Weaknesses and Challenges of Primary Healthcare System in Iran: A Review

Moghadam, Mahmood Nekoei; Sadeghi, Vahideh; Parva, Sahar

doi:10.1002/hpm.1105

Cited by 58 publications

(74 citation statements)

References 7 publications

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“…Promoting health is not only a responsibility but also a right and as mentioned by the Iranian constitution, the government must provide health care to population on an equitable basis (1). Iran has signed the Alma-Ata Declaration in 1978, aiming health for all by the year 2000 using the primary health care (PHC) strategy (2). Moving in this direction, policymakers in Iran decided to enact and enforce the laws to reach the goal (3).…”

Section: Introductionmentioning

confidence: 99%

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Structural and Contextual Dimensions of Iranian Primary Health Care System at Local Level

Baygi¹,

Seyedin²,

Salehi³

et al. 2014

Iran Red Crescent Med J

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Background:In recent years, family physician plan was established as the main strategy of health system in Iran, while organizational structure of the primary health care system has remained the same as thirty years ago.Objectives:This study was performed to illustrate structural and contextual dimensions of organizational structure and relationship between them in Iranian primary health care system at local level.Materials and Methods:A cross-sectional quantitative study was conducted from January to June 2013, during which 121 questionnaires were distributed among senior and junior managers of city health centers at Medical Sciences universities in Iran. Validity of the questionnaire was confirmed by experts (CVI = 0.089 and CVR more than 0.85) and Cronbach α was utilized for reliability (α = 0.904). We used multistage sampling method in this study and analysis of the data was performed by SPSS software using different tests.Results:Local level of primary health care system in Iran had mechanical structure, but in contextual dimensions the results showed different types. There was a significant relationship between structural and contextual dimensions (r = 0.642, P value < 0.001). Goals and culture dimensions had strongest effects on structural dimensions.Conclusions:Because of the changes in goals and strategies of Iranian health system in recent years, it is urgently recommended to reform the current structure to increase efficiency and effectiveness of the system.

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Section: Introductionmentioning

confidence: 99%

“…Despite the reforms, organizational structure of PHC system has not changed over the last thirty years (2). Organizational structure reform is required to have appropriate performance regarding new goals and strategies (9).…”

Section: Introductionmentioning

confidence: 99%

Structural and Contextual Dimensions of Iranian Primary Health Care System at Local Level

Baygi¹,

Seyedin²,

Salehi³

et al. 2014

Iran Red Crescent Med J

View full text Add to dashboard Cite

show abstract

“…Additionally, for the purpose of implementing the second phase of Iranian Targeted Subsidy Plan, "Health Reform Program" was designed, and a large budget was allocated to the health sector. The project consisted of seven programs including special packages to reduce the costs of patients in public hospitals, but it cannot yet be judged due to the unavailability of data about it (33,34). According to the new population policy, and in order to increase the country's population, the annual population growth rate and total fertility rate will probably increase.…”

Section: Iran J Health Sci 2017; 5(2): 39mentioning

confidence: 99%

An association between change in health expenditures and health indicators; A cross country comparison

2017

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Background and purpose: Improved life standards, over the past few decades, had led to an increase in health expenditures. The aim of this article was to compare the trend of health expenditure per capita and its association with health indicators in selected countries. Results: Denmark with health expenditure per capita more than the Netherlands had higher life expectancy at birth and more deaths as a result of alcohol abuse and tobacco smoking. Nigeria's health spending per capita was 2.5 times more than that of Liberia, because it had worse results in all health indicators with high mortality rate due to lower vaccination coverage for malaria, AIDS, and tuberculosis, and at the same time, high costs for the labor force and corruption in health system. Iran with health expenditure per capita less than Turkey had lower total mortality rate of infants and children under 5 years and lower total fertility. Well-organized PHC system and highly qualified professionals in the field of healthcare are among the strengths of the healthcare system in Iran. Conclusion: Increasing trend of health expenditures in selected countries did not have a significant impact on the health indicators trend. Countries must identify and invest on their health priorities to improve population health status.

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“…However, most studies conducted on the Iranian primary health care system showed that, despite having numerous achievements, it had notable weaknesses. Nekoei Moghadam et al referred to the weakness of the system in urban areas and the existence of several centers with different providers (8). In its report on the Iranian health system in 2007, the World Bank highlighted many of the Iranian health system achievements after the expansion of health networks, and then mentioned some of the existing problems, including the multiplicity of service delivery systems and fragmentation of the health system, especially in cities (9).…”

Section: Introductionmentioning

confidence: 99%

Utilization of Primary Health Care Services in Rural and Urban Areas in Shiraz

2018

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Background: Different factors affect individuals' behaviors when they encounter a health problem or a disease. This cross-sectional study was conducted to analyze health-seeking behaviors and utilization pattern of primary health care services among the households living in Shiraz, Iran. Methods: This household survey was conducted among 500 households living in urban and rural areas, selected through threestage sampling during 2016 -2017. The data were collected via a questionnaire designed by the researcher (Cronbach's alpha coefficient: 0.747), and the questions were answered by the most informed family members. The data were then analyzed using Chisquare, independent samples t-test, one-way analysis of variance (ANOVA) and Pearson correlation coefficient. Results: We found that 52.4% of the subjects were female, 65.6% were married and 34.4% had academic education. Furthermore, 95% were under the coverage of a health insurance, of which 64.4% had social security insurance. The mean age of the participants was 39.08 years. In terms of socio-economic characteristics of the households, 52.4% had a personal house and 56.6% were in the income group of 10 -20 million Rials. The average household size was 3.86. Further, 41.8% of the households had elderly member(s), 49.6% had hypertensive patient(s) and 32.8% of the households had diabetic member(s). Only 31.2% of the participants said they needed consultation on high-risk behaviors. According to our findings, the subjects had inappropriate health-seeking behaviors (direct referral to a specialist physician and disregarding the problem) when facing four out of the seven services surveyed (about 60%). The most important reason for disregarding the problem was that it did not seem serious to the individuals. Our results showed when facing simple illnesses, education level (P = 0.003), age (P = 0.001), insurance (P = 0.000), type of insurance (P = 0.000), income level (P = 0.001), residence (P = 0.001) and type of referral system (P = 0.004) had a statistically significant relationship with the possibility seeking service and the level of services utilized. The factors affecting the utilization of primary health care services when requiring nutritional counseling, psychological services, counseling for high-risk behaviors, elderly care, as well as hypertension and diabetic care were different. Conclusions: In half of the studied first-level health services, referral to specialist physicians was more common; this behavior would increase the health costs of the country. Therefore, it seems necessary to improve the quality of primary health care services, promote culture and adopt policies to encourage the referral system usage and carry out patient screening.

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Weaknesses and Challenges of Primary Healthcare System in Iran: A Review

Cited by 58 publications

References 7 publications

Structural and Contextual Dimensions of Iranian Primary Health Care System at Local Level

Structural and Contextual Dimensions of Iranian Primary Health Care System at Local Level

An association between change in health expenditures and health indicators; A cross country comparison

Utilization of Primary Health Care Services in Rural and Urban Areas in Shiraz

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