Encouraging local transport programs and transport infrastructure in poorly-resourced communities can help improve community access and strengthen engagement with health systems. Mobilizing community resources and leadership to implement a community-based transport scheme in rural Mozambique to support referrals to health facilities can help improve maternal and child health outcomes. It was feasible to implement a community-based transport program in rural areas with no external input of vehicles, fuel, personnel, or maintenance. However, lack of available transporters, barriers to fulfill requirements to opening and managing bank accounts, inequities in affordability of the scheme, and tensions regarding views on how to manage funds were implementation challenges identified that require further support.Positive impacts of program implementation included streamlining the process of identifying transport options and collaborators in the community, pre-negotiating travel prices to increase affordability, raising community attention to the role of transport in reducing delays in health care seeking, and raising awareness on the importance of early recognition of warning signs and prompt care seeking.Our community-based transport program uniquely emphasized community ownership and leadership at all stages. Decisions were built by consensus within each community, which allowed for flexibility to local conditions and supported local skill and capacity building for financial management.Transport schemes cannot be implemented in isolation from the wider health system strengthening efforts. This scheme used existing referral pathways rather than creating entirely new processes to help sustainability. Delays due to long distances to health facilities, poor road infrastructure, and lack of affordable transport options contribute to the burden of maternal deaths in Mozambique. This study aimed to assess the implementation and uptake of an innovative community-based transport program to improve access to emergency obstetric care in southern Mozambique.From April 2016 to February 2017, a community transport strategy was implemented as part of the Community Level Interventions for Pre-eclampsia Trial. The study aimed to reduce maternal and perinatal mortality and morbidity by 20% in intervention clusters in Maputo and Gaza Provinces, Mozambique, by involving community health workers in the identification and referral of pregnant and puerperal women at risk. Based on a community-based participatory needs assessment, the transport program was implemented with the trial. Demographics, conditions requiring transportation, means of transport used, route, and outcomes were collected during implementation. Data were entered into a REDCap database.Fifty-seven neighborhoods contributed to the needs assessment; of those, 13 (23%) implemented the transport program. Neighborhoods were selected based on their expression of interest and ability to contribute financially to the program (US$0.33 per family per month). In each selected neighborhood, a community management committee was created, training in small-scale financial management was conducted, and monitoring tools were provided. Twenty people from 9 neighborhoods benefited from the transport program, 70% were pregnant and postpartum women.These results demonstrate that it was feasible to implement a community-based transport program with no external input of vehicles, fuel, personnel, and maintenance. However, high cost and a lack of acceptable transport options in some communities continue to impede access to obstetric health care services and the ability for timely follow-up. When strengthening capacities of community health workers to promptly assist and refer emergency cases, it is crucial to encourage local transport programs and transportation infrastructure among minimally resourced communities to support access and engagement with health systems. If complications arise, transport to a health facility is often unavailable or of poor quality.Rural communities have limited access to health services because of distance, lack of transport, and poor roads, contributing to delays for pregnant and postpartum women accessing care.Community health worker (CHW) programs support delivering maternal and child health care in resource-limited settings and provide a valuable link between communities and facility-based health services.Given that delays reaching health facilities in case of emergency care in low- and middle-income countries can be reduced through the implementation of transport programs,The community transport program was embedded within the larger Community-Level Interventions for Pre-eclampsia (CLIP) in Mozambique Trial , which aimed to reduce maternal and perinatal mortality and morbidity by strengthening CHWs' capacity to identify high-risk pregnancies and refer them to the health facility when needed.Formative research preceding the CLIP Trial, which used an ethnographic approach to investigate the problem of access to care, revealed that the lack of transport was a major contributor to poor referrals and hence low access to health care.The transport program was designed to help facilitate the timely referral of pregnant women with obstetric emergencies to the nearest primary health facility.The study area included Malehice, Chaimite, Chissano, Messano, Três de Fevereiro, Ilha Josina, and Calanga administrative posts from Maputo and Gaza Provinces in southern Mozambique , which wA community-based participatory needs assessment was conducted to inform the community transport plan and to support the creation of a community fund to cover transport costs. While community financing programs to support transport for emergency referral have been used in other areas in sub-Saharan Africa,As part of the rapport-building stage, contacts were first made with the community chief in each administrative post to obtain permission for the proposed activities. Subsequently, neighborhood