Crucial Reforms Research Articles

THE SUPREME THEATRE: HOW INDIVIDUALISM AND THE EXTREME PUBLICITY ARE UNDERMINING THE DECISION-MAKING PROCESS OF THE SUPREMO TRIBUNAL FEDERAL

With the enactment of the 1988 Brazilian Federal Constitution, the Brazilian constitutional system witnessed a great expansion of the powers of the Judiciary, along with a considerable growth of the influence of the Supremo Tribunal Federal (STF) in the everyday life. Not only were such changes brought by crucial reforms, but also by the change of the social-political context. Such a context, characterized by the desire of re-democratization of the Country, led to a gradual opening of the Tribunal to the society. So far, one of the major connection tools between the Court and the public opinion has been the peculiar decision-making process of the STF. If on the one hand such process seems to have favoured transparency and participation of the society to the life of the Tribunal, on the other hand it has created not few concerns, namely with regard the high individualism and the extreme publicity that both govern the decision-making process. Indeed, the objective of the present work is to inquire the extent to which these issues affect the current decisional process of the Supremo, also with the aim to find how further negative consequences might be overcame. The research adopts an in-depth qualitative analysis of the relevant doctrine on the issues, with a small comparative glimpse on other constitutional experiences. The paper suggests the urgent need to reform the current mechanism of deliberation of the Supremo Tribunal Federal, with the aim of reducing the abovementioned disproportionate individualism and excessive transparency.

When Federal Standards Crash and Burn: The Need to Distinguish Aviation Product Liability Claims from In-Air Operations Cases

If you are injured in an aviation disaster or lose a loved one in a plane crash, may you seek recovery under state law? Do federal regulations provide adequate opportunities to compensate aviation crash victims? These are questions few people think to ask themselves. A more common query is what entity regulates the more than 16 million flights that occur yearly in the U.S., and how do you know whether the aircraft you fly on are safe? The tragic Boeing 737 MAX crashes initiated a federal oversight investigation into the Federal Aviation Administration (FAA). Industry whistleblowers revealed severe lapses in the FAA’s aircraft certification regime and a culture that promoted unsafe practices in aircraft design and manufacturing. Despite crucial reforms, the ability of uniform federal standards to protect aviation consumers is under fire. In a majority of U.S. jurisdictions, the Federal Aviation Act and associated federal regulations preempt all state law claims in aviation safety cases. The effect of this approach—few plaintiffs recover in aviation product liability suits, and the families of aviation crash victims go uncompensated. However, in Sikkelee v. Precision Airmotive Corp., the Third Circuit offered a new approach that advocates for field preemption for in-air operations claims but allows recovery under state law for aviation product liability cases. This approach adequately compensates aviation crash victims without undermining the FAA’s extensive and effective in-air regulatory scheme. This Comment addresses recent reforms to the FAA’s aircraft certification program and the ongoing circuit split regarding federal preemption of aviation safety claims. Further, this Comment seeks to analyze the fundamental differences between in-air operations regulations and rules governing aircraft design and manufacture to explain why different treatment of these claims is warranted. Ultimately, this Comment advocates for the Sikkelee methodology to provide ample opportunity for plaintiff recovery without unnecessarily undermining FAA regulatory authority.

Mapping the Inclusion of Children and Youth With Disabilities in Media Literacy Research

The way we communicate and make meaning in a complex socio-technical infrastructure demands multiple literacies. Media-literate citizens must be able to create, evaluate and effectively use information, media, and technology. The pandemic context demanded increased online learning and work, highlighting the importance of media literacy in citizens’ lives. Although in recent years, crucial reforms have happened in education for children with disabilities, media education for them is residual and framed on medical concepts neglecting how disability is socially constructed. Aiming to map recent research (2015–2021) in the field of media literacy and children with disabilities, a systematic literature review was conducted. The number of articles obtained from a search for “media literacy and children” in the scientific databases (<em>N</em> = 1,175) supports the relevance of media literacy in research. Filtering these data for “children with disabilities” reveals an inexpressive sample, with 12 articles included in the study after the eligibility phase. The overall results indicate that this population is significantly underrepresented in media literacy research, explained by a low prevalence of studies with disabled children as an audience. Moreover, research designs have shown a greater focus on conceptual approaches, highlighting a deficit of fieldwork and tangible interventions. Strong ableist media discourses emerged as a barrier to the promotion of media literacy in this population, with a clear mismatch between media representations and the current disability paradigms, besides all the positive aspects of the actions registered in the sample.

