Background
Efficient and effective management of budgets and financial resources is critical for
health systems to achieve their goals; in this regard, countries may face budgetary and
financial challenges owing to the weak prediction of resources and consumptions, and
lack of prioritization for their budget. This study aims to identify the most critical
policies and events that have affected public financial management and health budgeting
and existing challenges in Iran.
Methods
We conducted the present study in 2022 using a 2-stage qualitative method. First, by
reviewing upstream documents and laws, we identified evidence related to health
budgeting. Then, we conducted 13 semi-structured interviews with informed people in the
health budgeting field that led us toward the main challenges through thematic content
analysis.
Results
After reviewing 48 upstream documents related to health budgeting, we identified 85
policies. After reviewing the articles, we achieved 11 themes and 71 subthemes. The most
critical challenges of the budgeting cycle were as follows: (I) budget formulation,
including inappropriate budget structure, conflicts of interest and infringement, lack
of financial sustainability, and transparency; (II) budget execution, including a
nonexecutable approved budget, complicated allocation process, and ineffective
allocations; and (III) monitoring, reporting, and evaluation (MR&E), including
fragmentation of MR&E processes, ineffective monitoring and evaluation, weak
evaluation of platforms, and inadequate transparency.
Conclusion
Most challenges in the health budgeting system are related to the budget formulation
and approval stage that have their roots in implementation, monitoring, and reporting.
In addition, Iran's macroeconomic and financial issues have also damaged the budgeting
of the health sector. Budget problems affect the goals and outcomes of this sector,
especially the health system.