Financing of physical rehabilitation services in Iran: a stakeholder and social network analysis

Saeed Shahabi,Hosein Shabaninejad,Kamran Bagheri Lankarani,Ahmad Ahmadi Teymourlouy,Mohammad Kamali

doi:10.1186/s12913-020-05447-4

Abstract

BackgroundInadequate financing is one of the major barriers in securing equitable access to high-quality physical rehabilitation services, without imposing financial hardship. Despite this, no sufficient attention has been paid to physical rehabilitation services and no specific financial resources have been allocated to such services in many countries including Iran. Owing to the fact that effective decision- and policy-making requires identifying possible stakeholders and actors and their characteristics, in the current study a stakeholder analysis and also a social network analysis (SNA) was conducted to identify the potential stakeholders and also their characteristics involved in physical rehabilitation financing (PRF)-related policies in Iran.MethodsThe present study was performed in two phases. Firstly, semi-structured interviews and relevant document review were conducted to identify the stakeholders. Then, the position, power, interest, and influence of each stakeholder were determined using a web-based questionnaire. Secondly, SNA approach was utilized to map and visualize the interactions among stakeholders.ResultsThe findings showed that there are different stakeholders in PRF-related decision- and policy-making processes in Iran. In addition, the position, power, interest, and influence level of the identified stakeholders were varied. Moreover, although some stakeholders, like the Ministry of Health and the parliament have the highest level of power and position, they lack sufficient interest to participate in PRF-policies. Furthermore, SNA demonstrated that social network density was low, which indicates the lack of proper collaboration and interaction among the stakeholders.ConclusionAs many powerful and influential stakeholders had low interest levels to warrant participate in the FPR-related decision- and policy-making processes in Iran, employing careful and effective strategies, that is ongoing negotiations, receiving advocacy, and making senior managers and policy-makers aware can be helpful.

Highlights

Inadequate financing is one of the major barriers in securing equitable access to high-quality physical rehabilitation services, without imposing financial hardship
Rehabilitation services including physical rehabilitation services are considered as a group of interventions to reduce the functional and physical limitations in order to obtain a maximum level of independence [6]
Some participants believed that the Ministry of Health and Medical education (MOHME) did not hold itself responsible for financing and providing physical rehabilitation services in Iran, these services are introduced as a part of the health system [16]

Summary

Introduction

Inadequate financing is one of the major barriers in securing equitable access to high-quality physical rehabilitation services, without imposing financial hardship. Rehabilitation services including physical rehabilitation services (e.g. physiotherapy, occupational therapy, prosthetics, and orthotics services) are considered as a group of interventions to reduce the functional and physical limitations in order to obtain a maximum level of independence [6]. As a result, these services may have significant advantages for individuals, society, and national economies [7,8,9]. Does the provision of affordable physical rehabilitation services not impose any significant financial pressure on the health sector, and it can be a rational investment [14,15,16]

Objectives

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Results

Discussion

Conclusion