Document Type : Original Article

Authors

1 Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences

2 Social Determinant of Health Research Center, Isfahan University of Medical Science, Isfahan, Iran

Abstract

INTRODUCTION: The healthcare program has opponents and supporters with its multiple policies
and also its difficult implementation, which requires that its barriers and problems be addressed
comprehensively and extensively. This study was conducted aimed to determine the service
provision challenges by healthcare providers, from their point of view, in selected comprehensive
health centers of Isfahan.
MATERIALS AND METHODS: The present study is a descriptive‑analytic one. One‑hundred
and ninety‑seven healthcare providers were selected by census sampling method from the
population of female healthcare providers in Isfahan comprehensive health centers in 2017. The
data collection tool was a researcher‑made questionnaire in the field of individual–professional,
managerial–organizational, and executive challenges. Data analysis was done by repeated measures
ANOVA and post hoc test.
RESULTS: The findings indicated that there was a significant difference between the mean score
of individual–professional, managerial–organizational, and executive challenges (P < 0.001) from
the point of view of healthcare providers. According to least significant difference post hoc test, the
mean score of individual challenges was significantly lower than that of managerial and executive
challenges (P < 0.001). However, there was no significant difference between the mean score of
managerial–organizational and executive challenges (P = 0.46).
CONCLUSION: Based on the results, healthcare providers have put forward several challenges during
the implementation of the healthcare program. Meanwhile, executive and managerial challenges
have been considered more than individual challenges. Considering that this could lead to improper
service provision to the clients, the role of policymakers in this program to remove obstacles and to
provide satisfaction to healthcare providers is emphasized.

Keywords

1. The Ministry of Health and Medical Education. Evaluation of
Health System Reform Plan in the Treatment Area. 1st ed. Iran:
The Ministry of Health and Medical Education; 2015. P: 4‑20.
2. Behzadi F, Saki K, Keshavarzi A. Senior Health Administrators
and Experts on the Challenges of Health Reform Plan: Qualitative
Study. Abstract Proceedings of the International Conference
on Sustainable Development in the Health System, Isfahan
University of Medical Sciences, Isfahan, Iran; 2015. P: 9.
3. The Implementation of the Program for the Provision of Primary
Health Care Services in the Marginal Areas of Cities, Informal
Settlements and Towns “between” 20‑50 Thousand. Version3; 2015.
4. Bria Sera S, Kromoredio P, Kolehmainen – Aitken L R, Smith J,
Darmawan J. Decentralized application of the WISN methodology
in the Nusa Tenggara Timur province. Indonesia. Book chapter:
Applying the WISN method in practice case studies from
Indonesia, 2010, PP: 1‑9.
5. The Executive Order of the Provision and Development Plan for
Primary Health Care in the Urban and Indigenous Areas. Rev. 3;
2015.
6. World Health Organization. The World Health Report 2015:
Health Systems: Improving Performance. Geneva: WHO; 2015.
7. Fraser D, Cooper M. Myles Textbook for Midwives. 15th ed.
Elsevier: Churchill Livingstone; 2014. P: 3‑8.
8. Babashahy S, Akbari Sari A, Rashidian A, Olyaee Manesh A.
Payments of physicians employed in public and private hospitals
after modification of surgical and invasive services tariffs. Hakim
Res J 2012;15:38‑43.
9. Mahdian S, Jahangard M. Reviewing the Challenges of the
Health System Development Plan in Three Different Time Gaps
and Providing Solutions to Removing Obstacles Available in the
Review of the Performance of the 11th State in the Area of Health;
2015. P: 34‑5.
10. Aghababaean Dehaghani A, Moradi Niam A, Davari S.
Comparison of the status of the quantity of health care expert in
the health team with the organizational standards and announcing
the distance between standards. Presented in the Review of the
Performance of the Eleventh Government in the Field of Health;
2015. P: 15‑6.
11. Asfazade S, Rezapour A. Healthcare Management. Qazvin:
Today’s Hadith; 2012.
12. KhachianA, ManoochehriH, PazagadiM, Akbarzadeh BaghbanA.
Challenges of change management, experiences of managers in
faculty of nursing and midwifery. J Sch Nurs Midwifery Tehran
Univ Med Sci (Hiat) 2013;18:79‑88.
13. Bahadoran P, Alizadeh S, Valiani M. Exploring the role of
midwives in health care system in Iran and the world. Iran J Nurse
Midwifery Res 2009;4:117‑22.
14. Pourkazemi R, Beigi M, Kohan S. Assessment of barriers for
midwives to achieve professional management positions from
midwives’ point of view. Iran J Nurs Midwifery Res 2017;22:173‑7.
15. Shaban I, Barclay L, Lock L, Homer C. Barriers to developing
midwifery as a primary health‑care strategy: A Jordanian study.
Midwifery 2012;28:106‑11.
16. Sullivan K, Lock L, Homer CS. Factors that contribute to midwives
staying in midwifery: A study in one area health service in New
South Wales. Elsevier J 2014;27:331‑5.
17. World health organization, World health statistics, Geneva: WHO
2014: pp: 17‑31.
18. Gholipour A. Organizational Behavior Management (Individual
Behavior). 1st ed. Tehran: SAMT; 2012.
19. Kheyri F, Goudarzi L, Meshkini A, Khaki A. Syntactic Review of
the Six Plan Implementation of the Health System Development
Plan from the Point of View of the Surveillance Experts in the
Treatment Review of the Performance of the 11th Government in
the Area of Health; 2015. P: 21‑2.
20. Golmakani A, Mortazavi H, MohaddesHakkak H,
EftekhariNasab E, Rahimzadeh J, Darabi D. The views of the
beneficiaries of the Health Development Plan. Presented at the
Critic of the Performance of the Eleventh Government in the Field
of Health 2015: 55-54