PurposeNongovernmental organizations (NGOs) play a critical role in modern health-care systems complementing state organizations. The purpose of this paper is to investigate the challenges of NGOs' participation in Iran's health-care system.Design/methodology/approachThis qualitative study was conducted in 2020. Data were collected through semi-structured interviews with 26 participants: 11 managers and experts at the office of NGOs in the Ministry of Health (MOH) and universities of medical sciences and 15 chief executive officers (CEOs) of health-related NGOs in Tehran, Iran. The participants were chosen using the non-probabilistic approach of purposive sampling with maximum variation. Data analysis was performed using the thematic analysis method and MAXQDA 10 software.FindingsChallenges of NGOs' participation in Iran's health-care system are categorized into external and internal challenges. Financial issues, the process of getting permissions, lack of trust in NGOs, weak relationships with the public sector and lack of law are identified as main challenges. Building trust in NGOs, passing the NGOs' law, making people more familiar with NGOs and capacity development are the most important measures that improve the role of NGOs and resolve barriers to their participation in Iran's health-care system.Originality/valueIn this study, for the first time, the challenges of NGOs' participation in Iran's health-care system are investigated by examining the views of both the public sector and NGOs. Improving the participation of NGOs in the health-care system provides Iran's MOH with the opportunity to make use of the NGOs' capacities to eliminate public health issues.

‫بسطامی‬ ‫مالک‬ ، 2 ‫فراهانی‬ ‫شاهواروقی‬ ‫ندا‬ ، 3 ‫توانایی‬ ‫حسین‬ ‫امیر‬ ، 4 ، * ‫قنبری‬ ‫بهروز‬ 5 ‫الستی‬ ‫هانیه‬ ، 6 ‫چکیده‬ ‫زمينه‬ ‫هدف:‬ ‫و‬ ‫پ‬ ‫سرطان‬ ‫یشرفته‬ ‫مشکالت‬ ‫به‬ ‫منجر‬ ‫تنها‬ ‫نه‬ ‫ی‬ ‫بر‬ ‫ا‬ ‫ی‬ ‫ب‬ ‫یمار‬ ‫ان‬ ‫م‬ ‫ی‬ ‫شود،‬ ‫برا‬ ‫بلکه‬ ‫ی‬ ‫بیمار‬ ‫مراقبین‬ ‫نیز‬ ‫دشوار‬ ‫ی‬ ‫هایی‬ ‫دارد‬ ‫همهراد‬ ‫بهه‬ . ‫پهوهه‬ ‫مقابله‬ ‫نق‬ ‫تعیین‬ ‫هدف‬ ‫با‬ ‫حاضر‬ ‫پی‬ ‫در‬ ‫مذهبی‬ ‫ی‬ ‫فشار‬ ‫بینی‬ ‫مراقبتی‬ ‫م‬ ‫در‬ ‫سرطان‬ ‫به‬ ‫مبتال‬ ‫بیماران‬ ‫راقبین‬ ‫گرفت.‬ ‫انجام‬ ‫انتهایی‬ ‫مراحل‬ 2 ‫ایران.‬ ‫تهران،‬ ‫تهران،‬ ‫دانشگاه‬ ‫سالمت،‬ ‫روانشناسی‬ ‫دکتری‬ ‫دانشجوی‬ . 3 . ‫ا‬ ‫تهران،‬ ‫طباطبائی،‬ ‫عالمه‬ ‫دانشگاه‬ ‫روانشناسی،‬ ‫دکتری‬ ‫دانشجوی‬ ‫یران.‬ 4 . ‫روان‬ ‫ارشد‬ ‫کارشناسی‬ ‫(مكسا)،‬ ‫آال‬ ‫سرطان‬ ‫پیشگری‬ ‫و‬ ‫کنترل‬ ‫مرکز‬ ‫بالینی،‬ ‫شناسی‬ ‫فیروزگر،‬ ‫بیمارستان‬ ‫ایران،‬ ‫پزشكی‬ ‫علوم‬ ‫دانشگاه‬ ‫ایران.‬ ‫تهران،‬ 5 ‫فیر‬ ‫بیمارستان‬ ‫کبد،‬ ‫و‬ ‫گوارش‬ ‫تحقیقات‬ ‫مرکز‬ ‫استادیار،‬ . ‫ایران‬ ‫تهران،‬ ‫ایران،‬ ‫پزشكی‬ ‫علوم‬ ‫دانشگاه‬ ‫وزگر،‬ . ( * ‫مسئول)‬ ‫نویسنده‬ ‫تماس:‬ ‫شماره‬ 09123480128 Email: ghanbari.b@iums.ac.ir 6 ‫ایران.‬ ‫تهران،‬ ‫خوارزمی،‬ ‫دانشگاه‬ ‫سالمت،‬ ‫روانشناسی‬ ‫دکتری‬ ‫دانشجوی‬ . 5 1

BACKGROUND: Given the expanding range of health influencing factors, increasing expectations from the health systems, and general challenges such as insufficient resources, the health services needed by people cannot be provided completely by the governments alone. Therefore, nongovernmental organizations (NGOs)-government collaboration is considered a common approach in health-care provision for different communities. Since the NGO-government collaboration is complicated and usually influenced by many challenges and issues, the present study was conducted to identify collaboration challenges between the government and NGOs in providing health-care services. MATERIALS AND METHODS: Using a systematic review method and searching in ISI Web of Science, Scopus, PubMed, and Embase databases, using related keyword/terms, between March 2020 and June 2020, studies on NGO-government collaboration in the health area were collected without time limitation. After completing the article selection process, those articles that consistent with the research purpose were chosen for the final analysis. RESULTS: From 4236 initially collected studies, 16 studies were chosen for the final analysis. Based on the content analysis of the selected articles, 70 challenges were identified in the NGO-government collaboration to provide health-care services. These challenges were divided into five main themes: structural issues, process issues, issues related to roles and responsibilities, trust and communications issues, and control and power relation issues and 11 subthemes. CONCLUSION: The present study provides significant challenges by NGO-government collaboration in providing health-care services. Awareness of these challenges plays an important role in promoting such collaborations and enables these organizations to highly exploit the strengths of each other, resulting in a collaboration with win–win situation.

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