chiefs (known as secretários dos bairros) were contacted to support scheduling of the activities with community members. The first activity consisted of 3 rounds of meetings: initial meetings to assess needs and raise awareness about the community transport program, mobilization meetings with interested communities to prepare for implementation, and follow-up meetings with communities who implemented the program. Community meetings, as part of community engagement activities for the CLIP Trial, included pregnant women, women of reproductive age, partners and husbands, mothers and mothers-in-law, and the community in general and were conducted at the círculos . These meetings included discussions regarding launching the program; encouraging community contributions to the fund; sharing the list of transporters and management committee members; and presenting updates on uses, finances, and savings within the transport program. These community meetings occurred throughout the project and most meetings were conducted in Changana, the predominant local language. During the phase-out stage of the CLIP trial, a final round of community meetings was held to reflect upon the program achievements, and involved CHWs, selected community members, PHC facility staff, owners of the transport program vehicles and community leaders.Assessment of the transport program implementation utilized a mixed-methods approach. Both quantitative and qualitative data were collected using structured forms (referred to as logs). Quantitative data included demographic characteristics of meeting attendees and information associated with the management of funds and qualitative data included information on all medical complaints that required transport, transport methods used, transport users' and stakeholders' testimonials. Meeting details, including location, number of participants, and their backgrounds and messages discussed were also captured, including facilitator reflections and community feedback.Data collection was conducted by a team comprising a social scientist, a community liaison officer, 3 mobilizers, and 4 health activists employed by the CLIP Trial, separate from CHWs in the neighborhoods. All data collectors were fluent in both Portuguese and Changana.All data were sent to the Manhiça Health Research Center for data entry to a REDCap database .Approval for the CLIP Trial was obtained from the Institutional Bioethics Review Boards of Centro de Investigação em Saúde da Manhiça , the Mozambique National Bioethics for Health Committee (219/CNBS/14) and the University of British Columbia . Written informed consent was obtained from households participating in the CLIP Trial.During the needs assessment stage, 97 community dialogue sessions were held in 57 neighborhoods involving 2,456 participants between October 2015 and March 2016. These sessions involved discussion on the acceptability and feasibility of the community transport program, considering specific local conditions. Over half (35/57) of the communities engaged in the dialogues showed interest in the program and were invited to the subsequent step of establishing a community-based transport program.Create management committees: Initially, community health committees and primary health facilities were responsible for fund management. However, after consultation with the provincial health directorate and community members, it was requested that the fund be managed by people chosen by the community. Consequently, each neighborhood chose 3 to 4 individuals to be in a management committee to manage funds and implement the transport program. Communities were supported by CLIP trial staff in the creation of the committee. Committees were responsible for opening a bank account, collecting money from contributing households, depositing and withdrawing funds, and monitoring use of the fund. All committee members had to be literate, have adequate identification documentation, and be trusted by the community. Literacy and identification documentation were essential requirements for opening up a bank account.Funds were managed by management committees comprised of 3-4 people chosen by the community.Open bank accounts: When opening bank accounts, the study team provided support, including transport, to the management committees. Establishing bank accounts for a specific community activity required complex and lengthy procedures, which entailed multiple trips to the banks located in the urban centers. Issues encountered included the cost of preparing documentation like personal identification, personal income taxes declaration, and other bank account requirements. If a member could not read or write, they had to obtain a power of attorney for someone else to sign on their behalf.Prepare agreements with local transporters and management committees: Each participating neighborhood created a list of all local transporters including all community members who owned a means of transport (vehicles and tractors). Some communities required particular modes of transport, such as Calanga where a tractor was necessary to travel over sand. A meeting was held with each potential transporter to prepare a transportation agreement and to negotiate remuneration for the services provided. Transporters were sensitized about the need and benefits of the program and encouraged to provide discounted travel costs as a contribution and support to their communities. As a result of the sensitization, it was agreed that remuneration would cover only the cost of fuel. Costs were reduced on average US$5.12 per journey (Supplement 2 Table S2).The CLIP Trial provided start-up funds. As an institutional procedure, an agreement was established between the funder  and the management committees representing each participating community.In the 35 neighborhoods, CLIP staff conducted community involvement meetings to explain the steps to prepare for the program as follows.Provide training: Training was provided to committee management