Lessons Learned from Conducting a National Health Survey (Iran's Multiple Indicators Demographic and Health Survey 2010).

Dear Editor-in-Chief

Iran’s Multiple Indicator Demographic and Health Survey (IrMIDHS) was developed and implemented in 2010 to provide health policy-makers with more recent evidence (1, 2). For conducting this national household survey, the Iranian Ministry of Health & Medical Education (MoHME) commissioned the National Institute of Health Research (NIHR) to conduct the survey under the supervision of the MoHME’s Deputy for Health. This extensive survey was also conducted with the help of national (health insurance companies, and Statistics Center of Iran (SCI)) and international (UNICEF and UNFPA) organizations, faculty members and students of medical universities, research institutes, and NIHR.

Beyond this extensive survey same as other studies, there are experiences, ideas, and information that can shed light on the development and implementation of subsequent studies. Access to this valuable source of information can facilitate and accelerate similar surveys. Hence, we conducted a qualitative study (Semi-structured interviews and focus group discussions) to document the project’s management lessons learned, approaches, supervision procedures, challenges and the feedbacks of different stakeholders towards the design and implementation of the study, and to identify the advantages and limitations of the approaches and ways used in conducting this survey.

Our Findings showed acquisition and allocation of funds among different activities were important factors that affected the survey. In addition, the transparency in payments and equity in budget allocation were influential on motivating the manpower of surveys.

Finding ways to minimize the effect of bureaucratic processes on the studies are important. Due to instabilities in the country’s condition, forecasting the possible situations, especially economic issues, should be made carefully. Besides, the cost efficiency and practicality of the surveys should be noticed.

Cooperation of the studied population was essential to the success of the survey. One of the most important factors in public participation is their awareness of the study.

An important issue in a survey is to ensure that the respondents fully understand the questions (3). Our findings indicated that due to cultural and language differences in certain regions, some questions were incomprehensible for the respondents which made the process of inquiries more time-consuming. In some regions, it was difficult to follow households because of their reluctance to participate in the study, which could, to a large extent, be attributed to cultural barriers, especially in case of female respondents.

Time management is essential in implementation of national surveys because of the large number of participants, developers, and implementers. Issues such as goals, ways of accessing the respondents, socioeconomic and political situations of the country, and weather conditions must be taken into account when deciding on the time of beginning the survey, so that it would progress smoothly and at the same time adequate data are collected (4).

According to our findings, supervision checklists, quality assurance and data handling approaches should be provided before the study. Conducting proper pilot study can help to correct probability problems of the survey.

In conclusion, implementation of national and international surveys is an extensive effort that requires careful design and inclusion of different groups, particularly demographers and statisticians. Although such an extensive study was largely conducted well, some of the challenges associated with the design and implementation of the survey were avoidable, while others were inevitable. The national IrMIDHS-2010 survey required meticulous design due to the extent of the study and the considerable sample size. Due to its nature, people and groups involved in the survey encountered some challenges. Careful development of the framework and structure of a study is the cornerstone of its success.