How Health Policies change in Islamic Republic of Iran? A substantive theory to understand the policy process

Health policy-making process in Iran is extremely complex because of the impact of contextual factors and various actors with competing interest. It is not clear how the interaction of these factors bring about changes in policies. We propose a substantive theory to understand how policy changes form, and we provide policy practitioners with practical suggestions to improve the policy outcomes.

A qualitative method based on grounded theory research strategy was applied. For data collection we used in-depth one-on-one interviews with key informants who were involved in three major health policy figures in Iran. We explored the change mechanism by identifying the institutional context, action-interaction patterns and the consequent policy outcomes. For analyzing data, we conducted the three coding stages using Atlas-Ti software.

The main motivator of change in health policies is ‘impression making’ which its owners act in three contextual spheres of agenda-setting, documentation and implementation using certain strategic patterns to make it realized. Impression as the dominant determinant stream in health domain requires aligning four underlying streams of politics, idea, vertical individualism and problem with its requirements to realize the expected impressions of its owners. As long as the impressions are made, the change is in progress. By deviation of any contextual streams or reducing the eagerness to make impression, the change is stopped or downgraded regardless of the problem to be solved or the policy idea to be implemented completely.

Understanding the pattern of health policies changes through identifying role of contextual streams and adopted strategic patterns of behavior, reveals the casual mechanism behind the failure or success of polices. The theoretical model of policy change phenomenon provides policy practitioners with important lessons that enable them to control over the changes and improve the policy content and outcomes if they take them into consideration.