eISSN: 2449-8580
ISSN: 1734-3402
Family Medicine & Primary Care Review
Current issue Archive Manuscripts accepted About the journal Editorial board Reviewers Subscription Contact Instructions for authors Publication charge Ethical standards and procedures
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank
4/2024
vol. 26
 
Share:
Share:
Original paper

Strategies to improve the structure of primary health care in the villages of Iran: a qualitative study

Fereshteh Fani
1
,
Ghahraman Mahmoudi
1
,
Mohammad Ali Jahani
2
,
Seyed Amir Soltani
2
,
Jamshid Yazdani-Charati
3

  1. Hospital Administration Research Center, Islamic Azad University, Sari, Iran
  2. Social Determinants of Health Research Center, Health Research Institute, Golestan University of Medical Sciences, Gorgan, Iran
  3. Department of Biostatistics, School of Health, Institute of Addiction, Mazandaran University of Medical Sciences, Sari, Iran
Family Medicine & Primary Care Review 2024; 26(4): 450–463
Online publish date: 2024/12/29
Get citation
 
PlumX metrics:
 
1. Bitton A, Ratcliffe HL, Veillard JH, et al. Primary health care as a foundation for strengthening health systems in low-and middle-income countries. J Gen Intern Med 2017; 32: 566–571, doi: 10.1007/s11606-016-3898-5.
2. Fani F, Mahmoudi G, Jahani MA, et al. Gap Analysis of Providing Primary Health Care in Comprehensive Rural Health Centers of Iran. APJHM 2023; 18(3): 110–120, doi: 10.24083/apjhm.v18i3.2545.
3. Ly J, Sathananthan V, Griffiths T, et al. Facility-based delivery during the Ebola virus disease epidemic in rural Liberia: analysis from a cross-sectional, population-based household survey. PLOS Med 2016; 13(8): e1002096, doi: 10.1371/journal.pmed.1002096.
4. World Health Organization. Primary Health Care [cited 04.04.2022]. Available from URL: https://www.who.int/health-topics/primary-health-care#tab=tab_1.
5. Abedi G, Soltani Kontai SA, Yazdani Cheratee J. Evaluation of managed health care in contagious and non-contagious diseases in Golestan province, northern Iran during 2016. J Gorgan Univ Med Sci 2019; 21(2): 113–119.
6. Abedi G, Esmaeili Seraji Z, Mahmoodi G, et al. Evaluating the Implementation of Family Physician Program in Urban and Rural Areas of Mazandaran Province Based on Process Approach. J Babol Univ Med Sci 2020; 22(1): 126–134.
7. Behzadifar M, Shahabi S, Bakhtiari A, et al. Improving the primary healthcare in Iran: a policy brief. Yafteh 2022; 24(3): 72–80.
8. World Health Organization. Declaration of Astana: global conference on primary health care: Astana, Kazakhstan, 25 and 26 October 2018. Available from URL: https://apps.who.int/iris/bitstream/handle/10665/328123/WHO-HIS-SDS-2018.61-ara.pdf.
9. Kiani MM, Khanjankhani K, Shirvani M, et al. Strengthening the primary health care system in Iran: a comprehensive review study. SJSPH 2020; 18(2): 121–138.
10. Zanganeh Baygi M, Seyadin SH, Rajabi Fard Mazrae No F, et al. Adaptation of goals and organizational structure in Iran’s primary healthcare system, a systematic review. Payavard Salamat 2016; 9(5): 446–458.
11. Kumar P. How to strengthen primary health care. J Fam Med Prim Care 2016; 5(3): 543–546, doi: 10.4103/2249-4863.197263.
12. Ferreira JM. Avaliação da atenção primária à saúde: identificação dos atributos, indicadores de qualidade e estratégias de melhoria dos serviços. 2017. Available from URL: https://repositorio.ufrn.br/jspui/handle/123456789/24494.
13. McCullough K, Whitehead L, Bayes S, et al. The delivery of Primary Health Care in remote communities: A Grounded Theory study of the perspective of nurses. Int J Nurs Stud 2020; 102: 103474, doi: 10.4161/23288604.2014.969121.
