PHC Services Research Articles

Prevalence of hypertension and factors associated with the utilization of primary health care services for hypertension among hypertensive population aged 40 years and above in Pyin Oo Lwin Township, Myanmar.

Utilization of hypertension services at primary health care levels has not been assessed at township level, since launching of PEN interventions in Myanmar. This study aimed to determine the factors associating with the utilization of primary health care services for hypertension among 40 years and above hypertensive population. Community-based cross-sectional study was done in Pyin Oo Lwin Township, 2023. Multi stage sampling was conducted to recruit 40 years and above participants; response rate was 85%. Joint National Committee (JNC7) classification was used to define hypertension. Among hypertensive participants, descriptive analysis, Chi squared test and multiple logistic models were conducted, with a significance level of 0.05. Out of 1001 screening participants, prevalence of hypertension was 38.6% (386). Among 386 participants, 51.8% (200) utilized primary health care services provided by public health facilities. Rural residents (AOR = 2.79, CI = 1.68, 4.67), known hypertension (AOR = 4.36, CI = 2.39, 8.23), good perception on hypertension (AOR = 0.30, CI = 0.14, 0.62), perceived cost of travel as necessary (AOR = 0.57, CI = 0.35, 0.92) and awareness of available services (AOR = 4.11, CI = 2.55, 6.71) were associated with the utilization of primary health care services for hypertension. This study provided context-specific scientific evidence to tackle existing problems of low utilization of PHC services for hypertension. Strengthening health care infrastructure for quality hypertension care at primary health care level was also recommended.

Measuring progress towards universal health coverage in 22 Middle East and North African countries

PurposeMonitoring progress towards universal health coverage (UHC) has become increasingly important, especially given the centrality of UHC in achieving the sustainable development goals. We sought to estimate the progress towards UHC in the 22 Middle East and North Africa (MENA) countries. MethodsEmploying the Joint World Bank and World Health Organization Framework for Monitoring UHC, we estimated the UHC index for MENA countries using both service coverage and financial protection indicators. We also explored the correlation between the UHC index with government expenditure/investment in health. ResultsThe 2021 UHC index ranged from 48.2 (Somalia) to 90.3 (United Arab Emirates) with a mean, median, and standard deviation of 74.9, 77.4, and 11.1, respectively, with significant differences between low-income and high-income countries. Service coverage lags behind financial protection in most MENA countries. There is a significant positive relationship between UHC and government health spending/investments. ConclusionThe majority of MENA countries are yet to achieve UHC. There is a need to expand healthcare services, especially PHC services, and adopt strategies that address concerns related to financial protection.

Optimizing primary healthcare experience: assessing client satisfaction in Kaduna State, Northwest Nigeria

BackgroundClient satisfaction is a multidimensional construct focusing on clients’ perceptions and evaluations of the treatment and care received. It is one of the factors affecting the outcomes of healthcare and the use of health services. Therefore, we aimed to assess clients’ satisfaction with PHC services in Kaduna State, Northwest Nigeria.MethodologyA cross–sectional descriptive study was conducted in Kaduna State, Northwest, Nigeria which evaluate the satisfaction of clients and caregivers accessing healthcare in PHC centres. A sample size of 217 was determined using Fisher’s formula, with a multi-stage sampling technique used to randomly select eligible respondents, who have accessed at least a PHC service in any of the PHCs in the State were included in the study, A semi-structured, interviewer-administered questionnaire was administered, and the data collected was analyzed using SPSS version 23.0. Appropriate statistical tests were used to examine the association between dependent and independent variables, while predictor variables that showed significant association with the outcome variables were further subjected to logistic regression analysis, to determine factors that affect clients’ satisfaction with PHC services. Statistical significance was determined at an alpha level set at 0.05 at a 95% confidence interval.ResultsThirty-one percent of the respondents were satisfied with PHC services in Kaduna State with a mean composite satisfaction score of 3.78 ± 0.67. Age, ethnicity, level of education, and occupational status were factors affecting clients’ satisfaction with PHC services among the respondents. On multivariate analysis, age, ethnicity, educational status, and occupational status were significant factors affecting clients' satisfaction with PHC services. Clients of Hausa/Fulani extraction are one and a half times less likely to be satisfied with PHC services when compared to clients from other tribes [aOR = 1.5, 95% CI (1.21–4.67); p = 0.003]. In terms of educational status, clients with formal education are one and a one-third times more likely to be satisfied [aOR = 1.3, 95% CI (0.17–0.94)] with PHC service when compared with their counterparts with informal education (p = 0.034).ConclusionClients’ satisfaction with PHC services in Kaduna State, Northwest Nigeria was sub-optimal. Healthcare providers were recommended to improve their attitude bearing in mind clients’ peculiarities.

