Document Type : Original Article
Authors
1 Department of Health Services Management, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran
2 Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
BACKGROUND: Health system reform plan in public health sector in Iran in the first phase focused
on improving primary health care in suburban areas in and around big cities. The present study was
conducted to assess the implementation process challenges of the reform plan in comprehensive
health service centers at suburban areas of Isfahan in 2019.
MATERIALS AND METHODS: This qualitative study with conventional content analysis approach
was conducted in 2019. Participants were purposefully selected and interviewed at provincial
levels from Isfahan University of Medical Sciences health department and health‑care providers
of comprehensive health services centers. The saturation point was reached after 21 face‑to‑face
semi‑structured interviews. Thematic analysis was employed to analyze transcribed documents
assisted by MAXQDA version 10.
RESULTS: The results revealed four main themes; the human resource management, the executive
management, the electronic infrastructure, and the resource management.The major challenges
in the implementation planning process included: the referral system, monitoring and supervision,
electronic services infrastructure in the design and development of the EHR called the SIB system,
lack of instructions guide, salaries and benefits, inconsistent financial and human resources and
inappropriate allocation of theses resources.
CONCLUSION: Despite the achievements in the development of the Iran health system reform plan,
there were many challenges in the implementation planning process. It is recommended that theses
challenges be reviewed and amended by health system managers and policymakers.
Keywords
Health Systems: Improving Performance: World Health
Organization; 2000.
2. Olyaeemanesh A, Behzadifar M, Mousavinejhad N, Behzadifar M,
Heydarvand S, Azari S, et al. Iran’s health system transformation
plan: A SWOT analysis. Med J Islam Repub Iran 2018;32:39.
3. Tabrizi JS, Farahbakhsh M, Bazargani SH, Hassanzadeh R,
Zakeri A, Abedi L. Effectiveness of the health complex model in
Iranian primary health care reform: The study protocol. Patient
Prefer Adheren 2016;10:2063.
4. Han W. Health care system reforms in developing countries.
J public Health Res 2012;1:199.
5. Frenk J. The public/private mix and human resources for health.
Health Policy Plann 1993;8:315‑26.
6. Ghasemi SR, Zangeneh A, Gilan RN, Reshadat S, Saeidi S,
Ziapour A. Health‑related quality of life in informal settlements
in Kermanshah, Islamic republic of iran: Role of poverty and
perception of family socioeconomic status. Eastern Mediterr
Health J 2019;25:775‑83.
7. Burström B, Burström K, Nilsson G, Tomson G, Whitehead M,
Winblad U. Equity aspects of the primary health care choice
reform in Sweden‑a scoping review. Inte J Equity Health
2017;16:29.
8. Green A, Ross D, Mirzoev T. Primary health care and England:
The coming of age of Alma Ata? Health Policy 2007;80:11‑31.
9. Tabrizi JS, Pourasghar F, Nikjoo RG. Status of Iran’s primary
health care system in terms of health systems control knobs:
A review article. Iran J Public Health 2017;46:1156.
10. Takian A, Rashidian A, Kabir MJ. Expediency and coincidence
in re‑engineering a health system: An interpretive approach to
formation of family medicine in Iran. Health Policy Planning
2011;26:163‑73.
11. Aghajanian A, Mehryar AH, Ahmadnia S, Kazemipour S. Impact
of rural health development programme in the Islamic Republic
of Iran on rural‑urban disparities in health indicators. EMHJ‑East
Mediterr Health J 2007;13:1466‑75.
12. Adams AM, Islam R, Ahmed T. Who serves the urban poor?
A geospatial and descriptive analysis of health services in
slum settlements in Dhaka, Bangladesh. Health Policy Plann
2015;30:i32‑45.
13. Ahmed SM, Hossain A, Khan MA, Mridha MK, Alam A,
Choudhury N, et al. Using formative research to develop MNCH
programme in urban slums in Bangladesh: Experiences from
MANOSHI, BRAC. BMC Public Health 2010;10:663.
14. Rajabi F, Esmailzadeh H, Rostamigooran N, Majdzadeh R,
Doshmangir L. Future of health care delivery in Iran, opportunities
and threats. Iran J Public Health 2013;42:23.
15. Turley R, Saith R, Bhan N, Rehfuess E, Carter B. Slum upgrading
strategies involving physical environment and infrastructure
interventions and their effects on health and socio-economic
outcomes. JEBM, Cochrane Datab Syst Rev 2013;1:57.
16. Balasubramaniam SM, Paneerselvam VM, Senguttuvan M,
Subramanian J. Improving health of children in urban slums
through an integrated model based approach‑a case study from
Chennai. Indian Pediatr 2012;49:969‑70.
