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- W57740299 abstract "Background. Most countries that have based their healthcare systems on primary careenjoy better population health, lower health disparities, more equitable access to care, andlower costs. Iranian primary health care (PHC) has achieved population health indicessimilar to that of the best in the region during the past two decades. Despite this, thesystem showed itself to be both inadequate in meeting the evolving health needs of thepopulation and unaffordable by many. To address these shortages, in 2005 it was decidedto implement a new system, called family medicine (FM), together with Behbar (ruralinsurance for all) in rural areas and in urban areas of less than 20,000 population. The aimof this thesis was to identify facilitators of and barriers to the implementation of FM in Iran.Methods. Qualitative methods were used, particularly individual semi-structured interviewswith stakeholders at three levels: national (19 interviews), provincial (9), and local (43). Inaddition, three focus groups, document analysis, and observations in health centres wereused. The framework approach was employed as the main method for analysis, whileremaining open to accommodate emerging themes. The analysis was based on a modifiedfourfold framework consist of administration, bargaining, interpretation and institutionalstructuring components, originally introduced by Harrison (2004).Results. The study revealed four interdependent factors that influenced implementation:aspects of the policy; the existing environment; the experience of implementation; andattitudes and perceptions of local practitioners and the public. Making the policy in the'organized anarchies' of the health system, where ambiguity is prevalent, few peopleinvolved and imposing it on others was at the heart of problems with implementation. Thepolicy that was conceptually welcomed because of its innovation and incentive forcooperation, was badly put into practice. The core barrier was the merger of two diversepolicies, implemented concurrently by two hostile organizations (MOH & MIO).Conclusions. The thesis revealed the dynamic model of health policy analysis. The policywas essentially adopted on the basis of idealistic views rather than a real solution toexisting problems. Implementation was an attempt by two organizations with differentaims. Despite some efforts to reduce practical difficulties, the underlying divergencebetween Behbar and FM was too fundamental to be overcome. Parliament's attempt toseparate the purchaser from the provider resulted in great mistrust between the two and tosome extent undermined the essence of FM." @default.
- W57740299 created "2016-06-24" @default.
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- W57740299 date "2009-01-01" @default.
- W57740299 modified "2023-09-24" @default.
- W57740299 title "Implementing family medicine in Iran : identification of facilitators and obstacles" @default.
- W57740299 doi "https://doi.org/10.17037/pubs.00878723" @default.
- W57740299 hasPublicationYear "2009" @default.
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