Table 2. Citizen's expectations from government in response to COVID 19 outbreak in Iran
Paying attention to patients and their family members
- Following up patients during quarantine
- Providing attention and support to patients’ families
- Monitoring patients’ families
- Providing patients with health and hygiene facilities
Providing health support
- Providing equitable medical care
- Providing health packages to household
- Distributing masks and gloves via stores
- Disinfecting passages and public places
- Providing health services to deprived regions
- Producing and distributing medicines sufficiently
Appling strict restrictions
- Compulsory quarantine
- Timely quarantine
- Cash penalty
- Closing intercity roads
- Restricting travels
- Canceling foreign flights
- Closing all public centers
- Setting new traffic rules
- Dealing with lawbreakers seriously
- Dealing with rumor mongers seriously
Appling serious monitoring and control
- Officials’ honesty
- Crisis management by experts
- Using the experiences of other countries in pandemic control
- Providing healthcare centers with necessary permissions
- Fair distribution of medical services and equipment
- Monitoring the production and distribution of bread
- Cooperation and coordination of government agencies
Providing financial support
- Deferment of bank installments
- Non-payment of service bills
- Providing livelihood assistance packages
- Giving loans at low interest rates to some businesses
Mass media-related expectations
Adopting honesty and transparency
- Providing accurate news and statistics
- Providing transparency on transmission routes
- Providing transparency on the prevalence rate
- Providing transparency on high-risk groups
- Preventing the spread of false news
- Announcing the exact statistics of those affected by city
Providing comprehensive and inclusive health education
- Providing appropriate preventive training
- Teaching healthy behaviors
- Teaching how to use e-services
- Providing life-style change training
- Providing the required diet and exercise programs
In this study, a majority of the participants highlighted the need to pay attention to the follow-ups for the infected patients and their family to prevent further transmission. Breaking the transmission chain as well as the provision of financial and hygiene support during the pandemic was another main expectation. In other words, they believed if the necessary support were not provided to the infected, there would still be a possibility of the virus transmission. In addition, the fair and equitable provision of medical and preventive services to the public, especially the vulnerable groups, was the participants’ other demand. As a remarkable finding, the participants described the need for continuous monitoring and screening of the patients’ relatives and families to interrupt the transmission chain.
"If the patient is not monitored continuously during the quarantine, the virus may be transmitted to the other individuals."
"Households, especially those with patients, should be provided with financial supports to prevent them from attending outside. On the other hand, more sanitary facilities should be provided to these groups."
"Unfortunately, in some cities, the relatives and families of those infected with coronavirus are not concerned as the potential carriers of this virus. I think health centers should monitor them constantly."
Providing sufficient health supports was another subtheme, which contained a number of codes such as equitable medical care services. Many participants pointed to the unfair access to health care services in Iran and the importance of resolving this problem to facilitate the fight against COVID-19 outbreak. Further, some other participants believed that health packages should be submitted to households by the government and local institutions since, following the economic crisis, many persons cannot afford to buy the necessary personal protective equipment. A number of these individuals also pointed to the poor distribution of preventive measures such as masks and gloves across the country, which led to increased prices, corruption, and difficult access. Accordingly, they proposed the formation of a codified and transparent distribution structure by government. For example, they referred to solutions such as the use of the local stores' capacities to distribute aforementioned items and goods. Additionally, the importance of disinfecting the public passages and places were also noted. To sum up, the participants stated that rationale and continuous disinfection was vital according to the researchers' findings regarding the rapid spread of the virus in public places. More importantly, paying attention to vulnerable groups and appropriately responding to their needs was one of the other common expectations in this study.
"Direct payment for health services is very high in Iran. Although the government stated that the costs of treating the coronavirus patients were to be covered by the insurances, there are still individuals who have confronted with many challenges regarding the transportation and accommodation costs."
"It is constantly recommended that people should wear a mask, but there is no mask! Maybe there is, but not available to us. The government must create a proper structure for the distribution of these devices."
"Experts have recently stated that the virus would stay in the air for a longer period. I think, the crowded centers should be more disinfected. Although much effort is being made now, they can be more effective."
