A Pattern for Assessing the Health System Governance in the Islamic Republic of Iran: A Thematic Analysis

Governance in the health system is not just a vision, or a model for delivering services, but a key element in planning, implementing and evaluating activities to improve health. The main purpose of this study was to design a pattern for assessing Iran's Health System Governance.

The present study was descriptive in terms of purpose, qualitative in terms of application, and qualitative in terms of data type, which was conducted based on thematic analysis and deductive-inductive approach. 14 health system experts were selected through non-random-purposive sampling. To calculate reliability, test-retest reliability and coder reliability were used, which were 70 and 87 %, respectively. Also, Waltz and Basel method was used to assess the content validity of the extracted indices which was 85 %.

After 6 stages of thematic analysis, 137 basic themes, 15 organizing themes and 5 comprehensive themes (health system accountability, health system participation, health system policy formulation, health system service provision, health system efficiency and quality) were obtained, and finally, a model for assessing the governance of the health system in the Islamic Republic of Iran was designed. Organizational accountability included 7 themes, ethical accountability, 9, and legal accountability included 6 .Financial accountability included 8 basic themes, and efficiency and quality, 10 basic themes. Implementation included 8 themes, comprehensiveness, 4, reporting, 12, and transparency, 6. Structural policy included 23 themes, social inclusion and justice policy, 6, and fiscal policy included 11 basic themes. Medical services included 4 themes, financial services, 7, human services and human rights, 9, and information and technology services included 7 basic themes. In this pattern, participation and policy formulation were considered input, and accountability, efficiency and quality and service delivery were considered output.

Lack of a clear definition for an appropriate interdepartmental cooperation, Lack of meritocracy, having a guild oriented attitude, conflict of interests, not using a policymaking approach based on a collective evidence and wisdom are among the shortcomings of the current health system governance. In addition, healthcare costs imposed on people are too high.