Static Electricity: Institutional and Ideational Barriers to China’s Market Reforms

China’s “economic juggernaut” is often noted to have arisen from successful market reforms carried out in the context of high state capacity. In contrast, we demonstrate that crucial reforms to replace central planning with markets have stalled as a result of major barriers of two types: institutional and ideational. Focusing on the electricity sector, we find that market reforms pushed by China’s central government are hindered by deep inefficiencies that arise from the legacy plan and “plan-derived” institutions of subnational governments and grid companies, against which the central state has been largely ineffective. We also uncover fascinating ideational differences of the nature and purpose of “markets” that show how they often are envisioned more as a way to extend the planner’s “toolbox,” or to offer “salvation” for ailing incumbent firms, rather than to induce efficiency. Our empirical focus on three prominent types of “market-oriented” experiments in the electric power sector demonstrate clear limits to state capacity, limits that emanate from state actors rather than merely industry, despite high-priority central government goals of increasing efficiency, integrating renewable energy, and reducing emissions from the electricity sector.

Universal Health Coverage; A Way Forward

Universal health coverage means every person has access to quality health care without suffering financial hardships. The basis of universal health coverage lies in the primary health care concept, which was envisioned way back in 1978, as mentioned in Alma Ata Declaration1. The "World Health Report" published by the World Health Organization (WHO) in 2008 structures primary health care reforms in four groups. One of the crucial reforms was universal coverage reform to improve health equity2. WHO and UNICEF in 2018 documented how primary health care will be in the 21st century? The approach was towards universal health coverage and sustainable development goals. Sustainable development goals were to be achieved by 2030, and they were a continuation of millennium development goals 2000–20153. The resolution on Transforming our world: the 2030 Agenda for Sustainable Development adopted the target of universal health coverage by 2030, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all4. Currently, many developing nations do not have access to health services. About 100 million people are pushed into extreme poverty each year because of out-of-pocket spending on health. To make health for all, we need individuals and communities to have high-quality health services to take care of their families health. Skilled health workers providing quality, people-centred care and policy-makers should be committed to investing in universal health coverage. Universal health coverage should be based on intense, people-centred primary health care. Good health systems are rooted in the communities they serve. They focus not only on preventing and treating disease and illness but also on helping to improve well-being and quality of life5. Pakistan, the developing country, is struggling to provide good quality health services, mostly availed from the out-of-pocket expenditure.
 Both private and public sector hospitals were trying to deliver health services, but poor people failed to have access to many services due to poverty. To overcome this obstacle and address indicator 3.8 of SDGs, the current government developed a five-year program to improve the targeted population's health by increasing their access to quality health services. The initiative will also reduce poverty, as the government will cover most of their health budget through the "Sehat Sahulat Program". The program was part of the National vision to ensure Universal Health Coverage (UHC) for all Pakistani families. No one is denied quality healthcare services only because of financial constraints. Initially, it was piloted in selected four districts of Khyber Pakhtunkhwa, which was later extended to all over the province. Currently, 7.2 million families are getting free in-patient health care services, and the program's annual cost is 18 billion. It was a bold initiative of the current government, which helped improve access to UHC, thus addressing one of the sustainable development goals6,7.

Can the Post-COVID FDI Boost the Indian Economy?

Ever since the liberation of trade policies in India, Foreign Direct Investments (FDI) has been crucial in the growth of the economy, both at the macro as well as sector level. The association between FDI and economic growth is an area of interest globally. The investment decisions are affected by several national and international events that add to the volatility of the number of inflows. COVID-19 pandemic severely impacted the intensity of FDI inflows. But the strong resilience by our government manifested in crucial policy reforms and proactive decision-making minimized the impact. This article examines the potential impact of FDI on crucial macroeconomic variables using the Computable General Equilibrium (CGE) Model. Introducing the policy shock of $90 billion into the model, an increase of 5.68% per annum in GDP is estimated. Findings indicate that the impact of FDI shall be favourable to a large number of sectors mainly metals, construction, motor vehicle, computers, and electronics in terms of increased output, exports, and employment opportunities. The study offers logical implications for the policymakers to continue strengthening their moves to attract FDI.

