Iran J Psychiatry 2020; 15: 4: 351-357

Review Article

Logical Framework Approach a Platform for Integrating the

Mental Health and Nutritional Care for Controlling the Covid-19
Pandemic

Seyed-Ali Mostafavi1, Parviz Molavi2*, Fatemeh Mohammadi3

Abstract

Coronavirus infection (COVID-19) is spreading rapidly in the world beyond the health care capacity. The World Health
Organization (WHO) has announced an emergency state that needs quick and effective actions. In the lack of specific
medicine and vaccine, integration of mental health and nutritional care in the platform of a powerful managerial technique
named the “Logical Framework Approach” (LFA) could be helpful for successful control of this pandemic. The strengths
of the LFA for coronavirus management program are stakeholders’ involvement, integrative teamwork in research and
medical procedures, as well as Inter-sectoral cooperation. The related organizations like WHO and ministries of health of
every country could easily adopt this approach and act more efficiently to manage this pandemic.

Key words: Coronavirus; COVID-19; Logical Framework Approach; Mental Health; Nutrition; Pandemics

Coronavirus disease 2019 (COVID-19) pandemic has prevention programs used by some countries have not
been effective so far. One reason for this failure could be
raised serious concerns about health care capacity
worldwide. The spread of COVID-19 was so fast that lack of the systematic view in some policy-makers and
nearly all countries are engaged by its infection (1). not engaging all stakeholders and related expertise.
Although, many laboratories, research institutes, and Hence due to importance of nutritional care and mental
universities worldwide are working to discover specific health in prevention and treatment of the disease, we
treatments and vaccines for COVID-19 infection, it is aimed to write a narrative review on the “Logical
spreading among the people . Framework Approach” (LFA) as an overlooked platform
In addition to health and medical issues, coronavirus for integrating mental health and nutritional care into the
infection and its related death have many psychological management programs for covid-19 infection. In this
consequences for the patients and their families (2). emergency condition of pandemic, we believe that
Additionally, mental health and nutritional status of integration of nutritional and mental care to the regular
patients may interact with treatment of patients, and may medical care of coronavirus infected patients would be
take role in prevention of the infections and management cooperative.
of the pandemic (3). However, mental health and We choose to review the LFA because it is a powerful
nutritional status of patients with COVID-19 infection management method with capacity of analyzing the
are overlooked and urgent research and action in these hierarchy of problems and integrating the solutions to
fields are needed . achieve the goal. Hence, we decided to write this
Furthermore, coronavirus infection has induced a great narrative review to help researchers and policy-makers
economic burden to the governments (4). Hence, in their programs for controlling the COVID-19
countries and companies start to spend money and act pandemic.
against coronavirus infection. However, the coronavirus

1. Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
2. Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
3. School of Social Sciences, Allameh Tabataba’i University, Tehran, Iran.

*Corresponding Author:
Address: Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran,
Postal Code: 5614733775.
Tel: 98-45 33232520-21, Fax: 98-45 33232670, Email: pmolavi@tums.ac.ir; p.molavi@arums.ac.ir; p.molavi@yahoo.com

Article Information:
Received Date: 2020/04/13, Revised Date: 2020/05/11, Accepted Date: 2020/06/27
Mostafavi, Molavi, Mohammadi

