Abstract
BackgroundHealth systems reform is inevitable due to the never-ending changing nature of societal health needs and policy dynamism. Today, the Health Transformation Plan (HTP) remains the major tool to facilitate the achievements of universal health coverage (UHC) in Iran. It was initially implemented in hospital-based setting and later expanded to primary health care (PHC). This study aimed to analyze the HTP at the PHC level in Iran.MethodsQualitative data were collected through document analysis, round-table discussion, and semi-structured interviews with stakeholders at the micro, meso and macro levels of the health system. A tailored version of Walt & Gilson’s policy triangle model incorporating the stages heuristic model was used to guide data analysis.ResultsThe HTP emerged through a political process. Although the initiative aimed to facilitate the achievements of UHC by improving the entire health system of Iran, little attention was given to PHC especially during the first phases of policy development – a gap that occurred because politicians were in a great haste to fulfil a campaign promise.ConclusionsHealth reforms targeting UHC and the health-related Sustainable Development Goals require the political will to improve PHC through engagements of all stakeholders of the health system, plus improved fiscal capacity of the country and financial commitments to implement evidence-informed initiatives.
Highlights
Health systems reform is inevitable due to the never-ending changing nature of societal health needs and policy dynamism
This paper shed limelight on the recent health system reform in Iran, i.e., the Health Transformation Plan (HTP), and from the analysis described how the primary health care (PHC) was reorganized within the HTP
Findings are categorized based on the stages of the policy process, and are explained below: Problem identification and agenda setting Despite the numerous achievements of the PHC network programs, meaningful shortcomings existed
Summary
Health systems reform is inevitable due to the never-ending changing nature of societal health needs and policy dynamism. The Health Transformation Plan (HTP) remains the major tool to facilitate the achievements of universal health coverage (UHC) in Iran. It was initially implemented in hospital-based setting and later expanded to primary health care (PHC). No matter the robustness of a health system, reform is inevitable due to the need to respond to never-ending changing nature of societal health demands and policy dynamism [2, 3]. The institution is responsible for health policy formulation, resource mobilization, monitoring and evaluation, and regulating health service delivery throughout the health structure
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