members, CHWs, nurses, and transporters on the management and procedures of the transport program including assessing eligibility for beneficiaries based on emergency conditions and filling out transport vouchers. Building on the existing referral slip system used by CHWs, transport vouchers served to confirm the use of transport and facilitate payment. The voucher recorded the date, CHW signatures, nurse's name who assisted the patient, and transporter's name. During training sessions, roles and responsibilities were clarified.Management committee: The local management committees comprised entrusted community members to manage the transport fund. In addition, the committee provided oversight to ensure the fund was being used appropriately for eligible health emergencies .Local transport providers: Private transport providers in the communities were engaged to transport patients in 1-way trips to the nearest health facility when requested by the management committees.CHWs identified emergencies and eligible patients for transport .Nurses working at local health facilities received transported patients and confirmed transport vouchers that patients carried.Distribute supply materials: Start-up materials were distributed to management committees. These supplies included boxes to store small amounts of money for emergencies, vouchers for patients, and monitoring forms to log all transportation events.BOXA resident of the neighborhoodA member of a household that contributed to the community transport fundAn obstetric emergency, confirmed by community health worker (CHW)Serious medical condition, confirmed by CHW After the preparation process, a round of meetings were held to disseminate the key contacts, including the local transporters. These meetings also launched the program and the mutually agreed upon procedures .Meeting participants were mostly women (81%), between age 26 and 50 years . Fifty-fOf the 35 interested neighborhoods, 9 neighborhoods initially joined the community transport program. Testimonials from beneficiaries were shared at CLIP community engagement meetings. After witnessing the success of the program in those neighborhoods, 5 more neighborhoods requested to join the program. Of these, 4 were added to the program; 1 was unable to join because it did not meet the minimum required community contribution.Supplement 2, Table S3). These funds were used only for transport; community management committees volunteered their time, and CLIP supported administration of the program.Ultimately, 13 neighborhoods implemented the community transport program based on their willingness to participate and ability to contribute financially. This financial contribution was a requirement to consider the program operational in each neighborhood. The contribution amounted to an average of US$0.33 (ranging from US$0.07 to US$0.72) per family per month. Additionally, to support the start-up costs, the CLIP Trial provided seed funds, which ranged from US$35.29 to US$286.79, based on the predicted number of obstetric emergencies within the neighborhood for the duration of the CLIP Trial , the transport funds were utilized on 20 occasions in 10 neighborhoods. A majority of the cases were for obstetric emergencies and 70% of the beneficiaries were pregnant or postpartum women . AlthougTransport was provided to 11 pregnant and 3 postpartum women for cases of labor pains, hypertension, convulsions, hemorrhage, a suicide attempt, and fever . There wIn all cases, the transporter provided the voucher signed by the nurse to the management committee after the transfer and received the appropriate remuneration.One pregnant woman began to have contractions in the middle of the night. Early the following morning, her mother-in-law contacted the management committee to request transport. The mother-in-law shared that the transporter arrived quickly and took the woman to the health facility where she was assisted immediately. The woman had a normal delivery, and both mother and baby were well. She was discharged the following day and returned home via minibus paid for by her husband:I felt very good about being transported to the hospital by the transport program when I needed, and I would like to encourage the community to continue contributing the money for the funds because it helps people a lot. I hope this project continues to help more people. I'm very grateful to the management committee who called the transporter and if it were not for this I would have given birth at home. I will continue to contribute to the fund because I saw the importance of it. —Pregnant woman who used community transport system, Chissano, Gaza ProvinceAnother woman suffered from postpartum hypertension. A few days after delivery, she was visited by a CHW who found that she was very weak and not feeling well. The CHW recognized that she was hypertensive and recommended administration of an antihypertensive (methyldopa), seizure prophylaxis (magnesium sulfate), and referral to the nearest health facility as part of the CLIP Trial procedures. The CHW called the local transporter, who arrived quickly and took the woman to the nearest health facility. Upon arrival, the nurse assessed the woman and confirmed the hypertension diagnosis. The woman was later discharged. Because the transporter had already left, the woman paid for a minibus to return home. Notes taken by the facilitator during a general community meeting described how this woman's mother-in-law shared the story with others to encourage participation in the program.One mother-in-law said that the transport fund is working because her daughter-in-law was sick after delivery, and the driver had to be called to take her to the nearest health facility. After being taken care of, she improved and is well. All thanks to the transport fund of the community. She stresses that they must continue to contribute for the benefit of the community. —From a general community meeting, Messano, Gaza ProvinceWomen who