14. Doshmangir L, Bazyar M, Majdzadeh R, et al. So Near, So Far: Four Decades of Health Policy Reforms in Iran, Achievements and Challenges. Arch Iran Med 2019; 22(10): 592–605, doi: 10.34172/aim.2020.24.
15. World Bank Group. World Bank Open Data. Status of important care indicators in selected countries [cited 21.03.2022]. Available from URL: https://data.worldbank.org/.
16. Mehrolhassani MH, Dehnavieh R, Haghdoost AA, et al. Evaluation of the primary healthcare program in Iran: a systematic review. Aust J Prim Health 2018; 24(5): 359–367, doi: 10.1071/PY18008.
17. Rahmati-Najarkolaei F, Rakhshani T, Tavafian SS, et al. Health education performance in health houses: a descriptive study from Iran during April–September 2011. Shiraz E Med J 2018; 19(4), doi: 10.5812/semj.13940.
18. Naseriasl M, Janati A, Amini A, et al. Referral system in rural Iran: improvement proposals. Cad Saude Publica 2018; 34(3): e00198516, doi: 10.1590/0102-311X00198516.
19. Sajadi HS, Majdzadeh R. From primary health care to universal health coverage in the Islamic Republic of Iran: a journey of four decades. Arch Iran Med 2019; 22(5): 262–268.
20. Heshmati H, Hejri SM, Shakibazadeh E, et al. Emerging New Challenge for Providing Health Education in Iranian Rural Primary Health Care. Iran J Public Health 2021; 50(4): 846–847, doi: 10.18502/ijph.v50i4.6017.
21. Eri M, Kabir MJ, Babazadeh Gashti A, et al. Iranian Primary Healthcare providers` Perspectives on Providing Pre-hospital Emergency Services in Primary Levels of Healthcare System: A Qualitative Study. Iran J Health Sci 2019; 7(1): 46–54, doi: 10.18502/jhs.v7il.1024.
22. Shabani H, Rezayatmand R, Mohammadi F. Determinants of health expenditures in Iran and other country members of perspective document of 1404 of Iran. Health Information Management 2019; 16(1): 18–23, doi: 10.22122/him.v16i1.3818.
23. Yazdi Feyzabadi V, Ansari M, Amini Rarani M, et al. Health team in primary health care: Facilitators and inhibitors of the effective function. Journal of Management and Medical Informatics School 2014; 2(1): 74–66.
24. Bayati M, Keshavarz K, Lotfi F, et al. Effect of two major health reforms on health care cost and utilization in Fars Province of Iran: family physician program and health transformation plan. BMC Health Serv Res 2020; 20: 1–9, doi: 10.1186/s12913-020-05257-8.
25. World Health Organization. Progressing primary health care: a series of country case studies. Available at URL: https://apps.who.int/iris/handle/10665/326083.
26. Yildiz S, Kilic GN, Acar IH. Early childhood education during the COVID-19 outbreak: The perceived changing roles of preschool administrators, teachers, and parents. Early Child Educ J 2023; 51(4): 743–753, doi: 10.1007/s10643-022-01339-w.
27. Mohajan D, Mohajan H. Exploration of Coding in Qualitative Data Analysis: Grounded Theory Perspective. 2022. Res Advances Educ 2022; 1(6): 50–60.
28. Murray-Parahi P, DiGiacomo M, Jackson D, et al. Primary health care content in Australian undergraduate nursing curricula. Collegian 2020; 27(3): 271–280, doi: 10.1016/j.colegn.2019.08.008.
29. Currie J, Carter MA, Lutze M, et al. Preparing Australian nurse practitioners to meet health care demand. The Journal for Nurse Practitioners 2020; 16(8): 629–633, doi: 10/1016/j.nurpra.2020.06.023.
30. Thomas TH, Bloomfield JG, Gordon CJ, et al. Australia’s first transition to professional practice in primary care program: Qualitative findings from a mixed-method evaluation. Collegian 2018; 25(2): 201–208, doi: 10/1186/s12912-017-0207-5.
31. Laberge M, Gaudreault M. Promoting access to family medicine in Québec, Canada: Analysis of bill 20, enacted in November 2015. Health Policy 2019; 123(10): 901–905, doi: 10.1016/j.healthpol.2019.08.003.