Collaborations and Networks Within Communities for Improved Utilization of Primary Healthcare Centers: On the Road to Universal Health Coverage.

Community involvement depends on the level of linked and targeted activities for health by community members. This study examines the collaborations employed within communities to ensure sustainable access and improved use of healthcare in the community. This study was conducted in rural and urban local government areas in Anambra, Kano, and Akwa-Ibom, Nigeria. About 90 in-depth interviews and 12 focus group discussions were conducted with community stakeholders and service users. The findings were transcribed and coded via thematic analysis, guided by the Expanded Health Systems framework. Various horizontal collaborations in communities foster increased use of PHC services; promoting community health. Major horizontal collaborations in these communities were community-led, primary health facility-led, and Individual-led collaborations. Their actions revolved around advocacy, building and renovating PHC centers, equipping facilities, and sensitization to educate community members on the need to utilize services at PHC centers. Strategic involvements and collaborations of local actors within communities give rise to improvements in the utilization of primary healthcare centres, reportedly resulting in improved access to PHC healthcare services for community members.

Bridging the Gap in Primary Healthcare: Identifying Gaps and Recommendations to Enhancing the Utilization of PHC Services in Lebanon: A Qualitative Study

Bridging the Gap in Primary Healthcare: Identifying Gaps and Recommendations to Enhancing the Utilization of PHC Services in Lebanon: A Qualitative Study

Perception of Health Workers on the Integration of Mental Health Care with HIV Services in Primary Health Care Centres in Ogun East Senatorial District, Nigeria: A qualitative studyealth Services into HIV Care in Ogun East Senatorial District, Nigeria: A qualitative study

Background: People Living with HIV/AIDS have an increased incidence of mental health disorders as compared to the general population, and there exists an enormous gap between the demand and supply of mental health services, particularly in low- and middle-income countries. Aim/Objective: This study aimed to assess the association between HIV and mental health and the knowledge and perception of health workers on their integration in Primary Health Care Services in Ogun East Senatorial District, Nigeria Methodology: Four Focused Group Discussions were conducted among 27 PHC workers in Highly Active Antiretroviral Therapy (HAART)-enabled centres of Ogun East senatorial district, Nigeria using a focused group guide designed according to study objectives. Data were analyzed using a thematic analysis approach. Result: Six important themes were extracted from the data in this study (Table 2); “Integration of PHC services”, “Multiple mental/psychological health challenges”, “Multiple factors as causes of mental illness”, “Diverse manifestations of mental illness”, “Necessity of incorporating HIV and Mental Healthcare into PHC services”, and “Challenges of incorporating HIV and Mental Healthcare into PHC services.” Conclusion and Recommendation: The primary health workers identified the need to integrate mental health care into HIV care in PHCs. However, there is a need to scale up the capacity of PHCs for optimal performance in this regard.

Registered incidence of acute upper respiratory tract infections diagnosed by primary care physicians in Poland - 5-year retrospective analysis of the national health insurance database.

Upper respiratory tract infection (URTIs), caused by a variety of viruses and sometimes by bacteria, represents the most common acute illness in primary health care. The aim of the study was to explore the registered incidence of URTIs in Poland in the period between 2015-2019, and its burden on the health care system. A retrospective analysis was carried out of all medical encounters in Poland registered within the national billing database of public healthcare services. Medical services provided due to acute URTIs were classified according to the ICD-10 codes. Registered Incidence Rate (RIR) was calculated yearly, in a 100,000 population. A generalised additive model was used to calculate the Incidence Rate Ratio (IRR). In the analysed 5-year period, acute URTI was diagnosed in 24.3 million patients (61.7% of the whole population registered in PHC). The RIR of all acute URTIs in PHC was 50,762/100,000/year. Nearly 99% of consultations in this group of patients were provided by PHC physicians. Only 0.8% were referred to an OSC consultation and 0.4% were hospitalised. In PHC, indeterminate URTIs were most frequently diagnosed. The estimated IRR for children aged 1-4 years was 1.65 (95% CI: 1.64; 1.66, p<0.01) and for men 0.79 (95% CI: 0.79; 0.79; p<0.01). In the studied period, the number of patients consulted for acute URTI decreased slightly in PHC, but significantly in specialist services. The registered incidence of URTIs in Poland burdens mainly PHC physicians. Women and children aged 1-4 years are more frequent users of medical services related to URTIs. It appears that strategies for increasing patient empowerment to provide efficient self-care reducing the utilisation of PHC services are needed.