Our findings indicated various expectations regarding the political issues. The imposition of strict restrictions, adopting serious monitoring and controlling procedures, and providing financial support were recognized as the subthemes of this theme. With regard to the adoption of quarantine policies in some countries, the participants called for more serious policies on compulsory quarantine. On the other hand, some of the participants believed that the government had not implemented quarantine policies in a timely manner, and that it would be better if they took actions as soon as possible. Furthermore, another finding was to consider the effective punitive measures for those who do not follow the containment measures. In this study, some of the participants referred to the likelihood for the disease entering from other countries and asked the government to cancel all foreign flights. Since widespread rumors and misinformation are common after crises, serious measures against the rumor mongers would be a potential solution.
"Many people do not pay attention to quarantine and travel. The government must respond this very seriously. I think it should be a mandatory quarantine, like in European countries."
"Iran started quarantine too late. From the first day, home quarantine must have been started so that the disease would not have spread to the other cities."
"There are a number of punishments, but they are not enough. Most of these punishments are limited to cars and road transportation. I think individual fines should also be considered for individuals."
Many participants expected the authorities to be honest and transparent in providing reports and advice. They argued that honesty could be a proper incentive for citizens to participate and cooperate with the made decisions. Using related experts and experiences from other countries in managing the crisis was the other expectation noted by some individuals. In addition, the participants, regardless of their position, criticized the management of medical centers and believed that the local centers had no sufficient authority and autonomy to make quick decisions. Thus, delegating authority to local units might facilitate the process of meeting demands during this pandemic. More notably, a large proportion of the participants identified the fair distribution of medical supplies and equipment as well as inter-sectoral cooperation among stakeholders, as a prerequisite for effective response to COVID-19 outbreak.
"Many people have doubts in the sincerity of the authorities. If officials speak more honestly, people will be more supportive."
"We must use the experiences of successful countries such as South Korea and even Germany, which have very low mortality rates."
"Crisis management is a purely scientific and specialized matter and can be achieved by experienced managers. Experts of this field should be involved as well."
"Cooperation and coordination among responsible institutions and also integrated stewardship can be helpful."
In accordance with the adverse economic impacts of pandemics such as COVID-19, there were some recommendations to provide financial supports for the public. The participants noted that bank installments and maturities should be postponed due to the prohibition of commercial activities and a sharp decline in income. Moreover, the non-payment of service bills (water, energy, etc.) and the provision of livelihood packages by the government were also expected by the participants. Furthermore, supplying the low-interest loans to enhance the liquidity for commercial units and the general public during this recession was another expectation.
"Although we have no income, the bank has withdrawn the installments. In this situation, banks should be more considerate."
"… especially for poor households, payment of service bills must be canceled or at least postponed."
"In this recession, it is possible to facilitate the required liquidity by providing low-interest loans."
Mass media-related expectations
In this study, the participants expressed that adopting honesty and transparency principals by news agencies would promote the social capital. In addition, accurate news and statistics would prevent people from visiting invalid and fake news sources. Many participants believed that there was a need for more comprehensive information about the SARS-CoV-2 transmissions to prevent obsessions and other potential psychological disorders. Finding out how vulnerable groups are affected by the pandemic as well as its side effects were another point stated by the study participants. Remarkably, the participants believed that announcing the related information and statistics by city and location can be effective in informing citizens and adhering to the proposed principles.
"The official media must represents the real news to make people more confident."
"If the real news and information is provided, no one will refer to the rumors and fake news."
"Elderly people are very worried when it is announced in the news that the disease is more dangerous for this group. More information should be provided on the effects of the disease on the elderly and other high-risk groups."
Finally, the provision of comprehensive educational programs was the participants’ another expectation from policy-makers in response to COVID-19 pandemic. According to the findings, proper training in terms of the virus transmission prevention methods, healthy behaviors and how to use e-services were the common expectations. In general, many believed that the general public was not fully aware of the correct preventive methods, and that the capacity of the official and virtual media could be further exploited. One of the interesting findings was the importance of teaching how to change one's lifestyle based on the conditions posed by this pandemic. Certainly, since the implementation of quarantine policies may affect individuals’ nutritional and physical conditions, the provision of accurate educational services would prevent many complications.
"The media should provide relevant educational programs tailored to the perceptions of different persons in the community. Many programs use specialized terms not understandable to many people."
"Many individuals are not aware of e-services. Relevant training programs can be provided to prevent their direct presence in banks and organizations."
"I am very worried about my children's eating habits and physical condition during this period. I wish educational programs were provided so that we could act on them."