17. Kusuma YS, Kaushal S, Garg R, Babu BV. Birth preparedness
and determinants of birth place among migrants living in slums
and slum‑like pockets in Delhi, India. Sexual Reprod Healthcare
2018;16:160‑6.
18. Mathias K, Pandey A, Armstrong G, Diksha P, Kermode M.
Outcomes of a brief mental health and resilience pilot intervention
for young women in an urban slum in Dehradun, North India:
A quasi‑experimental study. Int J Mental Health Syst 2018;12:47.
19. Ghazizadeh Hashemi H, Larijani B, Sayyari A, Malekzadeh R,
Dinarvand R, Hajiaghajani M, et al. Minstry of health and medical
education. In: National Disease Prevention and Control Document
and Related Risk Factors in the Islamic Republic of Iran Over the
Period 1394‑1404. Tehran: AFTAB Andisheh; 2014. p. 178.
20. Zanganeh Baygi M, Seyadin SH, Rajabi Fard Mazrae No F,
Kouhsari Khameneh A. Adaptation of goals and organizational structure in Iran’s primary healthcare system, a systematic review.
J Payavard Salamat 2016;9:446‑58.
21. Aleemi AR, Khaliqui H, Faisal A. Challenges and patterns of
seeking primary health care in slums of Karachi: A disaster lurking
in urban shadows. Asia Pacific J Public Health 2018;30:479‑90.
22. Marcil L, Afsana K, Perry HB. First steps in initiating an effective
maternal, neonatal, and child health program in urban slums:
The BRAC Manoshi project’s experience with community
engagement, social mapping, and census taking in Bangladesh.
J Urban Health 2016;93:6‑18.
23. Joulaei H, Bhuiyan AR, Sayadi M, Morady F, Kazerooni PA.
Slums’ access to and coverage of primary health care services:
A cross‑sectional study in Shiraz, a Metropolis in Southern Iran.
Iran J Med Sci 2014;39:184.
24. Braun V, Clarke V. Using thematic analysis in psychology.
Qualitative Res Psychol 2006;3:77‑101.
25. LincolnYS, Guba EG. Naturalistic Inquiry. Vol. 75. Sage Thousand
Oaks, Newbury Park, CA: Sage; 1985.
26. Davari M. Economical challenges in Iran health system. J Health
Inform Manag 2011;7:915‑7.
27. Davari M, Haycox A, Walley T. Health care financing in Iran; is
privatization a good solution? Iran J Public Health 2012;41:14.
28. Stimpfel AW, Sloane DM, Aiken LH. The longer the shifts for
hospital nurses, the higher the levels of burnout and patient
dissatisfaction. Health Affairs 2012;31:2501‑9.
29. Damari B. Challenges and directions of public health development
in Iran from the viewpoint of provincial health deputies and
health center. Journal of School of Public Health and Institute of
Public Health Res 2015;13:1‑16.
30. Mahdiyan S, Akbari M, Bozorgi M, Amini‑Rarani M. Identifying
and prioritizing challenges related to promoting the health
system performance assessment in Iran. J Educ Health Promot
2020;9:169.
31. Abedi G, Soltani Kontai SA, Marvi A, Mazidi S, Abedini E,
Abbasi Chaleshtary A. SWOT analysis of health reform plan on
healthcare sector from the stakeholder perspective. J Mazandaran
Univ Med Sci 2018;28:199‑212.
32. Raisi M, Eskandari N, Abbasi M, Rahbar A. Customers’
satisfaction with the Iranian health system reform plan. J Educ
Health Promot 2019;8:170.
33. Chaman R, Amiri M, Dehaghi MR. The national family physician
and the quality of referral system. Payesh (Health Monitor)
2012;11:785‑90.
34. Nasrollahpour Shirvani SD, Mikanik E, Ashrafian Amiri H,
Kabir MJ, Jafari N, Tahmasbi B, et al. Evaluation of the referral
system situation in family physician program in northern
provinces of Iran: 2012‑2013. J Mazandaran Univ Med Sci
2014;23:27‑35.
35. Shaarbafchizadeh N, Aghdak P, Sahebi M. Outsourcing in health
facilities: Challenges in medical university of Isfahan in focus. Int
J Preven Med 2020;11:11‑172.
36. Bastani P, Garavand A, Abhari S. Evaluation of internet booking
system in websites of health centers affiliated with medical
universities in Iran. J Health Biomed Inform 2016;2:219‑28.
37. AbuAlRub RF, El‑Jardali F, Jamal D, Iblasi AS, Murray SF.
The challenges of working in underserved areas: A qualitative
exploratory study of views of policy makers and professionals.
Int J Nurs studies 2013;50:73‑82.
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