Economic and political determinants of the South African labour share, 1971–2019

This study examines the drivers of the steady decline in South Africa’s private sector labour share between 1971 and 2019. The focus on South Africa is instructive as its distributional contestation is bounded in a matrix of racial conflict. Crucial reforms on trade, finance and welfare were undertaken since 1994, but the study finds little evidence that the extension of the franchise promoted egalitarianism, since white economic elites invested in de facto political power. This study employs an Unrestricted Error Correction Model to estimate the drivers of the private sector labour share, and the findings suggest that globalisation, financialisation and public spending have decreased the labour share, while the effects of education have been positive but insufficient to halt the decline.

Delayed Initiation of Breastfeeding and Role of Mode and Place of Childbirth: Evidence from Health Surveys in 58 Low- and Middle- Income Countries (2012–2017)

Background: Timely initiation of breastfeeding is the first step towards achieving recommended breastfeeding behaviours. Delayed breastfeeding initiation harms neonatal health and survival, including infection associated neonatal mortality. Eighty percent of neonatal deaths occur in the low-and middle-income countries (LMICs), where delayed breastfeeding initiation is the highest. Place and mode of childbirth are important factors determining the time of initiation of breastfeeding. In this study, we report the prevalence of delayed breastfeeding initiation from 58 LMICs and investigate the relationship between place and mode of childbirth and delayed breastfeeding initiation in each country. Methods: We analysed data from the most recent Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) collected between 2012 and 2017 and reported by 2019. The study sample comprised all women who had a live birth in the 24 months preceding the survey. ‘Delayed’ initiation of breastfeeding was defined using WHO recommendations as starting breastfeeding after one hour of birth. We coded the stratifying variable for the place and mode of childbirth as “vaginal birth at a facility (VBF)”, “caesarean section birth (CSB) “, and “vaginal birth at home (VBH)”. We used respondent-level sampling weights to account for individual surveys and de-normalised the standard survey weights to ensure the appropriate contribution of data from each country. We report the prevalence and population attributable fractions with robust standard errors. The population attributable risk identifies the proportion of delayed initiation that we could avert among VBH and CSB if everyone had the same risk of delaying breastfeeding as in VBF. Results: The overall prevalence of delayed initiation of breastfeeding was 53.8% (95% CI 53.3, 54.3), ranging from 15.0% (95% CI 13.8, 16.2) in Burundi to 83.4% (95% CI 80.6, 86.0) in Guinea. The prevalence of delayed initiation of breastfeeding was consistently high among women who experienced caesarean section births; however, there was no direct association with each country’s national caesarean section rates. The prevalence of delayed initiation among women who experienced VBF was high in Sub-Saharan Africa and South Asia, even though the CSB rates were low. In some countries, women who give birth vaginally in health facilities were more likely to delay breastfeeding initiation than women who did not. In many places, women who give birth by caesarean section were less likely to delay breastfeeding initiation. Population attributable risk percent for VBH ranged from −28.5% in Ukraine to 22.9% in Moldova, and for CSB, from 10.3% in Guinea to 54.8% in Burundi. On average, across all 58 countries, 24.4% of delayed initiation could be prevented if all women had the same risk of delaying breastfeeding initiation as in VBF. Discussion: In general, women who give birth in a health facility were less likely to experience delayed initiation of breastfeeding. Programs could avert much of the delayed breastfeeding initiation in LMICs if the prevalence of delayed initiation amongst women who experience CSB were the same as amongst women who experience VBF. Crucial reforms of health facilities are required to ensure early breastfeeding practices and to create pro-breastfeeding supportive environments as recommended in intervention packages like the Baby-friendly hospital initiative and Early essential newborn care. The findings from this study will guide program managers to identify countries at varying levels of preparedness to establish and maintain a breastfeeding-friendly environment at health facilities. Thus, governments should prioritise intervention strategies to improve coverage and settings surrounding early initiation of breastfeeding while considering the complex role of place and mode of childbirth.

