Designing a Governance Model in the Country's Health System

 Today, governance in the health system is more important than ever due to the shortcomings in the health sector and the occurrence of crises such as the Covid disease pandemic. On the other hand, policy-making, especially implementing policies in the country's health sector, is facing shortcomings; the use of governance principles can be helpful in this regard. Therefore, this study aims to design a governance model for the country's health system.

 The present study is applied-developmental in terms of purpose. After reviewing the theoretical foundations and previous research, the governance strategies of the health system were identified. Then, the research model was designed using the fuzzy Delphi method and surveying 13 academic and executive experts who were purposefully selected. Finally, to validate the model, 169 managers and specialists of health system departments in Tehran were interviewed with a questionnaire, and the data were analyzed by structural equation modeling and SmartPLS software.

 Based on the research findings, it was confirmed that health governance has four functions of stewardship, service delivery, resource production, and financing, and in order to improve it, ten main strategies and 58 sub-strategies should be considered. Also, the governance model in the country's health system was designed, which includes causal factors (functions of the health system), underlying factors, facilitating/limiting factors, and consequences. Finally, the coefficient of determination for the variable of health governance strategies was 0.611 and for the variable of outcomes was 0.528.

 According to the results, health governance in the country is similar to the model of the World Health Organization in terms of structure and functions, but to improve the health system according to the country's native conditions, it is necessary to use various strategies. Also, the results showed that the health system's governance is a multifaceted and complex phenomenon. To improve it, a set of strategies should be implemented, which were classified into three categories: governance affairs, contractual affairs, and partnership affairs