Abstract
Philanthropic activities play an important role in health systems. Donors contribute to financing, generating resources, and providing healthcare services in Iranian health system. However, they face many challenges. This study aimed to identify barriers to donors' participation in the Iranian health system and to provide solutions. This qualitative study was performed using semi-structured interviews with 38 donors and 26 policy-makers and managers in the social affairs department of health ministry and medical universities in 2018. In addition, document analysis was performed and the relevant data were extracted. Thematic analysis was used for data analysis. All ethical considerations were followed in this research. Insufficient structures, poor communications, low trust, ineffective working processes, bureaucracy, insufficient senior managers' support, weak legal support and poor monitoring were the most important challenges for donors' participation in the Iranian health system. Effective donor participation in the health system requires the creation of an appropriate system including the right structures, processes, culture, and management. The necessary changes must be planned, led and monitored to promote donors' participation in healthcare. A conceptual model was developed to strengthen donors' participation in the health system. Iranian donors face structural, procedural, cultural, and managerial challenges when financing the health system, generating resources, and providing health services. Policy-makers and managers should tackle these challenges and adopt strategies to reinforce donors' participation in the health system. Planning, organizing, leading, monitoring, evaluation, transparency, accountability, and a commitment to meet donors' needs are necessary for successful philanthropy initiatives in the health sector.
Highlights
The Islamic Republic of Iran is a middle-income country with a population of about 84 million and per capita gross domestic product of $14 535.2 Iran’s health system is hybrid and the public, private and non-profit sectors are involved in financing, purchasing and providing health services
The results of this study provide useful information to health policy makers and managers to strengthen the participation of donors in financing, resource generation and health services delivery
Effective donor participation in the health system requires the creation of an appropriate system including the right structures, processes, culture, and management
Summary
The Islamic Republic of Iran is a middle-income country with a population of about 84 million and per capita gross domestic product of (purchasing power parity) $14 535.2 Iran’s health system is hybrid and the public, private and non-profit sectors are involved in financing, purchasing and providing health services. Medical universities are responsible for providing both medical education and healthcare services at the provincial level. The private and non-profit sectors are more involved in financing and providing specialized health services.[3]. The total health expenditure of the Iranian people was US$39.6 billion in 2018, which was 0.5% of the world total health expenditure. The per capita health expenditure of the Iranian people was US$484 in 2018, which was 1.2 times the average per capita health expenditure of the world. The government is facing challenges in financing and providing healthcare services. Private philanthropy may fill this gap and support the health system
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