32. Henderson R, Montesanti S, Crowshoe L, et al. Advancing Indigenous primary health care policy in Alberta, Canada. Health Policy 2018; 122(6): 638–644, doi: 10.1016/j.healthpol.2018.04.014.
33. Haj-Ali W, Moineddin R, Hutchison B, et al. Physician group, physician and patient characteristics associated with joining interprofessional team-based primary care in Ontario, Canada. Health Policy 2020; 124(7): 743–750, doi: 10.1016/j.healthpol.2018.04.014.
34. Marchildon GP, Allin S, Merkur S. Canada: health system review. Health Systems in Transition. 2020. Available from URL: https://iris.who.int/bitstream/handle/10665/336311/HiT-22-3-2020-eng.pdf.
35. McDonough JE. The United States health system in transition. Health Syst Reform 2015; 1(1): 39–51, doi: 10.4161/23288604.2014.969121.
36. Epperly T. The Patient‐Centred Medical Home in the USA. J Eval Clin Pract 2011; 17(2): 373–375, doi: 10.1111/j.1365-2753.2010.01607.x.
37. Khangah HA, Jannati A, Imani A, et al. Comparing the health care system of Iran with various countries. Health Scope 2017; 6(1): e34459, doi: 10.17795/jhealthscope-34459.
38. Baillie L, Gallini A, Corser R, et al. Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: a qualitative case study. Int J Integr Care 2014; 14: e009, doi: 10.5334/ijic.1175.
39. World Health Organization. Regional Office for Europe, European Observatory on Health Systems and Policies, Boyle S. United Kingdom (England): health system review. World Health Organization. Regional Office for Europe; 2011. Available from URL: https://apps.who.int/iris/handle/10665/330328.
40. Sharman A. A new paradigm of primary health care in Kazakhstan: Personalized, community-based, standardized, and technology-driven. Cent Asian J Glob Health 2014; 3(1): 186, doi: 10.5195/cajgh.2014.186.
41. Aizhan Z, Saipinov D. The stages of the healthcare system reform of the Republic of Kazakhstan. Procedia Soc Behav Sci 2014; 140: 657–661, doi: 10.1016/j.sbspro.2014.04.488.
42. World Health Organization. Regional Office for Europe, European Observatory on Health Systems and Policies, Katsaga A, Kulzhanov M, Karanikolos M, et al. Kazakhstan: health system review. World Health Organization. Regional Office for Europe; 2012. Available from URL: https://iris.who.int/handle/10665/330319.
43. Tejativaddhana P, Briggs D, Singhadej O, et al. Developing primary health care in Thailand: innovation in the use of socio-economic determinants, sustainable development goals and the district health strategy. Public Administration and Policy 2018; 21(1): 36–49, doi: 10.1108/PAP-06-2018-005.
44. World Health Organization. Regional Office for the Western Pacific. The Kingdom of Thailand health system review. Health systems in transition 2015; 5(5). Available from URL: https://iris.who.int/handle/10665/208216.
45. Tabrizi JS, Pourasghar F, Nikjoo RG. Status of Iran’s primary health care system in terms of health systems control knobs: a review article. Iran J Public Health 2017; 46(9): 1156–1166.
46. Aggar C, Gordon CJ, Thomas TH, et al. Evaluation of a community transition to professional practice program for graduate registered nurses in Australia. Nurse Educ Pract 2018; 32: 101–107, doi: 10.1016/j.nepr.2018.03.005.
47. Harfield SG, Davy C, McArthur A, et al. Characteristics of Indigenous primary health care service delivery models: a systematic scoping review. Global Health 2018; 14(1): 1–11, doi: 10.1186/s12992-018-0332-2.
48. Ouimet MJ, Pineault R, Prud’homme A, et al. The impact of primary healthcare reform on equity of utilization of services in the province of Quebec: a 2003–2010 follow-up. Int J Equity Health 2015; 14: 139, doi: 10.1186/s12939-015-0243-2.
