• Leila Doshmangir, Esmaeil Moshiri, Hakimeh Mostafavi, Minoo Alipouri Sakha, and Abraham Assan.
• Social Determinants of Health Research Center, Iranian Center of Excellence in Health Management, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. Doshmangirl@tbzmed.ac.ir.
• Bmc Health Serv Res. 2019 Sep 18; 19 (1): 670.

BackgroundHealth 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.MethodsQualitative 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.ResultsThe 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.ConclusionsHealth 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.

19 keywords...

hide…