Volume 18, Issue 2 (May 2020)                   Nursing and Midwifery Journal 2020, 18(2): 166-179 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
shirjang A, Mahfoozpour S, Masoudi Asl I, Doshmangir L. IRAN’S PRIMARY HEALTH CARE CHALLENGES IN REALIZING PUBLIC HEALTH COVERAGE: A QUALITATIVE STUDY. Nursing and Midwifery Journal 2020; 18 (2) :166-179
URL: http://unmf.umsu.ac.ir/article-1-3935-en.html
IRAN’S PRIMARY HEALTH CARE CHALLENGES IN REALIZING PUBLIC HEALTH COVERAGE: A QUALITATIVE STUDY
Ahmad Shirjang * 1, Soad Mahfoozpour2 , Iravan Masoudi Asl3 , Leila Doshmangir4
1- National Center for Health Insurance Research, Iran Health Insurance Organization, Tehran, Iran. Safety Promotion & Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. (Corresponding Author) , shirjangahmad@yahoo.com
2- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
3- Health Services Management Department, Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
4- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
Abstract:   (5015 Views)
Background & Aims: Despite many advances in health, health systems still do not meet all the needs of communities. Countries at the 2018 Astana Summit agreed to strengthen primary health care (PHC) in order to achieve universal coverage of health (UHC). This study aimed to identify the challenges of the PHC system in Iran and provide practical solutions to overcome them. Materials & Methods: This qualitative study was conducted using interviews and document reviews. Interviews were made with decision-makers, executive and academic experts, PHC executives, and experts. National and international documents were examined in the field of health. The WHO building blocks framework was used to encode the data. The data were analyzed by deductive content analysis using MAXQDA 12 software. Results: Due to changing health needs of people, PHC system in Iran today faces challenges why so the centralized structure does not have the flexibility to deal with changes. While the private sector plays a minor role in providing services, there is no coordination between levels of service delivery and consequently, parallel systems have emerged. Despite the scarcity of resources, there are problems in the planning and equitable distribution of resources.  Information systems are not yet complete.  University curricula are not in harmony with PHC and as a result, human resources are unable to respond to job requirements. Conclusion: In order to improve the health of the country and in line with international commitments as well as the need to reach the UHC, it must prioritize existing challenges and strategies, implement practical and tailor-made reforms while using the experiences of other countries to enhance PHC.
Keywords: Primary Health Care, Public Health Coverage, Iran
Full-Text [PDF 4164 kb]   (1883 Downloads)    
Type of Study: Research | Subject: بهداشت
References
1. Park K. Park's textbook of preventive and social medicine. Preventive Medicine in Obstet, Paediatrics and Geriatrics. India: Bhanot Publishers; 2005. [URL]
2. Bener A, Abdullah S, Murdoch JC. Primary Health Care in the United Arab Emirates. Fam Pract 1993;10(4): 444-8. [DOI:10.1093/fampra/10.4.444] [PMID]
3. Khayati F, Saberi MH. Primary Health Care (PHC) an ever strategy for health equity extension. J Health Adm 2009; 12(35):33-40. [Google Scholar]
4. Van Lerberghe W. The world health report 2008: primary health care: now more than ever. World Health Organization; 2008. [Google Scholar]
5. Shadpour K. Primary health care networks in the Islamic Republic of Iran. 2000. [DOI:10.26719/2000.6.4.822] [PMID]
6. Marandi SA. The integration of medical education and health care system in the Islamic Republic of Iran: a historical overview. J Med Educ2001;1(1):8-11. [URL]
7. Gressani D, Saba J, Fetini H, Rutkowski M, Maeda A, Langenbrunner J. Islamic Republic of Iran health sector review, volume I: main report. The World Bank Group. Human Development Sector, Middle East and North Africa 2007;1: 1575-81. [Google Scholar]
8. Ghoddoosi-Nejad D, Jannati A, Doshmangir L, Arab-Zozani M, Imani A. Stewardship as a Fundamental Challenge in Strategic Purchasing of Health Services: A Case Study of Iran. Value Health Reg Issues 2019;18: 54-8. [DOI:10.1016/j.vhri.2018.06.005] [PMID]
9. Asaei S. Iran's excellent primary health care system. United Nation International Children Emergency Fund (UNICEF): https: //www unicef org/iran 2014.
