Reviewing the National Health Services Quality Policies and Strategies of the Iranian Health System: A Document Analysis

Razieh Fallah Fallah, Mohammadreza Maleki Maleki, Aidin Aryankhesal, Aliakbar Haghdoost

Abstract


Background: High‑quality health care is an important component of efforts to reach Universal Health Coverage (UHC). Given this pivotal fact, poor quality of care is a significant bottleneck in the endeavors of Iran to UHC. This study was part of a broader qualitative study and aimed to provide supplementary data about the documents related to the National Quality Policies and Strategies (NQPS) health services in the health system of Iran to determine the degree of alignment with the World Health Organization (WHO) approach for NQPS, and to track change and development over time. Methods: This document analysis was performed following the READ approach for systematic document analysis in health policy research. Furthermore, qualitative content analysis following parallel forms of the mixed analysis in which the textual material proceeded with different inductive and deductive content‑analytical procedures simultaneously, applying the WHO practical approach for NQPS, was selected. Results: The 15 included records that met the inclusion criteria were released in the post‑Islamic Revolution period. The Ministry of Health was found as the most responsible authority for publishing the NQPS among the other authorities. Furthermore, 67% of NQPS was aligned with the goals and priorities of a broader national plan or policy. Contradictions, variations, and ambiguities were also found in the literature circumstances of the NQPS. There was no NQPS concentrated on the entire pathway of care in the Iranian health system, which developed according to the WHO approach for NQPS. Conclusions: Qualitative analysis of the current NQPSs based on the eight inter‑dependent elements and critical supplements, the technical perspective of broad stakeholders, community engagement, and steady commitment of policymakers are our recommendations for future efforts towards having NQPS.

Keywords


Government programs; Iran; policy; policymaking; quality improvement; quality of health care

Full Text:

PDF

References


Ghebreyesus TA. How could health care be anything other than

high quality? Lancet Glob Health 2018;6:e1140‑1.

Kruk ME, Pate M, Mullan Z. Introducing The Lancet Global

Health Commission on high‑quality health systems in the SDG

era. Lancet Glob Health 2017;5:e480‑1.

Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH,

Roder‑DeWan S, et al. High‑quality health systems in the

sustainable development goals era: Time for a revolution. Lancet

Glob Health 2018;6:e1196‑252.

World Health Organization. Handbook for National Quality

Policy and Strategy: A Practical Approach for Developing

Policy and Strategy to Imp rove Quality of Care. World Health

Organization 2018.

Danaei G, Farzadfar F, Kelishadi R, Rashidian A, Rouhani OM,

Ahmadnia S, et al. Iran in transition. Lancet 2019;393:1984‑2005.

Doshmangir L, Bazyar M, Najafi B, Haghparast‑Bidgoli H.

Health financing consequences of implementing health

transformation plan in Iran: Achievements and challenges. Int J

Health Policy Manag 2019;8:384‑6.

Doshmangir L, Najafi B, Mostafavi H, Moshiri E. Future

development through the past: Pathology of the financing

dimension of Iran’s health transformation plan. Clinicoecon

Outcomes Res 2020;12:345‑54.

Alinia C, Lahijan JD. Moving toward universal health coverage:

Four decades of experience from the Iranian health system.

Clinicoecon Outcomes Res 2019;11:651‑7.

Derakhshani N, Maleki M, Pourasghari H, Azami‑Aghdash S.

The influential factors for achieving universal health coverage in

Iran: A multimethod study. BMC Health Serv Res 2021;21:724.

Koohpayezadeh J, Azami‑Aghdash S, Derakhshani N,

Rezapour A, Kalajahi RA, Khasraghi JS, et al. Best practices in

achieving universal health coverage: A scoping review. Med J

Islam Repub Iran 2021;35:1320‑54.

Nafar H, Aghdam ET, Derakhshani N, Sani’ee N, Sharifian S,

Goharinezhad S. A systematic mapping review of factors

associated with willingness to work under emergency condition.

Hum Resour Health 2021;19:76.

World Health Organization. Quality Health Services: A planning

Guide. Geneva: World Health Organization; 2020.

Braithwaite J. Quality of care in the COVID‑19 era: A global

perspective. IJQHC Communications 2021;1:1‑3.

Organization WH. Maintaining Essential Health Services:

Operational Guidance for the COVID‑19 Context: Interim

Guidance. Geneva: World Health Organization; 2020.

