Review Article

Iran's Health Transformation Plan; Main Issues and Opportunities for Improvement: A Systematic Review


Background: The Health Transformation Plan (HTP), as the latest reform of Iran's health system, has been implemented gradually in several phases to facilitate the achievement of universal health coverage. We aimed to identify the achievements and challenges of the HTP from the beginning of its implementation in Iran health system.

Methods: In this qualitative systematic review, English papers were searched in PubMed, Scopus, Web of science, and Google Scholar search engines in addition to Persian databases such as Magiran and SID from 2014-2020. The Mixed-Methods Appraisal Tool (MMAT) checklists were used to assess the quality of the studies. Study selection, quality assessment, data extraction, and data analysis were done independently by two people. For analyzing the data, the Framework Analysis Method, based on the health system function framework of the WHO, was used.

Results: Overall, 32 papers were included based on the inclusion criteria. The results were divided into four main themes: stewardship, financing, resource generation and service delivery, and20 sub-themes in the form of achievements and challenges. Regulatory and standardization, service packages, medical equipment and supplies, and the quality of health services were more repetitive. Considering the challenges of HTP, purchase process, motivational factors, and health services capacity were more repetitive.

Conclusion: The administrative challenges in the implementation of the HTP have prevented the sustainability of the outcomes and their main goals. The use of strategic dynamic planning, anticipating sustainable financial resources, and strengthening the monitoring mechanisms could lead to further achievements.

