Document Type : Original Article


1 Department of Midwifery, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran

2 Department of Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran


BACKGROUND AND AIM: Considering that the Qom University of Medical Sciences was a pioneer
to implement the health system reform (HSR) in the domain of health services and the lack of a
study that has addressed the challenges and strategies to promote the HSR in the health domain,
this study was designed to explain the structural challenges and its solutions in the health domain
of the HSR in the city of Qom, Iran, 2017.
MATERIALS AND METHODS: This study was a qualitative research. The health managers, the
health‑care providers, and the recipients of health services referring to the health centers in Qom were
the participants in this study who were selected using the convenience sampling method. The data
were collected using individual interviews and with the guidance of a semi‑structured questionnaire.
Collected data were analyzed by the qualitative content analysis method with an inductive approach.
After extracting the challenges of the HSR in the health domain through a qualitative approach, these
challenges were prioritized through Delphi’s technique in terms of relevance and resolving strategies.
RESULTS: From the perspective of the study participants, the structural challenges of HSR in the
health domain in order of importance and priority included problems due to the SIB system, defects in
the instructions, the disruptions caused by multitasking, poor service coverage, incomplete health‑care
packages, and the shortage of resources.
CONCLUSION: According to the findings of this study, we hoped that the HSR in the health area
can be improved to increase its success by modifying the guidelines and the coverage of services,
modifying the SIB system, providing requires resources, completing the service packages, and
solving the multitasking problem.


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