Governance of Iranian Primary Health Care System: Perceptions of Experts
Background: Despite huge advances in improving most health indicators, Iranian primary health care (PHC) has faced several problems in improving the quality of care inside the health care system. Developed countries with similar problems have used various models of PHC governance for improving quality in their PHC system. This study aimed to obtain health professionals’ perspectives about the suitable pillars and components of Iran's PHC governance model.
Methods: A purposeful sampling method was used to select seven participants who had a minimum of five years of experience in PHC and background education in the field of medical sciences. Between Jan and Jun 2015, three focus group discussions (FGD) were conducted with seven PHC experts in Tabriz. Data were analyzed using the conventional content analysis method.
Results: The eight main categories including quality improvement, management and leadership, community involvement and customer participation, effectiveness of PHC, human resource development, safety, health care evaluation and audit, and health information management plus 51 sub-categories were identified according to participants' expects about the essential pillars and components for Iranian PHC governance model.
Conclusion: Pillars that suggested for designing Iran’s PHC governance model are presented according to internal informed expert’s opinions and taking into account PHC system real status. By adding the degree of importance for each component and proper performance indicators to this collection, assessing the progress of the PHC system towards excellence will be possible and it will prevent any mental judgments about system performance.
2. Harris SB, Green ME, Brown JB, et al (2015). Impact of a quality improvement program on primary healthcare in Cana-da: A mixed-method evaluation. Health Policy, 119(4): 405-16.
3. Armstrong K, Kendall E (2010). Translating knowledge into practice and policy: the role of knowledge networks in primary health care. Health Inf Manag, 39(2): 9-17.
4. Phillips C, Pearce C, Hall S, et al (2010). Can clinical governance deliver quality im-provement in Australian general practice and primary care? A systematic review of the evidence. Med J Aust, 193(10): 602-7.
5. Unützer J, Chan YF, Hafer E, et al (2012). Quality improvement with pay-for-performance incentives in integrated be-havioral health care. Am J Public Health, 102(6): e41-5.
6. Gauld R, Mays N (2006). Are New Zea-land's new primary health organisations fit for purpose? BMJ, 333(7580): 1216-8.
7. Tabrizi JS, Pourasghar F, Gholamzadeh Nikjoo R (2016). Primary health care gov-ernance pillars and components indevel-oped countries, a systematic review. IJPT, 8(4): 24045-59.
8. Marshall M, Sheaff R, Rogers A, et al (2002). A qualitative study of the cultural changes in primary care organisations needed to implement clinical governance. Br J Gen Pract, 52(481): 641-5.
9. Gerada C, Cullen R (2004). Clinical govern-ance leads: roles and responsibilities. Qual Prim Care, 12: 13-18.
10. Jones A, Killion S (2017). Clinical governance for Primary Health Networks. The Deeble Institute. Australian Healthcare and Hospitals Association. https://ahha.asn.au/system/files/docs/publications/210417_issues_brief_no_22-_clinical_governance_for_phns.pdf
11. Moghaddam AV, Damari B, Alikhani S, et al (2013). Health in the 5th 5-years Devel-opment Plan of Iran: main challenges, general policies and strategies. Iran J Public Health, 42(Supple1): 42-9.
12. Malekafzali, H (2009). Primary health care in the rural area of the Islamic Republic of Iran. Iran J Public Health, 38(Supple1): 69-70.
13. Askari R, Dolatian M, Shafil M, et al (2017). Challenges in implementing clinical gov-ernance: A qualitative study in Yazd, Iran. East Afr Med J, 94(1): 44-50.
14. Wellington H (2004). Clinical governance policy and procedures. The Australian Centre for Healthcare Governance.
15. Hutchison B, Levesque JF, Strumpf E, et al (2011). Primary health care in Canada: systems in motion. Milbank Q, 89(2): 256-88.
16. Parviz-Rad P (2013). Review of the status of clinical governance in both the health comprehensive scientific map and healthcare reform of Islamic Republic of Iran. North Khorasan University of Medical Sciences.
17. Sohrabi MR, Albalushi RM (2011). Clients’ satisfaction with primary health care in Tehran: A cross-sectional study on Irani-an Health Centers. J Res Med Sci, 16(6): 756-62.
18. Moghadam MN, Sadeghi V, Parva S (2012). Weaknesses and challenges of primary healthcare system in Iran: a review. Int J Health Plann Manage, 27(2): e121-e31.
19. Tabrizi JS, Pourasghar F, Gholamzadeh Nikjoo R (2017). Status of Iran’s Primary Health Care System in Terms of Health Systems Control Knobs: A Review Arti-cle. Iran J Public Health, 46(9): 1156-66.
20. Hackett M, Lilford R, Jordan J (1999). Clini-cal governance: culture, leadership and power-the key to changing attitudes and behaviours in trusts. Int J Health Care Qual Assur, 12(2-3): 98-104.
21. Degeling PJ, MaxwellS, Iedema R, et al (2004). Making clinical governance work. BMJ, 329(7467): 679-81.
22. Khangah HA, Jannati A, Imani A, et al (2017). Comparing the Health Care Sys-tem of Iran with Various Countries. Health Scope, 6(1): e34459.
23. Pickard S, Marshall M, Rogers A, et al (2002). User involvement in clinical gov-ernance. Health Expect, 5(3): 187-98.
24. Litva A, Canvin K, Shepherd M, et al (2009). Lay perceptions of the desired role and type of user involvement in clinical gov-ernance. Health Expect, 12(1): 81-91.
25. Sheikhattari P, Kamangar F (2010). How can primary health care system and commu-nity-based participatory research be com-plementary? Int J Prev Med, 1(1):1-10.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.