1. Heshmati B, Joulaei H(2016). Iran's health-care system in transition. The Lancet, 387(10013):29-30.
2. Lankarani KB, Ghahramani S, Zakeri M, Joulaei H(2015). Lessons learned from national health accounts in Iran: highlighted evidence for policymakers. Shiraz E-Med J,16(4):1-3.
3. Meymand FM, Aryankhesal A, Raeissi P(2016). Relationship between Quality of the referral Chain of hospital services and patient satisfaction. Global J Health Sci,9(2):68-75.
4. Emami Razavi SH(2016). Health system reform plan in Iran: Approaching Universal Health Coverage. Hakim Health Sys Res J,18(4):329-35.
5. Moradi-Lakeh M, Vosoogh-Moghaddam A (2015). Health sector evolution plan in Iran; equity and sustainability concerns. Int J Health Policy Manag,4(10):637-40.
6. Sajadi HS HM, Dehghani A, Khodayari R, Zandiyan H, Hosseini SS(2018). The Policy Analysis of Iran's Health Transformation Plan in Therapeutic Services. Hakim Health Sys Res,21(2):71-88.
7. Sharbafchizadeh N, Karimi S, Ansari M (2019). Identification of Effective Factors on the Implementation of Health Reform Plan Package for the Improvement of Hoteling Quality: a qualitative study. Journal of Health Based Research,5(2):131-49.
8. Ebrahimi A, Baki Hashemi MM (2019). Applying Interpretive-Structural Modelling to Review Priorities of Health Reform Plan: Evidence-based policy making. Journal of Health Administration JHA,22(3):9-27.
9. Raeisi AR, Shaarbafchizadeh N, Aghdak P, Fouladi Z (2019). Outcomes of Health Care Reform Implementation in Slum Areas of Isfahan: a qualitative study. Journal of Health Based Research ,5(1):81-100.
10. Raisi M, Eskandari N, Abbasi M, Rahbar A(2019). Customers’ satisfaction with the Iranian health system reform plan. J Educ Health Promot ,8(1):170-178.
11. Doshmangir L, Moshiri E, Mostafavi H, Sakha MA, Assan A(2019). Policy analysis of the Iranian Health Transformation Plan in primary healthcare. BMC Health Serv Res, 19(1): 670.
12. Ravanipour M, Ostovar A, Darabi H, Pouladi S (2020). Challenges of Health System Reform Plan in Bushehr: A Qualitative Study. ISMJ,22(6):415-31.
13. Shojaie B, Ferdosi M, Keyvanara M, Yarmohamadian MH (2018). The Overt and Covert Effects of Iranian Health Transformation Plan on Medicine and Medical Supplies. Health Scope,7(S):1-6.
14. Hong QN, Pluye P, Fàbregues S, et al (2018). Mixed methods appraisal tool (MMAT), version 2018. Registration of copyright ,1148552.
15. Eskandari N, Raissi M, Abbasi M. Explanation of the Management Challenges of Health System Reform in Health Care Domain city QOM: A Qualitative Study (Iran). Qom Unive Med Sci J. 2019;13:78-89.
16. Aryankhesal A, Meydari A, Naghdi S, Ghiasvand H, Baghri Y(2018). Pitfalls of revising physicians’ relative value units (RVUs) in Iran: a qualitative study on medical practitioners’ perspective. Health Scope,7(S):e63140.
17. Alidadi A, Ameryoun A, Sepandi M, et al(2016). The opportunities and challenges of the ministry of health and medical education in the implementation of healthcare reform. Health Research,1(3):173-84.
18. Abedi G, Soltani Kontai SA, Marvi A, Mazidi S, Abedini E, Abbasi Chaleshtary A (2018). SWOT analysis of health reform plan on healthcare sector from the stakeholder perspective. Journal of Mazandaran Unive Med Sci ,28(166):199-212.
19. Mohamadi E, Olyaeemanesh A, Majdzadeh R, et al (2019). Effect of the health transformation plan (HTP) on implementation processes, rules and regulations of basic health insurance organizations in Iran. Hakim Res J,21(4):255-65.
20. Ferdosi M, Kabiri S, Keyvanara M, Yarmohammadian MH (2017). Challenges of iran health transformation plan about inpatients payment: Viewpoint of experts. Health Scope,6(3):1-6.
21. Peikanpour M, Esmaeli S, Yousefi N, Aryaeinezhad A, Rasekh H (2018). A review of achievements and challenges of Iran’s health transformation plan. Payesh (Health Monitor), 17(5):481-94.
22. Rahmany K, Barati M, Ferdosi M, Rakhshan A, Nemati A (2018). Strategies for reducing expenditures in Iran's health transformation plan: A qualitative study. Med J Islam Repub Iran,32(1):591-7.
23. Yousefi MR, Taziki MH (2018). The Approach of Full-time Faculty Members in Clinical Practice: A Qualitative Study. Bimonthly of Education Strategies in Medical Sciences,11(2):115-22.
24. Jafari M, Nemati A, Mahmoudi MS, et al(2018). Implementation effect of specialist residency program: A case study on performance indicators of emergency departments. Int J Healthc Manag ,13(1):1-10.
