Esmaeil Moshiri1, Arash Rashidian2, Mohammad Arab3, Ardeshir Khosravi4. 1. Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, Deputy for Health Affairs, Semnan University of Medical Sciences, Semnan, Iran. 2. Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran. arashidian@tums.ac.ir. 3. Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 4. Deputy for Public Health, Iranian Ministry of Health and Medical Education, Tehran, Iran.
Abstract
BACKGROUND: In the 1980s, PHC implementation promoted the health care delivery and overall health status of the population in Iran. Identifying the crucial design and implementation aspects of the PHC program can highlight the way it was implemented in a difficult sociopolitical environment. Using a policy analysis approach unfolds the details of implementation in a context which was not overtly convenient for a great health system reform. METHODS: We conducted semi-structured interviews with 35 key participants and collected relevant literature and documents. We used a policy triangle framework to conceptualize the study and used a thematic data analysis approach to analyze the verbatim transcribed texts and documents. Data were analyzed with regard to the context, content, process and actors of the policy. RESULTS: Proper use of the conditions and opportunities, during the first years after a revolutionary political change resulted in the establishment of a PHC network in Iran. Talented actors, clear content with agreed objectives and a top-down approach to the implementation in a special sociopolitical context were the main influential factors to fulfillment of the PHC policy in Iran. However, full implementation of the policy was hampered by the failure of some main components like referral system. CONCLUSION: The policy triangle framework helped us to separate the different components of the PHC policy denoting that successful implementation of a policy requires attention to all related elements. Policy actors should invest in the development of an effective advocacy coalition, while giving ample attention to the implementation concerns. National health policies can be materialized even during financial hardships, if they align with the wider expectations of the public and politicians.
BACKGROUND: In the 1980s, PHC implementation promoted the health care delivery and overall health status of the population in Iran. Identifying the crucial design and implementation aspects of the PHC program can highlight the way it was implemented in a difficult sociopolitical environment. Using a policy analysis approach unfolds the details of implementation in a context which was not overtly convenient for a great health system reform. METHODS: We conducted semi-structured interviews with 35 key participants and collected relevant literature and documents. We used a policy triangle framework to conceptualize the study and used a thematic data analysis approach to analyze the verbatim transcribed texts and documents. Data were analyzed with regard to the context, content, process and actors of the policy. RESULTS: Proper use of the conditions and opportunities, during the first years after a revolutionary political change resulted in the establishment of a PHC network in Iran. Talented actors, clear content with agreed objectives and a top-down approach to the implementation in a special sociopolitical context were the main influential factors to fulfillment of the PHC policy in Iran. However, full implementation of the policy was hampered by the failure of some main components like referral system. CONCLUSION: The policy triangle framework helped us to separate the different components of the PHC policy denoting that successful implementation of a policy requires attention to all related elements. Policy actors should invest in the development of an effective advocacy coalition, while giving ample attention to the implementation concerns. National health policies can be materialized even during financial hardships, if they align with the wider expectations of the public and politicians.
Authors: Sydney Breneol; Janet A Curran; Robert Marten; Kirti Minocha; Catie Johnson; Helen Wong; Etienne V Langlois; Lori Wozney; C Marcela Vélez; Christine Cassidy; Sanjay Juvekar; Melissa Rothfus; Lydia Aziato; Lisa Keeping-Burke; Samuel Adjorlolo; Daniel F Patiño-Lugo Journal: Health Res Policy Syst Date: 2022-06-15