“That Name Is Dead to Me”: Reforming Name Change Laws to Protect Transgender and Nonbinary Youth

Content warning: this Article discusses suicidality. For transgender and some nonbinary youth, living under a chosen name is a first step toward becoming their authentic selves. For these youth, a name change is powerful; it allows them to choose a name that matches their gender identity. They consider their birth name to be a distressing “dead” name—one that they cannot relate to and need to bury. Using one’s chosen name decreases suicidality among transgender youth who face many challenges, including family rejection and other severe mental health stressors. Transgender and nonbinary youth can only require others to use their chosen names after obtaining a legal name change. But only two states in the nation currently allow minors to change their name legally without their parents’ consent and active assistance. Parental consent requirements are problematic because youth whose parents do not support their gender identity must wait, exposed to harm and distress. Thus, we deny them this first step towards correcting their gender and the accompanying mental health relief—delaying youth who have otherwise transitioned years before adulthood. In the meantime, with identification cards that do not match their gender identity, transgender and nonbinary youth are at risk of discrimination and other harm. They may drop out of school and avoid seeking employment for fear of bias and rejection. Our laws must change to protect our transgender and nonbinary youth by allowing them to change their legal name independently. Their mental health and well-being depend on these crucial reforms.

Italian National Recovery and Resilience Plan: a Healthcare Renaissance after the COVID-19 crisis?

Proposed for the first time by European Commission in May 2020, the “NextGenerationEU” (NGEU) program is the European Union’s most important effort to address key issues relating to public health and healthcare, digital and technological innovation, climate change, sustainable mobility, and key sociocultural aspects. In addition, the NGEU represents a response to the COVID-19 crisis through an extremely powerful financial intervention (over 800 billion euros). Italy is one of the main recipients of the NGEU plan’s resources with almost 200 billion euros received in grants and loans. Implementation of the NGEU in Italy will take place through the National Recovery and Resilience Plan (NRRP). The NRRP not only describes how the NGEU resources will be used, but it singles out crucial public law reforms in national legislation and organization. Unsurprisingly, public health intervention represents a major component of the NRRP. Here we summarize and discuss the rules, regulations and perspective envisaged by the NRRP to foster effective healthcare and to reshape the Italian National Health System through the redesigning of primary care, enhanced communication between hospital and community healthcare, and stronger implementation of digital technologies in public health. (www.actabiomedica.it)

Dynamic capital structure under changing market conditions in the oil industry: An empirical investigation

We study dynamics of capital structure in the oil sector, which has witnessed dramatic changes in the market conditions, such as significant changes in the price of oil, crucial reforms in legislation, and reduced access to credit over the last decade. Our analysis is focused on testing the main predictions of the tradeoff, pecking order, and market conditions models under a changing market environment. Our main contribution is to incorporate firms' heterogeneities related to indebtedness levels, share issues, long-term and short-term indebtedness within the capital structure analysis through the use of quantile regression as well as considering time dynamics. We identify general patterns in the sector, such as a preference in the oil industry for financing changes in investment through the issuance of new debt (mostly long-term debt). Generally, we find a changing capital structure across time and firms’ indebtedness characteristics. For example, oil firms with relatively high growth rates of new debt issuance are much more sensitive to changes in investment than firms with relatively lower rates of new debt issuance in a given year. Our results stress the importance of considering both time and cross-sectional asymmetries when explaining funding mechanisms adopted by a firm. Our study emphasizes the importance of time-varying aggregate factors on capital structure choices made by energy firms and therefore highlights the importance of policies that impact funding available for energy firms, independently of the idiosyncrasies that characterize their capital structure decisions. It also shed light on the importance of policies such as the establishment of anticyclical capital buffers in the energy industry.

Climate change and the sustainable development goal on food security: barriers and opportunities for progressive realization in Qatar and Nigeria

The United Nations Sustainable Development Goal 2 (SDG 2) contains a global commitment to “end hunger, achieve food security, and promote sustainable agriculture” by 2030. The realization of this goal under the current global political economy, climate change trends, and national realities is a daunting challenge. In this article, we draw on political ecology theory to examine the complex ecological, economic, geopolitical, climatic, and socially-induced barriers that threaten the achievement of SDG 2 in two oil producing countries with a high dependency on food imports: Qatar and Nigeria. First, we provide an overview of barriers to global food security and sustainable agriculture by discussing how the unevenness of power and resource distribution, reduced genetic diversity, land grabs, restrictive property rights, and the control of stable food production by big agri-businesses, all served to undermine hunger reduction and food security in the last 20 years. Second, drawing on newspaper analysis and an extensive literature review, we answer the questions: what are the current and future barriers to food security in Qatar and Nigeria? What efforts are these countries taking to address these barriers? What can both countries learn from one another? We also identify opportunities for new governance architecture on local food production. Finally, we suggest ways in which crucial reforms at local, national, regional and global scales might allow these countries to progressively realize SDG 2 by 2030 even under a climate change scenario. Keywords: Food Security; Import Dependency; Land Grab; Political Ecology; Property Rights; Sustainable Development Goals; Nigeria; Qatar