benefited from the community transport program often shared positive stories about their experience. Women and families were excited to share their experiences and encourage others to participate in the program. Women and families appreciated the initiative and encouraged others to join the program.One of the elders said that this mobilization will be very important for many women … One of the elders spoke of money for transportation in the event of an emergency … They suggested everyone should contribute. —From a meeting with elders and women of reproductive age in Malehice, Gaza ProvinceThere is transport that helps people in emergencies, but the price (of transport) is very high, and people who cannot afford the transport use the hand cart to take their relative to the health facility. There are times when a person dies for lack of money to pay for transport. —From a mobilization meeting with neighborhood chiefs, small business owners, partners, and husbands in Malehice, Gaza ProvinceCommunity members shared some of the challenges encountered during mobilization and follow-up meetings. Although most neighborhoods were able to develop a list of local transporters, some experienced difficulty collecting this information and had a lack of local transporters.The leaders were very happy but said there is only 1 tractor in the community…and the owner uses it on his farm, and it is not possible to take the community to the hospital. —From a meeting with neighborhood chiefs and small business owners in Calanga, Maputo ProvinceAdditional challenges included the highly bureaucratic process of opening bank accounts, which was limited to those who were literate, had the required identification and documents, and had personal income tax documentation. Because of this process, many community members could not participate in the management committee. From the perspective of CHW supervisors and directors of health facilities, it was important to distance CHWs and nurses from fund management so that there was no interference with the provision of clinical care. Further, there was tension over who benefited from the funds and how it was managed in the community. Men, in particular, highlighted how a community transport fund to support obstetric emergencies would not benefit them.The participants complained a lot about the issue of contributing to the fund, considering that the money would only benefit the pregnant women … Some ladies who were present said that they would not contribute because they do not or will not have children, so they would be contributing in vain. —From a meeting with neighborhood chiefs and small business owners in Malehice, Gaza ProvinceChallenges to implementation included lack of available transporters, barriers to opening bank accounts that limited participation, and tension on how to manage funds.Tensions emerged between those who did and those who did not contribute within the same neighborhood.The participants were not pleased by the fact that most people are not contributing to the fund. —From a meeting with community members in Messano, Gaza ProvinceFurthermore, inconsistent contributions challenged the sustainability of the transport program. Community management committees reported that there were difficulties in collecting contributions. This was sometimes related to the high burden of poverty among the neighborhoods. During implementation, the communities reported suffering from consequences of the droughts and shared that they already had trouble feeding their families and did not have extra funds to contribute.As for the emergency transport fund, they said they would like but what hinders is the hunger that has been going on because it has not been easy even to eat. —From a meeting with husbands and partners in Chaimite, Gaza ProvinceThe ultimate challenge was ensuring a smooth phase-out while motivating communities to continue with the program beyond the timespan of the CLIP trial. During the phase-out visits to each community, community leaders, particularly the heads of administrative posts in Gaza province, showed willingness to supervise the program implementation themselves. One of them, who possessed a vehicle herself, realized only during the phase-out stage that she could have played the role of a transporter, to which the CLIP team's response was to encourage the practice.–This assessment illustrates participative community-based efforts to address the lack of transport from the community to health facilities in rural Mozambique in the view of assuring a continuum of care, which is a gap already identified by formative research and existing literature.The program provided access to prompt health services and strengthened the relationship between CHWs and PHC nurses and their communities and health facilities.P<0.001) from under 10 women at baseline to 66–149 with the 10–15 month intervention, depending on different districts.Other community transport programs have been tried elsewhere. In Nigeria, Shehu et al. reported on mobilizing a local union of transport providers to provide timely and affordable transport for women with obstetric complications as well as other members of the community for emergency care.Organized on the principle of associativism (collective cooperation), which highlights cooperative and collaborative partnership making within communities for collective action to improve conditions,Core values of this initiative included ensuring community consensus, solidarity, participation, unity, cooperation, and the focus on common objectives.Lessons learned in designing and implementing the transport program in the CLIP trial in Mozambique included that in many of the cases, successful implementation depended on availability of transport, interest, and willingness of the community to manage the program, as well as affordability of the family contributions. Communities already close to primary health centers, such as Três de Fevereiro, were less inclined to