Patients and Health Professionals' Perceptions of Primary Health Care Services in Saudi Arabia: A Scoping Review.

This scoping review aims to identify and summarize existing evidence concerning the quality and capacity of PHC services in the Kingdom of Saudi Arabia (KSA) with a focus on the patients and healthcare professionals' perceptions of PHC. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The digital library, PubMed, and the search engine Google Scholar were searched to broaden our results for primary research involving patient and/or health professionals' perspectives on Primary Healthcare in KSA. A total of 38 publications were selected for the scoping review. Several studies examined patients' overall satisfaction with PHC services (n=14) while others focused their investigation on specific services provided by PHC (n=3). Several studies assessed the perceptions of certain groups of patients (n=5). Several studies examined health professionals' perceptions of the use of electronic health records (n=3), the safety culture (n=2), communicable disease management (n=1), emergency services (n=1), laboratory services (n=1), cost-effectiveness (n=1), and leadership (n=1). This review also included studies that assessed the health professionals' job satisfaction and burnout (n=6). Patients were satisfied with some aspects of PHC services while recognizing that improvements in some areas were needed. These included waiting time, physician-patient communication, access to the services in rural areas, patient involvement in disease management, and oral health. Health workers were positive about certain quality aspects and services provided by PHC such as EHRs, safety culture, communicable disease management, emergency services, and laboratory services. Health workers demonstrated a low level of job satisfaction due to several reasons, including, working conditions, financial incentives, and burnout.

Healthcare workforce equity for health equity: An overview of its importance for the level of primary health care.

Healthcare workforce crises often stem from healthcare workers' inequities. This study provides an overview of the main PHC workforce policy questions related to health equity, offering examples of evidence necessary to support the implementation of policies and strategies that increase equity in the health workforce and access to the PHC workforce and services. The equity-related policies in PHC and workforce were linked with the indicators listed in the Global Health Workforce Network Data and Evidence Hub and guidelines for health workforce management. The policy-relevant questions in PHC cover many workforce issues such as the optimal size, equitable distribution, relevant competencies to ensure equitable healthcare access, and equitable approaches for retention, training, recruitment, benefits and incentive schemes and governance. This will require intersectionality evidence of the optimised staffing to PHC workload, that PHC practitioners' training demonstrates evidence-based knowledge aligned with locally relevant expertise. Critical for equitable PHC access and health equity is the establishment of efficient measurement of PHC workforce equity and its implications for population health. Using indicators that measure health and workforce equity in research, policy, and practices may improve recruitment and retention, and respond more effectively to the PHC workforce crises.

Understanding the experiences of PHC nurses in caring for older patients in the post-fifth wave of the COVID-19 pandemic: an exploratory qualitative study.

To ensure the best possible care, the perspective of PHC nurse work experience during the COVID-19 pandemic should be considered when developing nursing care protocols for older patients who receive PHC services. This exploratory qualitative study was conducted with 18 nurses working continuously in PHC between the first and fifth waves of the pandemic. Semi-structured thematic interviews were undertaken. Qualitative thematic content analysis was conducted to identify and group the themes that emerged from the discourse. Interviews were transcribed and analyzed using thematic analysis. The first topic describes the nurses' experiences of physical and mental suffering in caring for older patients in response to the pandemic. The second topic covers the experience of reorganizing PHC work. The third topic focuses on the difficulties of caring for older patients. The final topic includes issues of support needs for nurses in PHC work. The experience and understanding of PHC nurses in caring for older people during the COVID pandemic should lead to significant changes in the system of nursing care for geriatric patients and in the cooperative role within geriatric care specialist teams. Drawing on the experience of COVID-19, it is necessary to work on the weak points of PHC exposed by the pandemic in order to improve the quality of care and life for geriatric patients.