Två artskilda perioder för pedagogisk forskning

How might we explain and understand Swedish educational policy and the development of the Swedish school system, from the comprehensive, equality-oriented direction introduced in the early 1960s to the fragmented and divided system of today? In the following I will claim that two fundamentally different educational policy periods can be discerned. The first coincides with the first three decades of the comprehensive school system, from 1962 to 1989, the second with the three decades from 1989/1990 to the present. These two periods have created quite different conditions for the work of schools, and also for educational research. The crucial reforms laying the foundations for the shift in educational policy between the two periods were heavily influenced and inspired by the transnational emphasis in the late 1980s on the individual rights set out in international conventions, implying a parental right to educational authority.
 In recent decades, the consequences of this shift have manifested themselves in a partly privatised and marketized school system, characterised and driven by a logic clearly distinguished from the ideals and aspirations underpinning the struggles of the earlier period for a democratic and equality-oriented school system.

Credit Risk Determinants in the Vulnerable Economies of Europe: Evidence from the Spanish Banking System

Purpose: The purpose of this paper is to investigate the determinants of non-performing loans in the Spanish banking system over the period 1997Q4–2015Q3. This timeframe includes not only the booming period for the Spanish economy but also an extended post-crises interval which is missing from other studies for Spain. Design/methodology/approach: Using quarterly data from the Central Bank of Spain and from the European Central Bank, the paper employs the ARDL approach to cointegration to identify the existence of a long or short-run relationship between NPLs and a set of macroeconomic, bank-related and country-specific indicators. Findings: Findings from the ARDL model indicate that macroeconomic, bank-specific variables and interest rates are important determinants of non-performing loans in the Spanish banking system. Specifically, the real GDP, the Spanish long-term government bond yield, the return on equity, the total credit granted by the Spanish banks and their capital to assets ratio, explain credit risk in Spain both in the short and the long run. Research limitations/implications: Data on the bank-specific variables are for the whole banking industry, and not for individual banks. If such data were available, a comparison of the credit risk determinants between small/ big banks, private/public or domestic/foreign could be possibly made. Originality/value: These findings provide useful evidence to bank managers and policymakers in dealing with loans' defaults in Spain and in undertaking crucial reforms to stabilize the economy.

Integration of DERs on Power Systems: Challenges and Opportunities

The integration of large amounts of distributed energy resources (DERs) as photovoltaic solar generation, micro-cogeneration, electric vehicles, distributed storage or demand response pose new challenges and opportunities on the power sector. In this paper, we review the current trends on: i) how consumers adopting DERs can self-provide energy services and provide other services at system level, ii) what can be expected at distribution networks and how retail markets will evolve with more proactive and market engaged consumers, iii) what are the effects and integration of DERs on wholesale markets, and iv) what are the challenges that DERs pose on cybersecurity and the opportunities for improving system resilience. Several recommendations are given for achieving an efficient integration of DERs. For instance, the design of a comprehensive system of prices and charges and the elimination of existing barriers for market participation are crucial reforms to achieve a level playing field between distributed and centralized resources when providing electricity services. This paper summarizes part of the work developed under the MIT Utility of the Future study.

ЄГИПЕТ ПІД ВЛАДОЮ АБДЕЛЯ ФАТТАХА АЛЬ-СІСІ: ВНУТРІШНІ ВИКЛИКИ ДЛЯ РОЗВИТКУ

Egypt is the demographic giant of the world with strategic location at the crossroads between different continents. The country was under rule of military generals since 1952 and the first competitive presidential elections in its history took place only in 2012. The latest period of military rule under the President Hosni Mubarak lasted from 1981 till 2011. It was a time of a relative stability and the lack of crucial reforms when Egypt was supported by generous US aid and tourism expenditures. Is this about to change after the ≪Arab Spring≫ and short term of Mohammed Morsi’s presidency? Such issues as demographic explosion and high levels of unemployment, forced military conscription, the lack of affordable housing and scarcity of water resources are examined. The author makes an attempt to analyze how Egypt is trying to cope with those challenges under the rule of Abdel Fattah el-Sisi. To this end he looks into the development of different spheres of economic activity like tourism, the transit via Suez Canal, remittances and cotton agriculture.