25. Etemadi M, Ashtarian K, Ganji N, Kangarani HM, Gorji HA (2019). Have the poor been considered in the Health Sector Evolution Plan? A qualitative study of the Iranian health system. Int J Hum Rights Healthc,13(1):45-57.
26. Olyaeemanesh A, Manavi S, Aghajani M (2017). Implementing the Health Transformation Plan with Emphasis on Supporting the Survival of Physicians in Deprived Areas: The Results and Challenges. Hakim Health Sys Res,19(4):228-37.
27. Khalajinia Z, Gaeeni M(2018). Challenges in Implementation of Health Care Reform in the Area of Treatment Qom City. Management Strategies in Health System,3(3):212-24.
28. Jahangir M, Khorakian A, Mortazavi SS, Elahi SE (2019). Risk management model of Iran’s health system transformation plan: A qualitative study. Payesh (Health Monitor),18(4):333-45.
29. Abbasi M, Eskandari N, Raisi M (2018). Iranian Health Reform Advantages in Health Care System: A Qualitative Study. Ann Mil Health Sci Res,16(1):4-12.
30. Gholami S, Oveisi S, Ghamari F, Etedal MG, Rajaee R (2015). Study of Educational Hospital Employees’ Satisfaction with the Administration of the Health Reform Plan in Ghazvin, 2015. Electron Physician,7(7):1500-4.
31. Alipour Z, Eskandari N, Abbasi M, Raisi M, Bakouei S(2019). Structural challenges in the health domain of the health system reform: A qualitative study. J Edu Health Promot, 8(1):55-64.
32. Gharibi F, Janati A, Beiknoori MF, Daghalian BA(2018). A survey of health system reform circumstances from the experiences of managers and nurses of Tabriz Taleqani hospital. Depiction of Health,6(1):1-10.
33. Shirozhan S, Hosseini M, Rajabi S, Sedighi Pashaki M (2018). Explaining the nurses' experiences of implementation of health system reform plan. JHPM ,7(4):1-7.
34. Jafari M, Ghasemyani S, Khodayari-Zarnaq R, Raoofi S (2021). Health Transformation Plan Achievements and Outcomes in Iran (2014-2020): A Scoping Review. Med J Islam Repub Iran,35(1):1126-35.
35. Moghaddam AV, Damari B, Alikhani S, et al (2013). Health in the 5th 5-years Development Plan of Iran: main challenges, general policies and strategies. Iran J Public Health ,42(1):42-9.
36. Moradi R, Karimi S, Yarmohammadian MH, Kiaei MZ, Mazaheri E (2018). Opportunities and challenges of resident specialists' attendance plan guidelines (health-care transformation plan) in Isfahan university hospitals in 2015. J Educ Health Promot, 7:39-46.
37. Ghanbari A, Moaddab F, Heydarzade A, Jafaraghaee F, Barari F (2017). Health system evolution plan; A new approach to health care delivery: The challenge ahead. Hakim Res J, 20(1):1-8.
38. Kiaei MZ, Moradi R, Hasanpoor E, Mohammadi M, Taheri A, Ahmadzadeh MS (2015). Hospital managers’ perception of recent health care reform in teaching hospitals of Qazvin, Iran. Biotechnology and Health Sciences,2(4):1-6.
39. Ebrahimpour A, Alimohammadzadeh Kh, Maher A (2019). Evaluating the Health Reform Plan in Ayatollah Taleghani Hospital, Tehran in 2010-2017 Using the Balanced Scorecard. Hakim Res J,22(2):100-11.
40. Bahmanziari N, Bastani P, Moradi R, Ahmadzadeh MS, Nazari M (2017). Nurses’ Satisfaction of Implementation of Health System Evolution Plan in Teaching Hospitals of Shiraz City, 2015 (IRAN). Qom Unive Med Sci J ,11(8):85-93.
41. World Health Organization(2006). The world health report 2006: working together for health: policy briefs. World Health Organization.
42. Hashemi B, Baratloo A, Forouzafar MM, Motamedi M, Tarkhorani M (2015). Patient satisfaction before and after executing health sector evolution plan. Iranian Journal of Emergency Medicine, 2(3):127-33.
43. Bastani P, Mousa Kazemi Z, Ahmadzadeh MS (2017). A comprehensive evaluation of the satisfaction rate related to implementation of health transformation plan in southern Iran in 2015. Daneshvar,24(129):75-86.
44. Dehghan A, Mirjalili MR, Zare Mehrjardi MH, Maliheh R, Samiyezargar A, Kazemeini SK (2016). Performance of health care system reform plan from the perspective of university hospitals executives in Yazd province in 2015. Management Strategies in Health System,1(1):43-9.
IssueVol 51 No 9 (2022) QRcode
SectionReview Article(s)
Health transformation plan Achievements Challenges Systematic review Iran

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How to Cite
Ghasemyani S, Raoofi S, Hamidi H, Khodayari-Zarnaq R. Iran’s Health Transformation Plan; Main Issues and Opportunities for Improvement: A Systematic Review. Iran J Public Health. 2022;51(9):1977-1989.