Health literacy and cultural responsiveness of primary health care systems and services in Australia: reflections from service providers, stakeholders, and people from refugee backgrounds

BackgroundPrimary health care [PHC] services with general practitioners (GPs) as the first point of access to health care services for people from refugee backgrounds in Australia can play a crucial role in building health literacy and promoting access to culturally appropriate services. To achieve equitable access and engagement, services and systems must be responsive to diverse health literacy and cultural needs. This study aims to explore how primary health services respond as a system and organisation to the health literacy and cultural needs of people from refugee backgrounds in Australia.MethodsThis exploratory qualitative study involved 52 semi-structured interviews among 19 Africans from refugee backgrounds, 14 service providers, including GPs and nurses, and 19 other stakeholders, such as service managers/directors. Participants resided in New South Wales, Victoria, and Queensland. Interviews were audio-recorded, transcribed, and coded into QSR NVivo 12. Data analysis was guided by reflexive thematic analysis.FindingsThree interrelated themes were identified from the data relating to the health literacy and cultural responsiveness of PHC systems and services. The first theme, ‘variable and ad hoc organisational response to health literacy and culturally responsive care,’ demonstrated that some organisations did not systematically address the inherent complexity of navigating the health system nor the capacity of services and providers to respond to the cultural needs of people from refugee backgrounds. The second theme, ‘individual provider responsibility,’ captured the individual providers’ interpersonal and relational efforts in supporting the health literacy and cultural needs of people from refugee backgrounds based on their motivation and adaptation. The third theme, ‘refugee patient responsibility,’ encapsulated people from refugee backgrounds’ adaptations to and learning of the health system to navigate and access services.ConclusionHealth literacy and culturally responsive practices need to be systematised by PHC organisations to be implemented and sustained over time. There is a need for diversity in the organisational leadership and health care workforce, organisational commitment, health literacy and culturally responsive care policies, provider training, and auditing practice as essential components of the change process. Engaging with refugee communities would allow services to focus on people from refugee backgrounds’ needs by design.

A Systematic Review of the Causes, Consequences, and Solutions of Emergency Department Overcrowding in Saudi Arabia.

This study aims to investigate and address the issue of emergency department (ED) overcrowding, a significant problem worldwide. The study seeks to understand the impacts of ED overcrowding on emergency medical healthcare services and patient outcomes. This systematic review follows the PRISMA flow diagram and the guidelines of the Cochrane Handbook. We systematically reviewed the causes and solutions of emergency department overcrowding. We went through Google Scholar, the National Center for Biotechnology Information, the British Medical Journal, Science Direct, Ovid, Cochrane, the Saudi Journal of Emergency Medicine, Medline, and PubMed as databases. Our criteria were articles done in Saudi Arabia from 2012 to 2022. One hundred and ninety-six (196) research papers were extracted; only 28 articles met our paper inclusion-exclusion criteria. The result of these papers regarding causes, consequences, and solutions was that non-urgent and returned visits lacked knowledge of PHC, triad, and telemedicine services. Prolonged LOS is due to slow bed turnover, laboratory and consultation time, and physical response to the final decision resulting in burnout staff, wrong diagnoses, and management plans. The crowding issues can be resolved by awareness, PHC access, triad systems, and technological and telemedicine services. High demand for emergency treatment should not be a hindrance to quality treatment. Physical, technological, and strategic measures should be put in place to fight the crowding problem in EDs in Saudi Arabia, as it may cause adverse effects such as transmission of diseases and death of patients.

Effects of utilization of basic health care provision fund on service delivery in primary health centres in Osun State

Background: One of the daunting challenges militating against the provision of quality healthcare services at the various primary health centres hindering the successive provision of sustainable and equitable PHC services. This study aimed to assess the effects of the utilization of the basic health care provision funds on service delivery in primary health centres in Osun State. Methods: A descriptive cross-sectional study was adopted for this study among 384 respondents selected using multistage sampling methods from different LGAs in Osun State between June 2023 and February 2023. The research instrument was a semi-structured questionnaire analysed with SPSS version 25.0. Univariate and bivariate analysis were done as appropriate and a p value of &lt;0.05 was taken as statistically significant. Results: The study found that the majority (93.2%) of BHCPF-supported PHCs received monthly releases. Most patients (98.2%) were satisfied with service delivery, which influenced patient utilization of PHC facilities, albeit without statistical significance. Conclusions: Most (90%) of the facilities provided most services in the component of PHCs, but less than one-third offered mental and dental health services. Implementing these services in BHCPF-supported PHCs is recommended.