World Health Organization. National quality policy and strategy

tools and resources compendium. Geneva: World Health

Organization; 2019.

Bowen GA. Document analysis as a qualitative research method.

Qual Res J 2009;9:27‑40.

Fisher MP, Hamer MK. Qualitative methods in health policy and

systems research: A framework for study planning. Qual Health

Res 2020;30:1899‑912.

Dalglish SL, Khalid H, McMahon SA. Document analysis in

health policy research: The READ approach. Health Policy Plan

;35:1424‑31.

Wesley JJ, editor Qualitative Document Analysis in Political

Science. T2PP Workshop. Vrije Universiteit Amsterdam; 2010.

Mayring P. Qualitative content analysis: Theoretical

foundation, basic procedures and software solution.

Klagenfurt, 2014. Available from: https://nbn‑resolving.org/urn:

nbn: de: 0168‑ssoar‑395173.

Assarroudi A, Nabavi FH, Armat MR, Ebadi A, Vaismoradi M.

Directed qualitative content analysis: The description and

elaboration of its underpinning methods and data analysis

process. J Res Nurs 2018;23:42‑55.

Sheikh K, Gilson L, Agyepong IA, Hanson K, Ssengooba F,

Bennett S. Building the field of health policy and systems

research: Framing the questions. PLoS Med 2011;8:e1001073.

Virtue A, Chaussalet T, Kelly J. Healthcare planning and its

potential role increasing operational efficiency in the health

sector: A viewpoint. J Enterprise Inform Manag 2013;26:8‑20.

Sołoducho‑Pelc L. Planning horizon as a key element of a

competitive strategy. Int J Econ Bus Manag Stud 2015;3:161.

General Health Policies announced by the supreme leader

of the IRI 2014. Available from: https://farsi.khamenei.ir

/news‑content?id=26083. [Last accessed on 2021 Aug 05].

General policies of the sixth five‑Year Plan for economic, social

and cultural Development of the IRI announced by the supreme

leader 2015. Available from: https://farsi.khamenei.ir/news

‑content?id=30128. [Last accessed on 2021 Aug 05].

General policies of the resistance economy announced by the

supreme leader 2014. Available from: https://farsi.khamenei.ir/

news-content?id=25370. [Last accessed on 2021 Aug 05].

Law on the state services management (revision) 2017.

Available from: https://rc.majlis.ir/fa/law/show/130021. [Last

accessed on 2021 Aug 05].

Council of Ministers. Regulations of the Supreme Health Council

and the reform program in the health system 2003. Available

from: https://rc.majlis.ir/fa/law/show/125879. [Last accessed on

Sept 03].

Law of the second five‑year plan for economic, social and

cultural development of the IRI 1994. Available from: https://

rc.majlis.ir/fa/law/show/92488. [Last accessed on 2021 Aug 05]

Law of the fourth five‑year plan for economic, social and cultural

development of the IRI 2004. Available from: https://rc.majlis.ir/

fa/law/show/94202. [Last accessed on 2021 Aug 05].

Law on the structure of the comprehensive system of welfare

and social security 2004. Available from: https://rc.majlis.ir/fa/

law/show/94018. [Last accessed on 2021 Aug 05].

Memorandum of understanding between MOHME and vice

president for women and family affairs 2018 [August 5]. 2021.

Available from: https://women.gov.ir/cat/280.

Comprehensive scientific map of the health 2010. Available from:

https://hc.sums.ac.ir/Dorsapax/userfiles/Sub462/Dabirkhane‑Files/

Scientificmap.pdf. [Last accessed on 2021 Aug 05].

Map of the health system reform based on the Islamic‑Iranian

model of progress 2012. Available from: http://elib.mui.ac.ir/site/

catalogue/44036. [Last accessed on 2021 Aug 05].

Plan of Dr. Seyed Hassan Ghazizadeh Hashemi, proposed

minister of health, for submission to the Islamic parliament

Available from: http://media.dolat.ir/uploads/

org/150219430585912600.pdf. [Last accessed on 2021 Aug 05].

Policies and plans of Dr. Saeed Namaki, proposed minister

of health, for submission to the Islamic parliament 2019.