49. Pineault R, Borgès Da Silva R, Provost S, et al. Impacts of Québec Primary Healthcare Reforms on Patients’ Experience of Care, Unmet Needs, and Use of Services. Int J Family Med 2016; 2016: 8938420, doi: 10.1155/2016/8938420.
50. Allin S, Martin E, Rudoler D, et al. Comparing public policies impacting prescribing and medication management in primary care in two Canadian provinces. Health Policy 2021; 125(9): 1121–1130, doi: 10.1016/j.healthpol.2021.06.002.
51. Rayner J, Khan T, Chan C, et al. Illustrating the patient journey through the care continuum: Leveraging structured primary care electronic medical record (EMR) data in Ontario, Canada using chronic obstructive pulmonary disease as a case study. Int J Med Inform 2020; 140: 104159, doi: 10.1016/j.ijmedinf.2020.104159.
52. Pitchforth E, Roland M. Specialist services in the community: a qualitative study of consultants holding novel types of employment contracts in England. Future Hosp J 2015; 2(3): 173, doi: 10.7861/futurehosp.2-3-173.
53. Aljunid SM, Srithamrongsawat S, Chen W, et al. Health-care data collecting, sharing, and using in Thailand, China mainland, South Korea, Taiwan, Japan, and Malaysia. Value Health 2012; 15(1): S132–S38, doi: 10.1016/j.jval.2011.11.004.
54. Rezapour R, Tabrizi JS, Farahbakhsh M, et al. Developing Iranian primary health care quality framework: a national study. BMC Public Health 2019; 19: 1–10, doi: 10.1186/s12889-019-7237-8.
55. Mahdavi M, Parsaeian M, Jaafaripooyan E, et al. Recent Iranian health system reform: an operational perspective to improve health services quality. Int J Health Policy Manag 2018; 7(1): 70, doi: 10.15171/IJHPM.2017.89.
56. Trankle SA, Usherwood T, Abbott P, et al. Integrating health care in Australia: a qualitative evaluation. BMC Health Serv Res 2019; 19(1): 1–12, doi: 10.1186/s12913-019-4780-z.
57. Mosadeghrad AM, Heydari M, Esfahani P. Primary Health Care Strengthening Strategies in Iran: A Realistic Review. SJSPH 2022; 19(3): 237–258.
58. Zarei E, Moghaddasfar T, Eidkhani V. Challenges and Problems of Public Private Partnership in Health System: A Review Study. Community Health 2018; 5(4): 386–402.
59. Goudarzi R, Meshkani Z, Barooni M, et al. Distribution of general practitioners in the health system of iran using equity indices (gini, atkinson). Health and Development Journal 2015; 4(3): 247–258.
60. Shahri S, Tabibi SJ, Nasiripour AA, et al. Effect functions on goals of health system in Iran. Payavard Salamat 2017; 11(3): 247–258.
61. Mosadeghrad AM, Esfahani P, Nikafshar M. Hospitals’ Efficiency in Iran: A Systematic Review and Meta-Analysis of Two Decades of Research. Payavard Salamat 2017; 11(3): 318–331.
62. Doshmangir L, Moshiri E, Farzadfar F. Seven Decades of Primary Healthcare during Various Development Plans in Iran: A Historical Review. Arch Iran Med 2020; 23(5): 338–352, doi: 10.34172/aim.2020.24.
63. Tabrizi JS, Goshayie EH, Doshmangir L, et al. The Barriers to Implementation of New Public Management Strategies in Iran’s Primary Health Care: A Qualitative Study. J Liaquat Uni Med Health Sci 2018; 17(1): 8–17, doi: 10.22442/jlumhs.181710542.
64. Christie AP, Downey H, Frick WF, et al. A practical conservation tool to combine diverse types of evidence for transparent evidence‐based decision‐making. Conserv Sci Pract 2022; 4(1): 1–20, doi: 10.1111/csp2.579.
65. Olalubi OA, Bello SI. Community-Based Strategies to Improve Primary Health Care (PHC) Services in Developing Countries. Case study of Nigeria. J Primary Health Care Gen Practice 2020; 4(1): 1–6.
66. Atkinson MK, Benneyan JC, Phillips RS, et al. Patient engagement in system redesign teams: a process of social identity. J Health Organ Manag 2022; 36(3): 293–313, doi: 10.1108/JHOM-02-2021-0064.