participate. Additionally, communities that did not have close access to a bank had fears on holding large sums of money in neighborhood settings. However, with introduction of mobile money innovations like M-Pesa, these concerns may be lessened. There were fears that CHWs and nurses may inappropriately manage the funds; therefore, community-based management committees were essential. The involvement of community leaders and stakeholders to build trust in the program was critical. Lastly, it was found that very poor communities were least interested in the program, which emphasizes that any individual program needs to be embedded into other poverty reduction strategies. Consequently, advocacy involving the Ministry of Gender, Children and Social Affairs and the Ministry of Transport and Communications in addition to the Ministry of Health, as well as engagement with other partners like nongovernmental organizations is needed. Based on such a cross-sector approach, the government could play a valuable role in providing overarching directives to support coordination of the various poverty reduction and health strengthening programs.,The Community Health Worker Performance Measurement Framework highlights that the ability to facilitate referrals from the community to the health facility while maintaining continuity of care and counter-referrals from the health facility back to the CHWs is essential for effective community health.Although national guidelines point to CHWs linking the community to the PHC facility through clear referral pathways, details are lacking on how to make this process cost-effective and timely, particularly for patients in remote areas.Though some transport challenges persisted, the program implementation had positive impacts including streamlining the process of identifying transport options and collaborators in the community, pre-negotiating travel prices to increase affordability, and raising community attention to the role of transport in reducing delays in health care seeking. Sharing stories of successful facility births and well-being of mothers and babies as a result of the new transport program contributed to building momentum and increased attention to maternal health in the community.The community transport program developed with the Mozambique CLIP Trial illustrates the importance of transport in ensuring maternal and child health by leveraging an existing referral system. Without access to transport from the community level to health facilities CHW performance and associated health outcomes may be compromised.A strength of the study was the close working relationship between the CLIP Trial staff and the community and respective community leaders, cultivation of leadership and collaboration among the local management committees, collaboration of multiple local stakeholder groups, and the constant feedback which allowed for adjustments to the program. Future areas for exploration include understanding the impacts of seasonality on referral patterns, the added value of transport programs for back-referrals, and the specific needs of extremely underserved communities.A limitation of the study was the relatively low participation of eligible neighborhoods (13 of 57), in part due to the complex and lengthy procedures to open a bank account and the short study period. This may mean that the participating communities were not representative of the region and limits the transferability of our findings through some of the broader challenges highlighted in this study regarding transport infrastructure that are common across the region.Data were collected by staff who supported the facilitation of the program, thus there may be some bias to reporting positive results, as often is the criticism of action research study design. Because the transport program was embedded in the CLIP Trial, there was overlap in the staff for training and supervision, thus there is limited information on the specific costing of external management to start the program. Furthermore, the time between transport request and when it was made available was not systematically recorded, though all were able to reach care within the recommended 4 hours for urgent referrals recommended in the CLIP Trial.Another limitation of the study was that the participation in the program depended on local capacity to raise money and fulfill the requirements for the administrative processes. With rates of poverty between 12% (Maputo Province) and 44% (Gaza Province),Additionally, some communities had poor road access and lack of transport options, which are key pillars for the program to take effect. Previous mapping of access to maternal health services found that approximately 85% of the roads are unpaved, hard to traverse in the rainy season and unpassable during seasonal flooding.While the community transport program was developed to help mitigate challenges in accessing care, emergency transport provided was often 1-way to health facilities, which could have also contributed to some of the nonadherence to the program. Faced with limited funds, community management committees decided to prioritize emergency transport to PHC facilities and not the other way, reasoning that once the person had been assisted at the facility, their health either would have stabilized, therefore the return home would not be as dramatic, or they would require further referral to higher-level facilities by ambulance instead. However, paying for transport back to the community emerged as a potential barrier that should be further investigated and addressed.Further, communities that faced challenges implementing the transport program were often those with a low density of health facilities.The gap created by lack of transport within the existing referral system between the community and the PHC facility poses a barrier to access to emergency obstetric care in southern Mozambique. In strengthening capacities for community health and the role of CHWs, it is crucial to