strategic Assumptions Surfacing and Testing methodology, a systems approach for learning in complex problem situations, is used, along with the participation of urban decision-makers, to reveal the strategic assumptions for the development of an in-house vaccination services system for vulnerable populations. Finally, after dialectical discussions, system development solutions have been synthesized and integrated, and based on the importance level and certainty of the right assumption, certain planning regions have been detected.FINDINGS: Generally, healthcare services to vulnerable groups during the pandemic must be redefined based on the boundaries of control, knowledge, and legitimacy. According to the findings, ۳۴ strategic defaults were identified and ۱۷ defaults were proposed in the secure planning area, including: redefining the provision of healthcare services to vulnerable groups during the pandemics; providing services to all vulnerable groups during disasters through Tehran’s joint emergency response call center; providing stable financial resources to perform services to vulnerable populations during the pandemics; collecting, updating, and integrating the related databases (such as elderlies, patients, people with disabilities, etc.); training service providers (e.g. call center operators, vaccinators, etc.) in accordance with the specific situations of vulnerable groups; developing guidelines for providing in-house services to vulnerable people; obliging the managers to be accountable for obeying protective laws relating to vulnerable groups in disaster; identifying the potential capacities of the private sectors and nongovernmental organizations; considering a medical support team; consulting with advisors and caregivers of vulnerable groups; using temperature recording devices to ensure the cold chain of vaccines; and setting up local disaster management support bases in order to assure the agility of the provided services to the vulnerable populations in Tehran.CONCLUSION: The current study deals with the critical rethinking of providing health services to vulnerable populations during a pandemic, by designing a systemic intervention. Besides finding learning fields from the COVID-۱۹ experiences, this research explores the strategies for redesigning and developing a more efficient healthcare service system for vulnerable groups in disasters like the COVID-۱۹ pandemic.

کلیدواژه ها:

In-house vaccination Services ، Urban Management ، Vulnerable groups ، Covid-۱۹ Pandemic ، Critical Systems Heuristics (CSH) ، Strategic Assumptions Surfacing and Testing (SAST)