67. Hung DY, Harrison MI, Liang S-Y, et al. Contextual Conditions and Performance Improvement in Primary Care. Qual Manag Health Care 2019; 28(2): 70–77, doi: 10.1097/QMH.0000000000000198.
68. Khodayari-Zarnaq R, Kakemam E, Arab-Zozani M, et al. Participation of Iranian non-governmental organizations in health policy-making; barriers and strategies for development. International Journal of Health Governance 2020; 25(1): 46–56.
69. Reidy J, Halvorson J, Makowski S, et al. Health system advance care planning culture change for high-risk patients: the promise and challenges of engaging providers, patients, and families in systematic advance care planning. J Palliat Med 2017; 20(4): 388–394, doi: 10.1089/jpm.2016.0272.
70. Tenbensel T, Silwal P, Walton L. Overwriting New Public Management with New Public Governance in New Zealand’s approach to health system improvement. J Health Organ Manag 2021; 35(8): 1046–1061, doi: 10.1186/s12913-017-2617-1.
71. Freeman T, Baum FE, Jolley GM, et al. Service providers’ views of community participation at six Australian primary healthcare services: scope for empowerment and challenges to implementation. Int J Health Plann Manage 2016; 31(1): 1–12, doi: 10.1002/hpm.2253.
72. Kilewo EG, Frumence G. Factors that hinder community participation in developing and implementing comprehensive council health plans in Manyoni District, Tanzania. Glob Health Action 2015; 8(1): 1–11, doi: 10.3402/gha.v8.26461.
73. Mubita A, Libati M, Mulonda M. The importance and limitations of participation in development projects and programmes. Eur Sci J 2017; 13(5): 238–251, doi: 10.19044/esj.2017.v13n5p238.
74. Amiri MM, Tavana AM. Successful implementation of General Health Policies in the Islamic Republic of Iran: barriers and mechanisms. East Mediterr Health J 2018; 24(12): 1127–1134, doi: 10.26719/emhj.18.009.
75. Harvey JB, Vanderbrink J, Mahmud Y, et al. Understanding how health systems facilitate primary care redesign. Health Serv Res 2020; 55(Suppl. 3): 1144–1154, doi: 10.1111/1475-6773.13576.
76. Schiavone F, Leone D, Sorrentino A, et al. Re-designing the service experience in the value co-creation process: an exploratory study of a healthcare network. Business Process Management Journal 2020; 26(4): 889–908, doi: 10.1108/BPMJ-11-2019-0475.
77. Nymberg VM, Bolmsjö BB, Wolff M, et al. ‘Having to learn this so late in our lives…’ Swedish elderly patients’ beliefs, experiences, attitudes and expectations of e-health in primary health care. Scand J Prim Health Care 2019; 37(1): 41–52, doi: 10.1080/02813432.2019.1570612.
78. Wain LM. Does integrated health and care in the community deliver its vision? A workforce perspective. J Integr Care 2020; 29(2): 170–184.
79. Yusof MM. A case study evaluation of a Critical Care Information System adoption using the socio-technical and fit approach. Int J Med Inform 2015; 84(7): 486–499, doi: 10.1016/j.ijmedinf.2015.03.001.
80. Tavakoli F, Nasiripour AA, Riahi L, et al. Design of a Model for Management of Referral System in the Iranian Urban Family Physician Program. Iran J Public Health 2020; 49(11): 2144–2151, doi: 10.18502/ijph.v49i11.4732.
81. Afrizal SH, Handayani PW, Hidayanto AN, et al. Barriers and challenges to Primary Health Care Information System (PHCIS) adoption from health management perspective: a qualitative study. Inform Med Unlocked 2019; 17: 100198, doi: 10.1016/j.imu.2019.100198.
82. Khalifa M, Alswailem O. Hospital information systems (HIS) acceptance and satisfaction: a case study of a tertiary care hospital. Procedia Comput Sci 2015; 63: 198–204, doi: 10.1016/j.procs.2015.08.334.
83. Khajouei R, Nejad SS, Ahmadian L. Methods used for evaluation of health information systems in Iran. JOHA 2013; 16(53).