Community health needs in Ukraine in the war context

Abstract The full-scale russia's invasion in Ukraine caused the migration of people, partially destroyed the medical infrastructure, disrupted access to services, so there is a need to connect people tocare. The e-tools allow to monitor the capacities of the healthcare system and utilization of services. However, there is insufficient data on the population's needs. The CHNA was conducted in March-May 2023 in 16 communities across 8 regions of Ukraine. It was based on the adapted methodology of the Philadelphia Healthcare Federation and applied the following research methods: statistical analysis of the operating PHC facilities, availability of medical staff, and current gaps in service delivery; structured survey of the community residents; FGDs with community decision makers and residents; in-depth interviews with heads of PHC facilities. The assessment results demonstrated limited access to healthcare services in remote settlements, and thus the need to develop new formats of healthcare provision. The study showed a difference in the perception of PHC services accessibility between decision makers and the population. The biggest need identified was for MHPSS services for IDPs and local residents. CHNA is critical to inform programming. To improve access to essential services, the USAID Public Health System Recovery &amp; Resilience project will support new approaches to PHC service delivery, including through mobile teams and task shifting to expand the role of nurses. To increase availability of MHPSS services, the project builds the capacity of the workforce and supports the delivery of evidence-based interventions such as mhGAP, CETA, Selfhelp+, CBT. Key messages • The developed CHNA is an effective tool for decision-makers to understand the main gaps in the availability of health services and to develop targeted interventions, especially in times of war. • Community-based MHPSS interventions are critical in time of war.

How can public health agencies support the adoption of a population health management approach in PHC? The case of SVN

Abstract Slovenia has a longstanding tradition of providing accessible and comprehensive PHC services. Established in 1927, Slovenian PHC strongly emphasizes addressing health equity and reaching out to vulnerable populations in local communities to identify environmental, social and behaviour-related risk factors and diagnose disease in its early stage of development. Through a cross-sectoral cooperation based on a community based approach and a strong collaboration of public health and primary care services, Slovenia has improved health and reduced health inequality over the last decades. Registered nurses in family medicine teams conduct regular screening and follow-up for people with noncommunicable diseases to reduce family doctors’ growing burden and workload. Each family medicine practice has a list of registered patients (a capitation list), managed in defined groups of healthy individuals; those with risk factors; and those with the most common chronic diseases. Financial incentives are given for meeting target values in screening check-ups. The National Public Health Institute manages and leads the noncommunicable disease prevention and control programme at the national level.

Assessment of Kaduna State Primary Health Care Board Financial Management Capacity on Primary Health Care Service Delivery in Kaduna State, Nigeria

The establishment of the Kaduna State Primary Healthcare Board was passed into law in 2015 to tackle fragmentation in primary healthcare and ensure preventive healthcare services are accessible and affordable to all. The institutional capacity of the SPHCB is aimed at tackling several issues, including poor release of funding, poor infrastructural services, inadequate health personnel capacity, poor supply of essential drugs and other commodities, poor referral system, poor monitoring, and supervision affecting the PHCs across the state. The paper specifically assesses the financial management capacity of the SPHCB in ensuring the funding of PHC services across the health centres. Both primary and secondary data were used and analysed using descriptive and inferential statistical tools. Linear regression analysis was used in testing the hypothesis postulated. It was revealed that the financial capacity has improved the funding for routine immunisation and family planning programmes at the PHCs in the LGAs. A timelier release of funds is necessary to ensure efficiency and transparency in PHC service delivery. Keywords: Financial management, PHC, service delivery, funding.

Barriers to optimal AEFI surveillance and documentation in Nigeria: Findings from a qualitative survey.

Effective spontaneous AEFI reporting is the first step to ensuring vaccine safety. Half of the global population lives in countries with weak vaccine safety monitoring systems, especially in the African, Eastern Mediterranean, and Western Pacific regions. Further, Immunisation services have been upscaled without commensurate effective AEFI surveillance systems. Hence, this study aims to comprehensively investigate the impediments to an effective AEFI surveillance system. Given the programmatic and regulatory implications, understanding these impediments would facilitate the development and implementation of policies and strategies to strengthen the AEFI surveillance system in Nigeria. A qualitative research design (using a grounded theory approach) was employed by conducting ten key informant interviews and two Focus Group Discussion sessions among the study population to identify the barriers impeding optimal AEFI surveillance and documentation in Nigeria. This study found that the AEFI surveillance system is in place in Nigeria. However, its functionality is sub-optimal, and the potential capacity is yet to be fully harnessed due to health systems and socio-ecological impediments. The identified impediments are human-resource-related issues- knowledge gaps; limited training; lack of designated officers for AEFI; excessive workload; poor supportive supervision and attitudinal issues; caregiver's factor; governance and leadership- moribund AEFI committee; lack of quality supervisory visit and oversight and weak implementation of AEFI policy guidance. Others include funding and logistics issues- no dedicated budget provision and weak referral mechanism; insecurity; socio-economic and infrastructural deficits- poverty, geographical barriers, limited ICT skills, and infrastructure; and poor feedback and weak community engagement by the health workers. Findings from this study provide empirical evidence and serve as an advocacy tool for vaccine pharmacovigilance strengthening in Nigeria. Addressing the impediments requires health system strengthening and a whole-of-the-society approach to improve vaccine safety surveillance, restore public confidence and promote vaccine demand, strengthen PHC services, and contribute to attaining UHC and SDGs.

