This study designs a management model of empowerment services for individuals with disabilities covered by the Iranian Welfare Organization. The findings (Fig. 1) show that six factors of planning, financing, resource production, coordination, employment and control impact the management model of empowerment services. We can consider the present research as one of the first studies on designing and presenting a management model of empowerment services to support individuals with disabilities in Iran. Findings of a research conducted by Lufi et al., "Investigating the achievement of equality for disabled individuals: empowering disabled individuals for organizational leadership", showed frustration among leaders and a lack of sustainable progress. A cause of disappointment in their view was the lack of meaningful participation of individuals with disabilities in policy-making and the lack of political will and interest in disability issues (6). A study on the motivations for entrepreneurship and setting up a personal business among individuals with disabilities in Sweden found that individuals with disabilities often find hardly a well-paid work, and different beneficiaries such as politicians and professionals should have a suitable planning for the business of individuals with disabilities, so that the governments can provide adequate supports (7). Research of Lee et al. investigated the accessibility of medical services for the disabled and compared them with normal people in Korea. The results revealed that financial resources and transportation are among the most important problems in accessing medical services (8). A research conducted by Griseh et al. on comparing access to jobs through public transportation for individuals with and without physical disabilities found that communication situations and collaborative teams, employee training in the mental health and workforce problems, and multi-level participation of individuals with disabilities strengthen performance of the disabled individuals in the work environment (9).
A main area of this pattern is "planning". Planning, as some said, should be prior to any management principle and should also be considered during other major functions. This function is not designed at the beginning of the program and ends there, but it is a continuous process (10). The local association of England has stated in developing the standards of public health workers that primary health care is at the forefront of the evolution of health in the society, whose requirements are changing rapidly and include many tasks that require changes to improve health. These changes require planning and design in a complex environment. It should be done by those who have high work standards, have sufficient and necessary information and adopt an evidence-based approach to their performance (11).
As for producing resources, the findings of Mistretta's research showed that when medical staff specialists are not sufficient, problems of the health level develop in the society (12). The reports of the World Health Organization show that this ratio is much higher in developed countries. The comparisons reveal a more successful performance in countries that have more accurately calculated the coordination between the training of human resources and the needs of rehabilitation centers. Therefore, the recruitment of rehabilitation students will be more effective, it matches with the dispersion of centers and the prevalence of disabilities in each region and the distribution of human resources by the Ministry of Health, Treatment and Medical Education based on the data got from centralized information organizations. However, the training programs of rehabilitation experts in Iran are similar many times to the training programs in other countries of the world. Some researchers found the rehabilitation education system in Iran to be incomplete and mentioned the failure of public education and the failure of the university education system for its reasons (13).
As for financing, Nusrat Nejad et al. found in their research that providing financial resources for health services is a most important concern of most governments in all countries with any level of income. Governments cannot provide all or a large part of treatment and rehabilitation expenses from the general budget of the government (14). Abdi et al. considered in their research the financing of rehabilitation in Iran to be unbalanced and cited as its reason the lack of credits to compensate the cost, the weakness of the insurance system, and the therapeutic market view of rehabilitation (13). As research in Germany also pointed out, financial obstacles and the lack of integration in the inter-organizational referral system can affect the weak layer of the society (15). The results of a research conducted by Rasoulinejad et al. showed that currently the inadequacies and inefficiencies of our country's health system in the provision of services and financing are significant (16). Developing support and incentive policies, such as allocating subsidies and donors' financial help to the disabled through separate channels, will be beneficial in expanding these services. This problem was also observable in the United States, so that sudden changes in covered benefits and confusion about the financial eligibility to benefit from Medicaid government insurance were among some barriers to access to medical services for the disabled (17).
Coordination was supposedly one of the effective dimensions in the management of empowerment services for individuals with disabilities. Various institutions and employees of rehabilitation services perform various tasks in the rehabilitation process, and their effective communication and coordination with each other is necessary for a desirable rehabilitation system. The research of Oliver et al. confirmed that effective cooperation and communication between service provider organizations is necessary for successful rehabilitation (18). Setting up multidisciplinary teams is one of the important strategies for orienting primary health care in care patterns. There is no uniform pattern to these teams but they comprise a range of skills and professions including health workers, nurses, family doctors, pharmacists, nutritionists, social workers, traditional medicine experts and administrative staff who respond to the full needs of individuals under their own coverage (19). Another study that has shown the importance of teamwork and its consequences: "An inter-professional team simulation experience in providing services to old patients with complex conditions". It examined the effectiveness of a teamwork-based educational intervention of educational videos, distance learning, and participation in group discussions for the nursing, midwifery, pharmacy, and health care professions and concluded that providers made significant improvements in teamwork skills and these changes have concretely increased the satisfaction of older adults receiving services (20). As for the coordination, another statement of interest to experts is a coordination between insurance companies and units of services for individuals with disabilities. Mehr Al-Hasani et al. stated in research that individuals who do not have health insurance may delay their request for care and are more likely to be hospitalized for more complex and chronic conditions such as diabetes or high blood pressure. Life and investment insurances, supplementary treatment insurances, long-term care insurances, home care insurances and rehabilitation service insurances are some well-known insurances that directly or indirectly provide benefits to old people over the world (21).
Control, as the findings show, is an effective factor for the management of empowerment services for individuals with disabilities covered by Iran Welfare Organization. Increasing health system costs and limited resources for increasing demands make rationing of health care inevitable. Rationing is a strategy to control costs and increase efficiency in using limited resources of health systems (22). Health care rationing can be applied at four levels: health care policy makers, health care managers, health care providers, and patients. Health care rationing can apply through a fixed budget, benefits package, payment mechanisms, queuing, co-payments, and deductibles (23). Aghakhani et al. in their descriptive analytical study, "Investigating the performance of nurses in providing safe care for old patients hospitalized in the internal departments of medical training centers in Urmia", have investigated and monitored the performance of the medical staff, including nurses. The authors conclude that there is a need for educational programs to promote safe care according to patient safety standards and the principal goal of the health system that is quality services. Research suggestion: nurses with more work experience should work next to novice nurses (24). Cane et al. stated in research that analyzing the satisfaction of health services is necessary to evaluate the access and performance of medical services (25). The authors of a study, "Role of Monitoring in Improving the Quality of Primary Health Care in Tanzania", have reported that monitoring of primary health care is useful not only to assess the quality of primary health care but also to maintain and improve the quality standards of primary health care (26).
Employment was, in the current research, one factor of the management of empowerment services for individuals with disabilities. Lelhojaj stated, in his research on the societal entrepreneurship in the employment of disabled people, that government employment packages and necessary trainings influence the quality and work productivity of individuals with disabilities (27). Another research showed that the employers' loans and subsidies in empowering women had a significant impact on increasing their empowerment in the social dimension and employment (28). A study entitled "Comparison of access to jobs through public transportation for people with and without physical disabilities" showed that communication situations and collaborative teams, employee training in the mental health and workforce problems, and multi-level participation of individuals with disabilities strengthen the performance of the disabled in the workplace (29).