Integration of mental health to the medical could help in coronavirus control project or could be
procedures for coronavirus treatment suffering from the coronavirus control project. The
We are at beginnings steps of the new coronavirus brain storming technique can be used to identify the
pandemic. However, based on the literature, similar stakeholders. The project manager also can map the
pandemics of SARS, MERS, and Ebola, the infection interest & power matrix of stakeholders separately
has serious psychological consequences for the patients outside the LFA matrix (17).
and their family, in addition to medical problems (5, 6). 3. Analysis of objectives: The main objective should be
Several studies have reported the short-term and chronic determined according to the core problem. Then the
psychological consequences of previous coronaviruses main objective should be broken down to the smaller
related with sever anxiety, depression, distress and post- and more manageable objectives in order to achieve
traumatic stress disorders (5-7). Furthermore, anxiety in the goal. The hierarchy of objective could be plotted
critically ill patients will provoke the pathways of like an objective tree (16).
inflammation (8). On the other hand, decreasing anxiety 4. Analysis of strategies: Identifying and comparing
and depression in patients may enhance the immune different solutions for coronavirus issue in order to
system and similarly may be effective in treatment of control the pandemic (18). These strategies in
coronavirus patients (9). Hence, integration of mental coronavirus crisis may include community-based
health care to the regular medical treatments could be education, Regulations imposed by governments,
effective for the new coronavirus patients . encourage quarantine if necessary, Vast educational
Integration of nutritional care to the medical programs, TV programs & advertisements, Early
procedures for coronavirus treatment detection and isolation of positive cases and People
Nutritional and dietary factors may help the coronavirus they've contacted, coronavirus vaccine development
infected patients in two mechanisms. One, by decreasing program, coronavirus medicine development
the inflammation pathways in the respiratory system, program, Promoting mental health, nutritional status
and second by enhancing the immune system (10, 11). and complementary medicine (19, 20).
Knowing the immunosuppressant effect of protein- 5. Analysis of the other factors: The process of
energy malnutrition in critically ill patients, the role of identifying any systems, ethnics, countries, societies,
nutritional support for coronavirus patients in ICU wards religious, cultures and the other parameters as social,
is highlighted. Previous studies suggest that dietary anti- political, economical, legal, environmental and
inflammatory factors and antioxidant nutrients such as technological, which have the effects on the
vitamin C, vitamin D, vitamin E, omega-3, beta- pandemic; and analyzing the symptoms to find the
carotene, and selenium and zinc may enhance the causes, and decreasing the problems and then control
immune and respiratory systems (12). Accordingly, it (21).
integration of nutritional interventions could be effective The above analytical approach is used to set up a
in treatment of the new coronavirus infection. management framework named Logical Framework
Matrix. This Logframe summarizes the essentials of
LFA could be helpful in Coronavirus management project, hierarchy of objectives and activities and
programs assumptions (vertical logic; columns 1 and 4 in table 1),
The LFA is a powerful project management tool with and how the project's development, outputs and
pervasive use in many subject areas including medical outcomes will be monitored and assessed (horizontal
and health projects (13). LFA is a managerial approach logic; columns 2 and 3 of table 1). An example of a
for implementation, achievement, and monitoring of any Logical Framework Matrix for management programs of
program including projects in health care systems (14). coronavirus is presented in table 1. In this matrix, in
While many companies and agencies are now using this addition to task priority, a milestone is being set (16,
approach in managing their projects, its application is 21). Moreover, responsibilities, cost and budget are
overlooked in health care programs. The WHO, determined carefully for each task (table 2). The
governments, universities and institutes could easily executive guarantor of the milestone activities for
adopt this approach and act more efficiently to slow coronavirus control program is the portfolio
down the spread of coronavirus. Therefore, we aim to management office in the WHO which is delegated to
introduce this management approach here . the Ministry of Health in each country.
The LFA for coronavirus pandemic management may The strengths of the logical framework approach for
include five key analytical and logical elements to help coronavirus management program are stakeholders’
integrative actions (15-18): involvement, integrative team work in research and
1. Problem analysis: Is the process of finding the core medical procedures, as well as Inter-sectoral cooperation
problem (rapidly spread of coronavirus in the world) in all parts of society. Moreover, in the logframe
causes and effects related to coronavirus infection. responsibilities, cost and budget are determined carefully
Furthermore, priorities are determined. This for each task, which leads to an arranged process to
technique is similar to the problem tree analysis (16). achieve the goals. In the absence of specific medicine
2. Stakeholder analysis: Is the process of identifying and vaccine for coronavirus infection, adjunction of the
any individual, group, organization or system that

352 Iranian J Psychiatry 15: 4, October 2020 ijps.tums.ac.ir

 COVID-19 Mental Health and Nutritional Care

regular medical care for the patients with coronavirus management programs in some countries. In
complementary medicine, mental health care and the case of Iran which are under the most severe and
nutritional care should be addressed (22, 23). cruel political and economic sanctions which has
Figure 1 shows the dynamic association of COVID-19 affected medical affairs are more vulnerable to develop
managerial process with Political, Economic, Social, epidemic in spite of excellent health care professionals
Technological, Legal and Environmental (PESTEL) (24). Hence, stopping the political sanctions is essential
factors. In these critical days, unfortunately, political and to win the war against viruses.
economic situations may negatively influence on