Available from: http://shafaonline.ir/fa/news/222020/%

D8%B3%DB%8C%D8%A7%D8%B3%D8%AA%E2

%80%8C%D9%87%D8%A7 -%D9%88 -%D8%A8%D

%B1%D9%86%D8%A7%D9%85%D9%87%E2%8

%8C%D9%87%D8%A7%DB%8C-%D8%B3%D8% ‑

B9%DB%8C%D8%AF-%D9%86%D9%85%DA%A9%DB%8C%D9%88%D8%B2%DB%8C%D8%B1-%D9%BE%DB%8C%

D8%B4%D9%86%D9%87%D8%A7%D8%AF%DB%8C-%D8

%A8%D9%87%D8%AF%D8%A7%D8%B4%D8%AA. [Last

accessed on 2021 Aug 05].

General plan of the proposed minister of health, Dr. Bahram

Ainollahi, for submission to the Islamic parliament 2021.

Available from: https://behdasht.gov.ir/%D8%A7. [Last accessed

on 2021 Sept].

Joint operational plan of universities and faculties of medical

sciences 2021. Available from: https://iem.iums.ac.ir/

content. [Last accessed on 2021 Jun 01].

Haghdoost A, Mehrolhassani M, Khajehkazemi R, Fallah M,

Dehnavieh R. Monitoring indicators of Iranian health system

reform plan. Hakim Res J. 2013;16:171-81.

Marandi SA. The health landscape of the Islamic Republic of

Iran. Med J Islam Repub Iran 2016;24:56‑64.

Sajadi HS, Majdzadeh R. Who would be the ideal minister

to run the current health system of Iran? Int J Prev Med

;8:59.

Mehrabi Tavana A, Meskarpour Amiri M. New view on health

policies of the Islamic Republic of Iran: Health system reform.

Ann Trop Med Public Health 2017;10:767‑U314.

Amiri MM, Tavana AM. Successful implementation of General

Health Policies in the Islamic Republic of Iran: Barriers and

mechanisms. East Mediterr Health J 2017;24:1127‑34.

Sajadi HS, Kashi FG, Majdzadeh R. Identifying National Health

Priorities: Content analysis of the Islamic Republic of Iran’s

General Health Policies (GHPs). World Med Health Policy

;12:123‑36.

Harirchi I, Hajiaghajani M, Sayari A, Dinarvand R, Sajadi HS,

Mahdavi M, et al. How health transformation plan was designed

and implemented in the Islamic Republic of Iran? Int J Prev Med

;11:121.

Mousavi SM, Sadeghifar J. Universal health coverage in Iran.

Lancet Glob Health 2016;4:e305‑6.

Yusefi AR, Bastani P, Bordbar S, Sadeghi A, Hesami SZ.

The effects of health transformation plan implementation on

the performance indicators of public hospitals. Health Scope

;7:e62566.

Sajadi HS, Ehsani‑Chimeh E, Majdzadeh R. Universal health

coverage in Iran: Where we stand and how we can move

forward. Med J Islam Repub Iran 2019;33:9.

Olyaeemanesh A, Behzadifar M, Mousavinejhad N,

Behzadifar M, Heydarvand S, Azari S, et al. Iran’s health system

transformation plan: A SWOT analysis. Med J Islam Repub Iran

;32:39.

Moradi‑Lakeh M, Vosoogh‑Moghaddam A. Health sector

evolution plan in Iran; Equity and sustainability concerns. Int J

Health Policy Manag 2015;4:637‑40.

Mahdavi M, Parsaeian M, Jaafaripooyan E, Ghaffari S. Recent

Iranian health system reform: An operational perspective to

improve health services quality. Int J Health Policy Manag

;7:70‑4.

Sajadi HS HM, Dehghani A, Khodayari R, Zandiyan H,

Hosseini SS. The policy analysis of Iran’s health transformation

plan in therapeutic services. Hakim Health Sys Res

;21:71‑88.

Sajadi HS, Hosseini M, Dehghani A, Khodayari R, Zandiyan H,

Hosseini SS. Policy Analysis of Health Transformation Paln in

Treatment And Curative Services in Islamic Republic of Iran:

Final Report of the Research Project. National Institutes of

Health Research; 2015.

Doshmangir L, Moshiri E, Farzadfar F. Seven decades of primary

healthcare during various development plans in Iran: A historical

review. Arch Iran Med 2020;23:338‑52.