84. Almunawar MN, Anshari M. Health information systems (HIS): Concept and technology. arXiv: 12033923 2012, doi: 10.48550/arXiv.1203.3923.
85. Shahid J, Ahmad R, Kiani AK, et al. Data protection and privacy of the internet of healthcare things (IoHTs). Appl Sci 2022; 12(4): 1927, doi: 10.3390/app12041927.
86. Jahanbakhsh M, Sharifi M, Ayat M. The status of hospital information systems in Iranian hospitals. Acta Inform Med 2014; 22(4): 268–275.
87. Barzekar H, Ebrahimzadeh F, Luo J, et al. Adoption of Hospital Information System Among Nurses: a Technology Acceptance Model Approach. Acta Inform Med 2019; 27(5): 305–310.
88. Ebnehoseini Z, Ebrahimipour H, Koohjani Z, et al. Challenges of Health Information Systems (HISs) During COVID-19 Pandemics: Lessons Learned from Teaching Hospitals in a Developing Country. Shiraz E-Med J 2022; 23(2): e116017, doi: 10.5812/semj.116017.
89. Tabrizi JS, Karamouz M, Sadeghi-Bazargani H, et al. Health Complex Model as the Start of a New Primary Healthcare Reform in Iran: Part B: The Intervention Protocol. Iran J Public Health 2019; 48(1): 147–155, doi: 10.18502/ijph.v48i1.803.
90. Azimi R, Mahmoudi G, Esmaeili H-A. Ranking factors affecting the attraction of foreign medical tourists in hospitals affiliated to mashhad university of medical sciences based on marketing mix model. Iran J Public Health 2018; 47(10): 1593–1598.
91. Storey J, Holti R, Hartley J, et al. Devolving healthcare services redesign to local clinical leaders: does it work in practice? J Health Organ Manag 2019; 33(2): 188–203, doi: 10.1108/JHOM-05-2018-0144.
92. Zaman SB, Khan RK, Evans RG, et al. Exploring barriers to and enablers of the adoption of information and communication technology for the care of older adults with chronic diseases: scoping review. JMIR Aging 2022; 5(1): e25251.
93. Cnossen S. Mobilizing VAT revenues in African countries. International Tax and Public Finance 2015; 22(6): 1077–1108.
94. Organization WH. High-level commission on health employment and economic growth: report of the expert group. 2016. Available from URL: https://www.who.int/publications/i/item/9789241511285.
95. Wiseman V, Lagarde M, Batura N, et al. Measuring inequalities in the distribution of the Fiji Health Workforce. Int J Equity Health 2017; 16(1): 115, doi: 10.1186/s12939-017-0575-1.
96. Ruth JB, Umaima A-M, David JN, et al. Strengthening the Healthcare Workforce for Universal Health Coverage in Nigeria: Lessons and Strategies. IJTDH 2023; 44(17): 27–36.
97. Zhong K, Chen L, Cheng S, et al. The Efficiency of Primary Health Care Institutions in the Counties of Hunan Province, China: Data from 2009 to 2017. Int J Environ Res Public Health 2020; 17(5): 1–15, doi: 10.3390/ijerph17051781.
98. Espinosa-González AB, Delaney BC, Marti J, et al. The impact of governance in primary health care delivery: a systems thinking approach with a European panel. Health Res Policy Syst 2019; 17(1): 65–80, doi: 10.1186/s12961-019-0456-8.
99. Abimbola S, Olanipekun T, Schaaf M, et al. Where there is no policy: governing the posting and transfer of primary health care workers in Nigeria. Int J Health Plann Manage 2017; 32(4): 492–508, doi: 10.1002/hpm.2356.
100. Budrevičiūtė A, Kalėdienė R, Petrauskienė J. Priorities in effective management of primary health care institutions in Lithuania: Perspectives of managers of public and private primary health care institutions. PLOS ONE 2018; 13(12): 1–17, doi: 10.1371/journal.pone.0209816.
Copyright: © 2024 Family Medicine & Primary Care Review. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
 
Quick links
© 2025 Termedia Sp. z o.o.
Developed by Bentus.