10. Aghajanian A, Mehryar AH, Ahmadnia S, Kazemipour S. Impact of rural health development programme in the Islamic Republic of Iran on rural-urban disparities in health indicators. East Mediterr Health J 2007; 13 (6): 1466-75. [DOI:10.26719/2007.13.6.1466] [PMID]
11. Malekafzali H. Primary Health case in Islamic Republic of Iran. Journal of the School of Public Health and Institute of Public Health Research 2014;12(2): 1-11. [URL]
12. Javanparast S, Baum F, Labonte R, Sanders D. Community health workers' perspectives on their contribution to rural health and well-being in Iran. Am J Public Health 2011;101(12): 2287-92. [DOI:10.2105/AJPH.2011.300355] [PMID] [PMCID]
13. Beaglehole R, Irwin A, Prentice T, Organization WH. The world health report 2003: shaping the future. World Health Organization; 2003. [URL]
14. Economou C. Health systems in transition. Health 2010;12(7). [Google Scholar]
15. Marchildon GP. Health systems in transition. Canada: University of Toronto Press; 2013. [Google Scholar]
16. Vargas-Zea N, Castro H, Rodríguez-Páez F, Téllez D, Salazar-Arias R. Colombian health system on its way to improve allocation efficiency-transition from a health sector reform to the settlement of an HTA agency. Value Health Reg Issues 2012;1(2): 218-22. [DOI:10.1016/j.vhri.2012.09.004] [PMID]
17. Zanganeh Baygi M, Seyadin SH, Rajabi Fard Mazrae No F, Kouhsari Khameneh A. Adaptation of goals and organizational structure in Iran's primary healthcare system, a systematic review. Journal of Payavard Salamat 2016;9(5): 446-58. [Google Scholar]
18. Organization WH. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. World Health Organization; 2010. [Google Scholar]
19. Hatami H, Razavi S, Eftekhar A, Majlesi F, Sayed Nozadi M, Parizadeh S. Textbook of public health. Tehran: Arjmand; 2004. [URL]
20. Hulme D. The Millennium Development Goals (MDGs): a short history of the world's biggest promise. Manchester : Brooks World Poverty Institute, University of Manchester; 2009. [DOI:10.2139/ssrn.1544271]
21. Spigel L, Schwarz D, Bitton A. ISLAMIC REPUBLIC OF IRAN: country case studies on primary health care. World Health Organization; 2018. [URL]
22. Organization WH. Country cooperation strategy for WHO and Islamic Republic of Iran: 2010-2014. 2010. [URL]
23. Krippendorff K. Reliability in content analysis: Some common misconceptions and recommendations. Hum. Commun Res 2004;30(3): 411-33. [DOI:10.1111/j.1468-2958.2004.tb00738.x]
24. Mays N, Pope C. Assessing quality in qualitative research. BMJ 2000;320(7226): 50-2. [DOI:10.1136/bmj.320.7226.50] [PMID] [PMCID]
25. Manyazewal T. Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities. Archives of Public Health 2017;75(1): 50. [DOI:10.1186/s13690-017-0221-9] [PMID] [PMCID]
26. Mehrolhassani MH, Sirizi MJ, Poorhoseini SS, Feyzabadi VY. The challenges of implementing family physician and rural insurance policies in Kerman province, Iran: a qualitative study. Health and Development Journal 2012;1(3): 193-206. [URL]
27. Sohrabi M-R, Albalushi RM. Clients' satisfaction with primary health care in Tehran: A cross-sectional study on Iranian Health Centers. J Res Med Sci 2011;16(6): 756-62. [PMCID]
28. Habibzadeh F. The control of non-communicable diseases in rural Iran. Lancet (London, England) 2012;379(9810): 6-7. [DOI:10.1016/S0140-6736(11)61678-4]
29. Rahmanian K, Shojaie M. The prevalence of pre-hypertension and its association to established cardiovascular risk factors in south of Iran. BMC research notes 2012;5(1): 386. [DOI:10.1186/1756-0500-5-386] [PMID] [PMCID]
30. Lankarani KB, Alavian SM, Peymani P. Health in the Islamic Republic of Iran, challenges and progresses. Med J I.R. Iran 2013;27(1): 42. [PMCID]
31. Moghadam MN, Sadeghi V, Parva S. Weaknesses and challenges of primary healthcare system in Iran: a review. Int J Health Plann Mgmt 2012;27(2): e121-e31. [DOI:10.1002/hpm.1105] [PMID]
32. Moghaddam AV, Damari B, Alikhani S, Salarianzedeh M, Rostamigooran N, Delavari A, et al. Health in the 5th 5-years Development Plan of Iran: main challenges, general policies and strategies. Iran J Public Health 2013;42(Supple1): 42. [PMCID]
33. Baygi MZ, Seyedin H, Salehi M, Sirizi MJ. Structural and contextual dimensions of Iranian primary health care system at local level. Iran Red Crescent Med J 2015;17(1): e17222. [DOI:10.5812/ircmj.17222] [PMID] [PMCID]