Perceived stress in the Primary Care Nursing team working in the COVID-19 pandemic

Background: PHC services reflect poor working conditions and, in line with the COVID-19 pandemic, nurses end up being exposed to higher levels of stress. Objectives: To identify the level of perceived stress of PHC nursing workers during the COVID-19 pandemic. Methodology: Analytical cross-sectional study carried out in PHC units in a medium-sized Brazilian municipality. Questionnaires were applied to characterize socioeconomic, demographic, work and life habits of nursing workers and PSS-14 to 130 nursing workers. Data were entered and analyzed in the SPSS® software, version 22.0. Results: The PE, 27.5% of the nurses and 30.7% of the nursing technicians had, respectively, a normal and moderate level of PE. It was verified by the rho that PE was negatively correlated with the number of hours of sleep and hours of leisure. Conclusion: The results indicate the need for investment by the government so that these professionals have psychological support, quality of life and that there is no work overload aimed at the worker's health.

Organização da atenção e vigilância em saúde na atenção primária frente à COVID-19 em municípios do Nordeste brasileiro

Abstract The aim of this study was to analyze the organization and development of primary health care and surveillance, including normative frameworks and the implementation of local health actions. Qualitative descriptive multiple-case study involving three municipalities in the state of Bahia. We conducted 75 interviews and a document analysis. The results were categorized into the following two dimensions: approach to the organization of the pandemic response; and development of care and surveillance actions at local level. Municipality 1 was found to have a well-defined concept of the integration of health and surveillance with a view to organizing team work processes. However, the municipality did not strengthen the technical capacity of health districts to support surveillance actions. In M2 and M3, delays in defining PHC as the entry point for the health system and the prioritization of a central telemonitoring service run by the municipal health surveillance department compounded the fragmentation of actions and meant that PHC services played only a limited role in the pandemic response. Clear policy and technical guidelines and adequate structural conditions are vital to ensure the effective reorganization of work processes and foster the development of permanent arrangements that strengthen intersectoral collaboration.

Financing of health services for undocumented immigrants in Iran: common challenges and potential solutions

IntroductionIran is host to one of the largest urban refugee populations worldwide, about two million of whom are undocumented immigrants (UIs). UIs are not eligible to enroll in the Iranian health insurance scheme and have to pay out-of-pocket to access most health services. This increases the likelihood that they will delay or defer seeking care, or incur substantial costs if they do seek care, resulting in worse health outcomes. This study aims to improve understanding of the financial barriers that UIs face in utilizing health services and provide policy options to ensure financial protection to enhance progress towards UHC in Iran.MethodsThis qualitative study was conducted in 2022. A triangulation approach, including interviews with key informants and comparing them with other informative sources to find out the complementary findings, was applied to increase data confirmability. Both purposive and snowball sampling approaches were used to select seventeen participants. The data analysis process was done based on the thematic content analysis approach.ResultsThe findings were explained under two main themes: the financial challenges in accessing health services and the policy solutions to remove these financial barriers, with 12 subthemes. High out-of-pocket payments, high service prices for UIs, fragmented financial support, limited funding capacity, not freeing all PHC services, fear of deportation, and delayed referral are some of the barriers that UIs face in accessing health care. UIs can get insurance coverage by using innovative ways to get money, like peer financing and regional health insurance, and by using tools that make it easier, like monthly premiums without policies that cover the whole family.ConclusionThe formation of a health insurance program for UIs in the current Iranian health insurance mechanism can significantly reduce management costs and, at the same time, facilitate risk pooling. Strengthening the governance of health care financing for UIs in the form of network governance may accelerate the inclusion of UIs in the UHC agenda in Iran. Specifically, it is necessary to enhance the role of developed and rich regional and international countries in financing health services for UIs.