A Stakeholder Perspective on Diabetes Mellitus and Diabetic Retinopathy Care in Iran; A Qualitative Study

Objective: To assess the national health system for management of diabetes mellitus (DM) in Iran, with particular focus on diabetic retinopathy (DR). Materials and Methods: In this qualitative study, the national stakeholders related to DR and DM management system were invited to participate. Two researchers performed interview using a semi-structured questionnaire recommended by the World Health Organization titled "Tool for Assessment of Diabetic Retinopathy and DM Management Systems". The questionnaire contains seven different sections, each consisting of dosed and open-ended questions, and a final Likert-type score, ranging from 1 indicating the worst to 4 indicating the best status. Inconsistencies were resolved through a collective decision of the research team, followed by a focus group discussion with stakeholders at the Ministry of Health. Results: Fourteen stakeholders out of 15 total invitees were interviewed (response rate: 93.3%). There were national priorities, defined policies, and running programs (score = 3), but the care system should be strengthened in terms of implementation of clinical guidelines, with specific reference to the availability of regular screenings for DR (score = 2). The network of care providers, health information systems, and promotional programs were insufficient (score = 2). The health workforce and technology for DR and DM were acceptable (scores 4 and 3, respectively); however, there were concerns about the appropriate distribution and utilization of resources and out-of-pocket costs paid by patients. Conclusion: The existence of national policies, programs, a qualified workforce, and modern technology is promising. Nevertheless, other aspects of the health system need to be improved to ensure access to health and eye care for people with DM and achieve universal health coverage.