encourage local transport programs and transport infrastructure in poorly-resourced communities to support access and engagement with health systems. The community transport program developed as part of the Mozambique CLIP Trial illustrated that it was feasible to implement such a program to address not only emergency obstetric care needs but also health problems. The program was implemented with no external input of vehicles, fuel, personnel, or maintenance and with minimum requirements within the communities. The transport program facilitated several emergency cases that would not have otherwise had prompt access to health care.However, there were numerous challenges such as appropriate members of the community to manage the fund, unfavorable terrain, few available transport options, and poverty. Addressing these challenges is recommended to ensure the strategy is sustainable. This includes increasing community awareness and leadership to maximize demand and decrease the cost per family, establishing agreements with banking systems that make processes more flexible, and raising awareness and interest among potential implementing partners in health, public works, and nongovernmental organizations to support community efforts and infrastructure. Among such partners, there is a need to assign or create capacity to perform rapid needs assessments before implementation to account for communities' specific needs with particular attention to existing infrastructure, socioeconomic inequities within communities, gender and cultural norms, existing knowledge and awareness about care seeking, as well as geographical and climatic challenges.


In February 2020, the first sample test was confirmed as positive for corona virus in Masih Daneshvari Hospital that is the reference center in Iran for all pulmonary and respiratory diseases. The decisions made in a hospital or organization to manage a crisis is very vital. Success in managing any crisis requires a scientific and scholarly attitude. This paper was distilled from experiences gained in Masih Daneshvari Hospital in Tehran, capital of Iran, in March 2020 at the stubborn time of coping and managing corona virus crisis. This study was conducted using participatory action research, a methodology which identifies problems in practice, and finds methods to solve them. This Action research involves five stages: statement of the problem, planning, data interpretation and analysis, action, and evaluation of the research process during performing the study. The whole hospital was equipped for corona virus patients in 10 phases during one week and 250 active beds were equipped for these patients. Three models, namely, “corona virus crisis management model”, “Pharmaceutical care management in coronavirus crisis model” and “nursing in coronavirus crisis model” were planned and implemented. During one month of implementing these three models, the supervision team monitored the accurate implementation of instructions and resolving or revising the possible deficiencies and faults. The Masih Daneshvari crisis management model in coronavirus, can be a useful and applicable model in other corona virus centers.  In late December 2019, a group of patients with pneumonia with idiosyncratic etiology were reported to a local healthcare center. The cause of this idiosyncratic pneumonia was a novel corona virus (COVID-19) . The decisions made in a hospital or organization to manage a crisis is very vital. These decisions ought to be made rapidly without wasting any time. Highly experienced individuals should manage the crisis, and they should know that making any wrong decision may result in great negative consequences. Success in managing any crisis requires a scientific and scholarly attitude. Crisis management is considered as a long, complex and technical process. This paper was distilled from experiences gained in Masih Daneshvari Hospital in Tehran, capital of Iran, in March 2020 at the stubborn time of coping and managing corona virus crisis. This study was conducted using participatory action research, a methodology which identifies problems in practice, and finds methods to solve them. Action research is applied as an effective research method, leading to facilitation of changes and promotion of services in industry and education, and recently, in healthcare. This method improves the clinical care, team work, communication, and clinical management . Action In March 2020, the first sample test was confirmed as positive for corona virus in Masih Daneshvari Hospital that is the reference center in Iran for all pulmonary and respiratory diseases. This hospital had experienced coping with influenza in 2009. The crisis management team was formed by the head and vice-president of the hospital and major decisions for managing corona virus crisis were made. Given that corona virus was a viral contagious respiratory disease, crisis coping was divided into ten phases to manage it correctly, avoid confusion and mess, and prevent fear and anxiety in the staff. To do so, Ward 3 of the hospital was selected as the pilot ward. All patients in this ward were transmitted to other wards or hospitals in less than 24 h. This ward enjoyed experienced nurses, knowledgeable head nurses, and 30 beds. The staff received personal protective equipment and all trainings related to personal protection were provided again. Some information on corona virus was given to the staffs. The benefit of this type of planning was that it clarified the amount of equipment and supplies required for managing the crisis, the number of hospitalized patients, the nursing approach and performance, services, nurses’ and staff’s fears and anxiety, and pharmaceutical management. Having announced Masih Daneshvari Hospital as the reference hospital in Tehran, 30 corona virus patients were hospitalized there in less than 24 h. Hence, the management team decided to implement the second phase wherein wards 4 and 6 were equipped for hospitalization