Policy analysis of the Iranian Health Transformation Plan in primary healthcare
Policy analysis of the Iranian Health Transformation Plan in primary healthcare
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DOI：
10.1186/s12913-019-4505-3
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发表时间：
2019-09-18
影响因子：
2.8
通讯作者：
Assan, Abraham
中科院分区：
文献类型：
--
作者：
Doshmangir, Leila;Moshiri, Esmaeil;Assan, Abraham
背景由于社会卫生需求和政策动态的不断变化，卫生系统改革是不可避免的。今天，卫生改革计划仍然是促进伊朗实现全民健康覆盖的主要工具。最初在医院实施，后来扩大到初级保健。本研究旨在分析伊朗PHC水平的HTP。方法通过文献分析、圆桌讨论和半结构化访谈等方式收集定性数据，并对卫生系统微观、中观和宏观层面的利益相关者进行访谈。一个定制版本的沃尔特和吉尔森的政策三角形模型，结合阶段启发式模型来指导数据分析。结果HTP是通过政治过程产生的。虽然该倡议旨在通过改善伊朗的整个卫生系统来促进全民健康覆盖的成就，但对初级保健的关注很少，特别是在政策制定的第一阶段-出现这一差距是因为政治家们急于兑现竞选承诺。针对全民健康覆盖和与健康相关的可持续发展目标的卫生改革需要通过卫生系统所有利益攸关方的参与来改善初级保健的政治意愿，以及提高国家的财政能力和实施循证倡议的财政承诺。
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.