Zimbabwe Ministry of Health and Child Care. Quality Assurance

and Quality Improvement Policy 2015. Available from: https://

workspace.who.int/sites/GLL4QUHC/NQPS.

Zimbabwe Ministry of Health and Child Care. Quality Assurance

and Quality Improvement Strategy 2016‑2020. Available from:

https://workspace.who.int/sites/GLL4QUHC/NQPS.

Zimbabwe ministry of health and child care. The national health

strategy for Zimbabwe 2016‑2020. Available from: https://zdhr.

uz.ac.zw/xmlui/handle/123456789/703.

Afghanistan Ministry of Public Health. National Health

Strategy 2016‒2020 2016. Available from: https://extranet.who.

int/countryplanningcycles/sites/default/files/planning_cycle_

repository/afghanistan/afghanistan_mophstrategy2016‑2020_

final09september2016111201614508950553325325.pdf.

Indonesia ministry of health. NQPS draft 2019. Available from:

https://drive.google.com/file/d/10‑8Cish4RP‑w3BTn2GWCvuh1s

JYNM6_/view.

Malawi ministry of health & population. Quality Management

Policy for the Health Sector 2017. Available from: https://

workspace.who.int/sites/GLL4QUHC/NQPS.

State of Palestine, Ministry of health. National Health

Strategy 2017 ‑2022. Available from: http://www.site.moh.

ps/Content/Books/OhV2yDbK3NBuMaBgzXrM13Tgf5E

k46VMsINeNQ9CvdRJ68×SIueheN_CUmin4TqPtVNgd

v3aBpOzbD57AZWl5OPlGu6RsGzmnu3mNE745Rr5.pdf.

Federal Ministry of Health. Sudan National Health Care Quality

Policy and Strategy 2017. Available from: https://workspace.

who.int/sites/GLL4QUHC/NQPS.

United republic of Tanzania, ministry of health, community

development, gender, elderly and children. The national

health policy 2017, 2017. Available from: http://www.tzdpg.or.tz/fileadmin/documents/dpg_internal/dpg_working_groups_

clusters/cluster_2/health/JAHSR_2017/8.The_Nat_Health_

Policy_2017_6th__24_October__2017.pdf.

Uganda ministry of health. Health sector quality improvement

framework and strategic plan 2015/16‑2019/20 2016. Available

from: https://workspace.who.int/sites/GLL4QUHC/NQPS.

Adindu IHIA. Health Security in Africa and Quality of Health

Services. Health Itam H I, Anthonia A 2012;2:43-50.

Chan BT, Veillard JH, Cowling K, Klazinga NS, Brown AD,

Leatherman S. Stewardship of quality of care in health systems:

Core functions, common pitfalls, and potential solutions. Public

Adm Dev 2019;39:34‑46.

Esmailzadeh H, Rajabi F, Rostamigooran N, Majdzadeh R. Iran

health system reform plan methodology. Iran J Public Health

;42(Suppl 1):13‑7.

Luisi D, Hämel K. Community participation and empowerment

in primary health care in Emilia‑Romagna: A document analysis

study. Health Policy 2021;125:177‑84.

Damari B, Rostamigooran N, Farshad AA. Challenges of

Memorandum of Understanding as a tool for strengthening

intersectoral collaboration in health system. Soc Determ Health

;5:170‑6.

Damari B, Heidari A, Bonab MR, Moghadam AV. Designing a

toolkit for the assessment of Health in All Policies at a national

scale in Iran. Health Promot Perspect 2020;10:244‑9.

Damari B, Moghaddam AV, Dari SB. improving approaches of

intersectoral collaboration for health by health and food security

high council in IR Iran. SJSPH 014;11:1‑16.

Khodayari‑Zarnaq R, Kabiri N, Alizadeh G. Health in first to

sixth economic, social, and cultural development plans of Iran:

A document analysis. J Health Res 2020;10:1‑10.

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(Suppl 1):42‑9.

Mahdavi M, Sajadi HS. Qualitative analysis of Iranian sixth

five‑year economic, social, and cultural development plan from

universal health coverage perspective. BMC Health Serv Res

;21:966.

Blasimme A, Fadda M, Schneider M, Vayena E. Data sharing for

precision medicine: Policy lessons and future directions. Health

Aff (Millwood) 2018;37:702‑9.