34. Malekafzali H. Primary health care in the rural area of the Islamic Republic of Iran. Iran J Public Health 2009;38(Suppl 1): 69-70. [Google Scholar]
35. Khangah HA, Jannati A, Imani A, Salimlar S, Derakhshani N, Raef B. Comparing the health care system of Iran with various countries. Health Scope 2017;6(1). [DOI:10.17795/jhealthscope-34459]
36. Davoodi S, Sheikhvatan M, Karimi A, Ahmadi SH, Sheikhfathollahi M. Determinants of social activity and work status after coronary bypass surgery. Asian Annals 2010;18(6): 551-6. [DOI:10.1177/0218492310386630] [PMID]
37. Mehrolhassani MH, Dehnavieh R, Haghdoost AA, Khosravi S. Evaluation of the primary healthcare program in Iran: a systematic review. Aus J Primary Health 2018; 24(5):359-67. [DOI:10.1071/PY18008] [PMID]
38. Long L-A, Pariyo G, Kallander K. Digital technologies for health workforce development in low-and middle-income countries: a scoping review. Global Health: Science and Practice 2018;6(Supplement 1): S41-S8. [DOI:10.9745/GHSP-D-18-00167] [PMID] [PMCID]
39. Ayatollahi H, Sarabi FZP, Langarizadeh M. Clinicians' knowledge and perception of telemedicine technology. Perspect Health Inf Manag 2015;12(Fall) : 1c. [PMCID]
40. Yazdizadeh B, Mohtasham F, Velayati A. Impact assessment of Iran's health technology assessment programme. Health Res. Policy Syst 2018;16(1): 15. [DOI:10.1186/s12961-018-0286-0] [PMID] [PMCID]
41. Asadi F, Hosseini A, Moghaddasi H, Nasr Haydarabadi N. Primary health care information systems in health centers of Tehran, Iran. Health Inform Manage 2012;9: 1-10. [Google Scholar]
42. Javanparast S, Baum F, Labonte R, Sanders D, Rajabi Z, Heidari G. The experience of community health workers training in Iran: a qualitative study. BMC health services research 2012;12(1): 291. [DOI:10.1186/1472-6963-12-291] [PMID] [PMCID]
43. Baygi MZ, Seyedin H. Imbalance between goals and organizational structure in primary health care in Iran-a systematic review. Iranian journal of public health 2013;42(7): 665. [PMCID]
44. Nekoei Moghadam M, Amiresmaili M, Sadeghi V, Zeinalzadeh AH, Tupchi M, Parva S. A qualitative study on human resources for primary health care in Iran. Journal of Health Planning and Management 2018;33(1): e38-e48. [DOI:10.1002/hpm.2405] [PMID]
45. Karimi M, Mirzaei M, Rahim Z. Educational needs of family physicians in Yazd province. The Journal of Medical Education and Development 2012; 6(1):39-46. [URL]
46. Shirjang A, Mahfoozpour S, Masoudi Asl I, Doshmangir L. Challenges and strategies for improving the rural family physician program in Iran. Medical Science 2020; 24 (102): 647-57. [Google Scholar]
47. Sharifi-Yazdi M, Yazdani S, Ahmadi S, Rahbar MR, Sharifi-Yazdi S. Explaining Current and Changing Teachers' Educational Needs in Health Care Behvarz Training Centers during 2012-2013 in Iran. J Med Educ 2015;14(3): 119-28. [Google Scholar]
48. Javanparast S, Baum F, Labonte R, Sanders D, Heidari G, Rezaie S. A policy review of the community health worker programme in Iran. Journal of public health policy 2011;32(2): 263-76. [DOI:10.1057/jphp.2011.7] [PMID]
49. Mehryar A. Primary health care and the rural poor in the Islamic Republic of Iran. Asia and Pacific Population Studies Centre. Ministry of Science and Technology: Tehran; 2004. [Google Scholar]
50. Takian A, Doshmangir L, Rashidian A. Implementing family physician programme in rural Iran: exploring the role of an existing primary health care network. Fam Pract 2013;30(5): 551-9. [DOI:10.1093/fampra/cmt025] [PMID]
51. Sheikhattari P, Kamangar F. How can primary health care system and community-based participatory research be complementary? Int J Prev Med 2010;1(1): 1. [PMCID]
52. Acosta Ramírez N, Giovanella L, Vega Romero R, Tejerina Silva H, de Almeida PF, Ríos G, et al. Mapping primary health care renewal in South America. Fam Pract 2016; 33(3): 261-7. [DOI:10.1093/fampra/cmw013] [PMID]
53. Lionis C, Philalithis A. Patient satisfaction with medication: a challenge for primary health care. Fam Pract 2008; 25(5): 319-20. [DOI:10.1093/fampra/cmn075] [PMID]
Add your comments about this article : Your username or Email:
CAPTCHA
Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Nursing And Midwifery Journal

Designed & Developed by : Yektaweb