of these patients. Besides, the knowledge and experiences of nurses in Ward 3 were given to these nurses. Subsequently, the ICU for TB patients was converted to corona virus ICU. Then, the CCU patients were transferred to other hospitals and the CCU was ready to admit corona virus patients. At the completion of the capacity of these wards, the surgical ward 1 and 2 and surgical ICU ward 1 and 2 were also ready to admit corona virus patients. For the hospital to concentrate on corona virus crisis and to avoid the probability of spread of the disease to patients undergoing surgery, all operations were cancelled. All out-patient clinics were off and all hospital activities focused on care-giving and hospitalization of corona virus patients. Considering the mean presentation of 300-400 cases per day to the hospital Emergency Room and triage, three triage wards were activated to avoid patient pile-ups.The whole hospital was equipped for corona virus patients in 10 phases during one week . Also, 2The Nursing Committee developed a model of giving care to corona patients after initial visits of nursing wards, interviewing physicians and nurses, and holding numerous sessions for planning care-giving of these patients . PlanninThe importance of transmission of the disease in a study in China shows that 41% of cases of coronavirus occur in hospitals. This includes patients currently hospitalized and the health care team, which includes physicians and nurses, radiologists and all those who are in direct contact with patients. Another issue is the transmission from one patient to another . Given tIt was also decided that all nurses go to breakfast and lunch with the same clothes they wore at the onset of their work shift and avoid pile-ups at the meal times. Food and breakfast were given to nurses as packaged meals/snacks and all nursing staff was required to wear their face shields and goggles from the beginning of their work and avoid any contact of hands with their eyes. All nurses were obliged to wear double-gloves during working with patients though they could wear single-gloves when writing reports. The use of latex gloves was preferable in all treatment wards . AccordiBecause the sleeping rooms are not separate in the hospital pavilion, so, it is highly possible that previous nurses might have contaminated the beds. Also, taking off clothes might infect nurses. Considering that personal protective equipment is made of fibers and materials that induce sensitivity in some individuals and given that they cost much money, planning work shifts as 12-h periods is the best method of preventing increased use and chances of sensitivity in nurses . DormitoThe manager of medicinal care ward estimated a list of medical equipment and supplies and the required medicines like antiviral, antibiotic, serums, electrolytes, etc. along with personal protective equipment such as isolation gown, mask, hat, shoe cover, face shield, and goggles and also hospital requirements like radiology appliances, ECMO set, CRRT set etc. for 8 months and sent it to Deputy-in-Food and Drug . At the From 20 of February to 23 of April, 1745 patients with COVID-19 were hospitalized in Masih Daneshvari Hospital. PCR test showed that 1200 of them were definitely positive for corona virus. Of these, 196 passed away. The mean hospital presentation was 300 patients per day of whom 15 were hospitalized per day. These patients were hospitalized with symptomatic pulmonary CT scan and acute respiratory distress syndrome. The reduction in hospital presentations after the third week was due to the increased number of hospitals that admitted corona patients. The high mortality rate (%11/2) in this hospital was due to its being the reference hospital for respiratory disorders in Iran as highly experienced practitioners worked there. Hence, many of the admitted patients were critically ill patients and were admitted here with acute respiratory distress syndrome or even shock from other hospitals. The importance of contagion of the disease in the study in China shows that %41 of infection with corona virus occurs in the hospital. This includes patients already hospitalized in wards and also the healthcare team, i.e., physicians, nurses, radiology technicians and all individuals that are directly in contact with patients. Another noticeable issue is transfer of disease from one patient to another . In MasiThe ‘order’ in a viral disease crisis ought to be ‘minimal contact and greatest services’. To do so, all staffs should plan to meet all of the patient’s therapeutic needs and interventions concurrently when she/he is at patient’s bedside; for example, she must meet the patient’s needs for food, drug, vital signs, and serum change and lab test at one time .Our findings showed that phasing the hospital for converting it to corona hospital improved the managerial performance and control of the condition and helped in enhancing patient organization and hospitalization. Phasing increased opportunities of examining protective needs of the staff and prevented lack of confidence in the healthcare system or creation of mess in the hospital. The use of crisis management model based on coordination, cause to promotion of hospital preparation . Janius stated that in a crisis management model, coordination among state health departments, hospital managements, concession companies and utility providers must be developed . In our The novelty aspects of our model were that Masih Daneshvari was the first hospital in Iran which hospitalized patients with COVID-19 and had the highest number of outpatients and inpatients. By presenting this model and implementing it, the hospital was able to overcome the problems caused by the crisis and act well in treating patients. Having a crisis management model for Hospitals is essential for being responsive against internal and external risks.The Masih Daneshvari Crisis Management Model can be a useful and applicable model in other corona virus centers.