Document Type : Original Article


1 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences

2 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Health Managers Development Institute (HMDI), Ministry of Health and Medical Education

3 Health Managers Development Institute (HMDI), Ministry of Health and Medical Education, Secretariat of Supreme Council for Health and Food Security, Ministry of Health and Medical Education, Tehran, Iran


BACKGROUND: Family physician (FP) is one of the best strategies to reform health system and
promote population health. Due to the different context, culture, and population, implementing this
reform within cities would be more challenging than in rural areas. This study aimed to assess the
challenges and strengths of Urban FP Program in Fars Province of Iran.
MATERIALS AND METHODS: It was a qualitative study using framework analysis for collecting and
interpreting data. The participants included health policy‑makers, top managers, and involved health
staff selected through purposive and snowball sampling. Participating in the program or working
as a physician in urban areas were among inclusion criteria. Three focus groups with experts as
well as the content analysis of national documents were also performed. The research tool was a
semi‑structured interview guide. Interviews and focus groups were recorded and transcribed word
by word. The framework of triangle for data analysis and the content was analyzed using MAXQDA
2010 software.
RESULTS: The participants’ mean age was 44.9 ± 6.4 years, with a mean work experience of
13.2 ± 7.4 years. The transcripts revealed six themes and 17 subthemes. The emerging themes
included three challenges and three solutions as following: social problems, financial problems, and
structural problems as well as resistance reduction, executive meetings, and surveillance.
CONCLUSION: Resolving staff shortage, decreasing the public resistance, and eliminating
unnecessary referrals were among the strategies used by Fars, during FP implementation. To
be successful in implementing this program, the required perquisites such as infrastructures
and culture growth must be undertaken. The current study suggests the establishment of the
electronic health record to improve the pace and quality of service provision as well as reducing


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