Document Type : Original Article


Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran


BACKGROUND AND OBJECTIVES: Because the performance assessment of the health system
is used as the basis for decision‑making and demonstrates progress or failure in achieving the goals
of the health system, promoting the health system performance assessment can play a major role
in improving and enhancing the health system. Therefore, the main aim of the study was to identify
and prioritize the challenges of promoting the health system performance assessment.
MATERIALS AND METHODS: There were two approaches in both qualitative and cross‑sectional
studies. At first, using semi‑structured interviews with 52 performance appraisers, data related
to the challenges of promoting the health system performance assessment were collected and
thematically analyzed. Then, in cross‑sectional terms, the performance appraisers were provided
with researcher‑made checklists which contained a list of challenges to determine the priority of
challenges by scoring. The data were handled and analyzed using MAXQDA Plus version 12 and
Microsoft Excel.
RESULTS: Our results revealed five themes and ten subthemes on the challenges of promoting
the health system performance assessment. Themes (subthemes) included infrastructures (cultural
and technological), implementation (organizational support, process, and responsibilities), human
resources (motivation and training), assessment (performance monitoring), and content of
measures (reliability and validity). We also prioritized 31 listed challenges in three priority groups,
including below average, average, and above average.
CONCLUSION: Our findings suggest that promoting the health system performance assessment
in Iran can be accomplished by allocating financial and nonfinancial motives to the performance
assessment staffs, using performance assessment results in policymaking, clarifying tasks of
assessment process executors, and reviewing and adapting the performance assessment indices
according to contingencies in the health system.


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