Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 11 2 2025 06 15 133 148 EN Yosra Azizpour 1 Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Sarmad Salehi 1 Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Azita Karimi Department of Health, Noncommunicable Disease Group, Tehran University of Medical Sciences, Tehran, Iran Samaneh Akbarpour Sleep Breathing Disorders Research Center (SBDRC), Tehran University of Medical Sciences, Tehran, Iran./Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 2025 01 03 2025 05 18 Introduction: Surveillance systems play a vital role in managing non-communicable diseases (NCDs). This study explores the challenges encountered in the implementation of Iran's hypertension (HTN) and diabetes surveillance system, using Tehran University of Medical Sciences (TUMS) as a case study. Methods: This study employed a two-part approach, consisting of a literature review and an expert panel discussion. In the first part, a literature review was conducted using PubMed and Google Scholar, encompassing studies published between 2000 and 2023 in both Persian and English. The objectives of this review were to: 1) investigate the history of diabetes and HTN surveillance system and 2) identify implementation challenges of the surveillance system for these conditions. The sources included national guidelines, health surveys, published reports, and academic papers. In the second part, five expert panel discussions (formal focus groups) were conducted semi-structured with seven TUMS specialists. These sessions aimed to pinpoint the challenges in implementing diabetes and HTN surveillance in Iran. Finally, data from both parts were analyzed using conventional content analysis with an inductive approach and were categorized and coded using MAXQDA software to extract the key challenges in implementing the surveillance system. Results: The National HTN Prevention and Control Program was initiated in 1992 and later expanded its focus to include individuals (both males and females) aged 30 and older in rural areas. In 2004, it merged with the National diabetes Prevention and Control Program, which was established in 1991. This program primarily targeted high-risk individuals aged 15 to 39, as well as those over 40 in selected pilot rural areas. Together, these programs now address both HTN and diabetes prevention through the IraPEN program, launched in 2014. The analysis identified three main categories and eleven subcategories, resulting in a total of 78 codes. The issues have been categorized into three areas: healthcare recipients (lack of public awareness and social issues), healthcare system employees (staffing issues and inadequate training), and upper levels of the healthcare system (ineffective policies, poor evaluation and monitoring, outdated facilities, weak management, insufficient data, and financial constraints). Conclusion: The study identifies challenges within Iran's healthcare system that impede surveillance programs. To improve outcomes, we should prioritize public education, provide better support for healthcare workers, and implement stronger management practices. By adopting these changes, we can enhance the surveillance systems for HTN and diabetes. https://jbe.tums.ac.ir/index.php/jbe/article/view/1559