Reformas de laicização do Estado e da Sociedade na ação governativa de Afonso Costa no início da 1ª República portuguesa (1911 e 1913)

In two different governments that joined or chaired, Afonso Costa (1871-1937) introduced in the Portuguese society a set of structural reforms, with a view to secularization and the creation of a state and a modern nation. As justice minister of the Provisional Government of the Republic decreed in February compulsory civil registration, and in April 1911, the law of the Church’s State Separation. These decrees will be subsequently ratified by the Constituent Assembly of 1911. In July 1913 establishing the Ministry of Education, but now as President of the Government. Analyse programmatic policy and doctrine that underlies the content of these regulations in order to carry out these crucial reforms to a state and a modern nation in Portugal of the early twentieth century by also Professor of Judicial Organization, it is the main objective of this small essay.

Undermining housing affordability for New York’s low-income households: The role of policy reform and rental sector restructuring

While public programmes, rent controls and subsidy schemes have not resolved New York’s historic and long-standing housing crisis, they have been important in dampening the housing problems of low-income New Yorkers. Along with an encroaching neo-liberal hegemony, however, since the 1990s redistributive policies have come under growing pressure. This article focuses on the neo-liberal restructuring of the city’s rental market and the effects on housing affordability. First, we outline the most crucial reforms and policy changes, at various scales, that have impacted the rental market in recent decades. Second, we demonstrate, using survey data, how reforms have affected the rental market structure before assessing how supply changes have affected affordability. We find that policy reforms have led to a reduction in inexpensive rental units in the city, reshaping patterns of affordability among different income groups, with particularly negative outcomes for low-income households, specifically among Black and Minority Ethnic Groups.

Lessons learned in Germany: in the past decade, Germany has invested a great deal of money into science funding schemes that have markedly changed its research landscape. Was the money well spent, and how will it be spent in future?

The collapse of Lehman Brothers in 2008 marked the beginning of a global financial crisis that has since affected the world economy and nations' finances. Even major economies such as the USA or Japan have been struggling with the aftermath of the events that started in 2008 while many European countries still suffer from high unemployment, recession and strained budgets. The crisis has also had a major impact on science as governments are forced to cut down on their investment into research and education. A few countries have escaped this predicament, however, and managed to maintain or even increase their investment into research, notably Germany as a major economy. In the past 10 years, Germany has invested heavily in its science system—and that was sorely needed. At the turn of the millennium, Germany's research system was not in the best state: Universities were chronically underfunded and brain drain depleted the country of young talent. “Policymakers recognized that something clearly had to be done. A political consensus was found that crossed party lines and was agreed on by the federal and the state governments”, said Peter Gruss, former President of the Max Planck Society from 2002 to 2014. The red–green coalition government under Chancellor Gerhard Schroder initiated crucial reforms about financing Germany's research sector, realizing that knowledge and innovation fuel economic growth and are key elements to global competitiveness—especially in a country with few natural resources. The governments under Angela Merkel, who became chancellor after Schroder's defeat in 2005, have largely implemented these reforms. Yet, some of the measures are scheduled to run out and German politicians and scientists debate on how to continue the success of the past decade. > At the turn of the millennium, Germany's research system was not in the best state: universities were chronically underfunded and brain …

Family medicine in Iran: facing the health system challenges.

Background:In response to the current fragmented context of health systems, it is essential to support the revitalization of primary health care in order to provide a stronger sense of direction and integrity. Around the world, family medicine recognized as a core discipline for strengthening primary health care setting.Objective:This study aimed to understand the perspectives of policy makers and decision makers of Iran’s health system about the implementation of family medicine in Iran urban areas.Materials/Patients and Methods:This study is a qualitative study with framework analysis. Purposive semi-structured interviews were conducted with Policy and decision makers in the five main organizations of Iran health care system. The codes were extracted using inductive and deductive methods.Results:According to 27 semi-structured interviews were conducted with Policy and decision makers, three main themes and 8 subthemes extracted, including: The development of referral system, better access to health care and the management of chronic diseases.Conclusion:Family medicine is a viable means for a series of crucial reforms in the face of the current challenges of health system. Implementation of family medicine can strengthen the PHC model in Iran urban areas. Attempting to create a general consensus among various stakeholders is essential for effective implementation of the project.