Policy analysis of the Iranian Health Transformation Plan in primary healthcare

Abstract

Background Health 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. Methods Qualitative 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. Results The 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. Conclusions Health 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.

Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage

“…Some advocated for revisiting how healthcare sectors are being financed and suggested forgoing private health insurance as the least sustainable and equitable methods of healthcare financing. Others stressed that besides primary health care (PHC) and UHC, social health insurance (SHI) should be given priority in all and not just low- and middle-income countries (LMICs) [ 3 , 4 ].…”

“…The secondary health care is delivered via a network of district health clinics, which is an independent authority from the MoHME, provided by hospitals and coordinated/regulated by treatment deputy of medical universities under the supervision of MoHME. Tertiary health services are provided predominantly in big cities by private and public hospitals and coordinated/regulated by MoHME [ 3 , 17 ].…”

“…Evidence suggests that despite the introduction of the universal basic benefits package under the SHI fund in Iran, inequalities in health financing indicators and access to health care services continue to exist, particularly for low-income groups and rural residents [10,11]. Some of the reforms that contributed towards achieving UHC were previously analysed (e.g., Family Physician program, PHC, hospital autonomy, and Health Transformation Plan implementation [3,[12][13][14][15][16][17][18][19]); however, more studies need to evaluate the impact of the health insurance reforms implemented in Iran.…”

Stakeholder analysis of childhood obesity prevention policies in Iran

“…Therefore, different organizations and stakeholders should make appropriate policies in this respect. Studies show that, similar to other countries [12], there are conflicts of interest among stakeholders in the healthcare system and that health priorities are not prioritized properly in Iran [13]. Adhikari et al evaluated the Malawian health system stakeholders and showed that having problems in coordinating between stakeholders would create many problems for health system policies [14].…”

Future Development through the Past: Pathology of the Financing Dimension of Iran’s Health Transformation Plan

“…During the past decades, the Iranian health system has implemented several policy plans such as Primary Health Care(PHC) network (1985) [10], National Health Insurance coverage program [11], and rural family physician program(2004) [12] to improve health status and achieve to UHC. These resulted in the improvement of some health outcomes like life expectancy at birth, and mother and child morbidity and mortality rates [12,13]. Along with other challenges to implementing and continuing the policy reforms, the financing dimension of the reforms has also been a pivotal and challenging issue…”