Abstract
Background. Considering the need for new health programs, the Health Transformation Plan, as one of the largest health system reform programs, has been implemented in Iran since 2014.
Methods. This cross-sectional, applied study was conducted qualitatively on 27 participants in 2019 (19 service providers and eight service recipients). The data collection tool was a semi-structured interview guide that was validated through a comprehensive literature review, and consultation with health strategy transformation experts. The research plan was approved by the ethics committee and the research work commenced accordingly. The research work was carried out at the research participants’ workplace (employees) via interviewing process. All the interviews were recorded daily. The data interpretation and analysis were conducted through coding and content analysis approach.
Results. The data analysis for participants’ groups (i.e., service givers, human resources, infrastructure, education, and service recipients), using the open coding stage and the initial concept in the sub-coding stage, indicated 10 minor and five major categories.
Conclusion. Appropriate education, quality of services, financial support, and specialized manpower can be considered as possible ways to cope with the challenges in the health transformation plan.
Extended Abstract
Background
Health Transformation Plan (HTP), as one of the largest health system reform programs, has been implemented in Iran since 2014. One of the most important priorities of this plan is to promote the community health indicators. The main goals of the health system transformation plan include increasing people's satisfaction and community health indicators, establishing justice in financing the health, and reducing the burden of direct payment by the patient are among the most important goals of the HTP. The first step in HTP implementation was to provide health insurance for the population who do not have health insurance coverage, and the establishment of a special package for patients admitted to the hospitals of the Ministry of Health. The second step in the field of treatment included seven executive packages, namely reducing the payment of patients admitted to public hospitals, increasing the length of physicians’ stay in remote areas, the permanent presence of specialist physicians residing in public hospitals, improving the quality of hoteling in public hospitals, and improving the quality of visit services. In public hospitals, there was also a program to promote natural childbirth, as well as a program to provide financial support for incurable and needy patients. The third step was implemented in the field of health in 12 steps from the beginning of 2014 to 2020. First, it was conducted in the city outskirts and then in city centres with a population of 20 to 50 thousand people in the form of modern Primary Health Care (PHC) for all age groups.
Methods
This study was a qualitative research work using the content analysis method for analyzing the data. In this study, 27 providers and managers of the health department and clients of comprehensive health service centres (19 service providers and eight service recipients) were interviewed. The study population included various employees from Zahedan University of Medical Sciences including managers and deputies of health deputy, heads of city health networks and their deputies, heads of development units, staff, heads of departments and health care providers), as well as ordinary people referred to the Urban Health Service Centers that had received at least one service package. The eligibility criteria for service providers to participate in this study included one year of experience in the affiliated units of Zahedan University of Medical Sciences, participating in the study voluntarily, and having enough time and ability to speak at an acceptable level. Regarding the receivers of the health services, those who had referred to the comprehensive urban health service centres and received the service package at least once, participated in the study voluntarily, and had public health and the ability to speak at the desired level were selected as our participants. The exclusion criteria were included, desiring not to continue their participation, not being available, and suffering from mental illnesses. The research participants were 13 men and 14 women, aged between 30 and 40 years old, and educated (bachelor's degree).
Results
A total of 13 men and 14 women participated in this study, most of them were between 30 and 40 years old, (55.5%), educational background of the majority was bachelor's degree in different fields, 13 people, (48.2%). In the analysis of the interviews, 10 subcategories and five main categories (service provision, human resources, infrastructure, education, service recipients) were extracted. The most important sub-themes were financial challenges, equipment and building, Sib Portal (Samaneh), educational problems, users perspective and suggestions. For example, the most important financial challenges in this study were the delay in the payment of salaries, insufficient salaries of personnel, partial and scattered distribution of some health items due to the lack of funding, difficulty in allocating credits, and the difference in payment to the forces in private sector companies.
Conclusion
Based on the research results, it can be concluded that appropriate training, quality of services, financial support, permanent and specialized manpower, are the key factors to address the challenges in the health transformation plan. On the other hand, since one of the means of the health system to realize the health transformation plan is human resources, therefore the ability and flexibility of the personnel play an important role in the speed of service delivery and quality of services. Furthermore, employing specialized personnel and providing the necessary training for them, ensuring justice in their payment and valuing management specialists in decision-making and policy-making are important factors in improving the performance of the health system. For the health system transformation plan to continue, certain measures need to be taken such as levelling all diagnostic and treatment services, reviewing and adjusting financial resources, and making the electronic health record system more efficient.