Table 1. Example of a Logical Framework Matrix for Coronavirus Management Programs

Project outline Measurable indices Method of affirmation assumptions

(Goal to super
GOAL: Reduction of the
goal): successful
Reducing the incidence of %Contribution of coronavirus to total death percent which
Coronavirus
coronavirus and associated rate coronavirus contributes
portfolio
death to total death rate
management

PURPOSE:
1- Provide virus free
environment for all
people - % of people access to virus free
2- Informing all people environment Incidence of (Purpose to
in the society about - % of people informed about coronavirus infection as goal)
coronavirus coronavirus ways of transition and will report by ministry of
3- Equip sufficient protection health officials Successful
hospital beds for - % of empty beds devoted to enrolment of all
coronavirus infected coronavirus infected patients Rates of recovering stakeholders and
patients - % of patients treated by new from coronavirus their contribution
4- Inventing new medicines according to clinical infection as will report to reach the
medicine for treating trial studies by ministry of health objectives and
people affected by - % of people who developed officials goals
coronavirus immunity against coronavirus
5- Inventing new
coronavirus vaccine
OUTPUTS:
1- Promoting the
knowledge, attitude
Total hours in TV
and practice of
%of people act according to the programs devoted to
society members (Outputs to
coronavirus prevention guidelines healthy habits to
toward coronavirus purpose)
% of new cases or incidence of coronavirus prevent coronavirus
infection Well
infection
2- Breaking the virus management
% of people immunized by new coronavirus KAP questionnaires
transmission chain process of
vaccine.
3- Finding coronavirus activities and
% of people treated by new coronavirus Clinical trials of
vaccine and tasks
medicines. coronvirus vaccine and
medicine
medicines
4- Efficient prevention
and treatment of
coronavirus infection
ACTIVITIES:
INPUTS & RESOURCES:
1- Community-based (Activity to
education No. of health care output)
2- Regulations imposed professionals that
Month 2

Month 3

Month 4

Month 5
Month1

by governments focus on community Well satisfied

3- Encourage education and program
quarantine if treatment requirements
necessary No. of hospital beds (such as
4- Vast educational and equipments PESTEL*
programs devoted to analysis and
5- TV programs & coronavirus infection SWOT analysis)

Iranian J Psychiatry 15: 4, October 2020 ijps.tums.ac.ir 353

Mostafavi, Molavi, Mohammadi

advertisements No. of scientists and

6- Early detection and researchers that
isolation of positive focus on developing
cases and People vaccines and
they've contacted medicines
7- Coronavirus vaccine Supplies expend in
development development of
program vaccine
8- Coronavirus Supplies expend in
medicine program development of new
9- Promoting mental medicines
health, nutritional Legislations which
status and support this program
complementary
medicine No. of agencies and
organizations dealing
with coronavirus issue
Funding and other
resources that
support this program

Total Cost

No. of health care

professionals that
focus on community
education and
treatment
* PESTEL stands for Political, Economic, Social, Technological, Legal and Environmental, SWOT stands for Strengths,
Weaknesses, Opportunities and Threats

Table 2. Milestone Activities for Coronavirus Control Program (Detailed list of Activities and Resources
Allocation to each Task Could be Filled in This Timeframe(
Responsibility
Sub- Year 2020
(Name of Materials &
Activity Activity Duration Requirements Cost Budget
Person / Equipments
(Task ) April May June July August Organization)

1.
2.
3.
4. etc

354 Iranian J Psychiatry 15: 4, October 2020 ijps.tums.ac.ir

 COVID-19 Mental Health and Nutritional Care

PESTEL

PESTEL

PESTEL

PESTEL

PESTEL

Figure 1. COVID-19 Control Process; indicates the Dynamic Association of COVID-19 Managerial Process with
Political, Economic, Social, Technological, Legal and Environmental (PESTEL) Factors

Iranian J Psychiatry 15: 4, October 2020 ijps.tums.ac.ir 355

Mostafavi, Molavi, Mohammadi

Limitation avoidance/approach model of immune system

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