Davoud Shamsi, Mohsen Mohammadian Saravi, Khalil Ali Mohamadzadeh, Azadeh Ashrafi,
Volume 28, Issue 2 (4-2025)
Abstract
Introduction: Good governance, as one of the fundamental concepts in healthcare system management, plays a key role in enhancing the efficiency, effectiveness, and equity of healthcare services. This concept, Emphasizing principles such as transparency, accountability, participation, and legality, has been considered as a framework for improving policymaking and management in Iran's healthcare system.
This study conducted in 2024 aimed to design and present a model of good governance in the healthcare system using a mixed approach of thematic analysis and Partial Least Squares (PLS) method.
Methods: The research method included both qualitative and quantitative components. The qualitative phase, involved managers, health policy experts, specialists from the Ministry of Health and Medical Education, and academic scholars. Sampling was done using purposive and snowball sampling methods, with 17 participants selected until theoretical saturation was reached. In the quantitative phase, the Partial Least Squares (PLS) method was used for model fitting. The statistical population for this section included all experts and managers in Iran's healthcare sector, with a minimum sample size of 384 determined based on Cochran's formula.
Results: The results of thematic analysis of the qualitative data and model fitting showed that the final good governance model in the healthcare system consists of seven main dimensions: effectiveness, efficiency, equity, transparency and accountability, participation, legality, and leadership. Each dimension comprised specific components, and the importance of each was confirmed in strengthening good governance.
Conclusions: This study presents a comprehensive good governance model for the healthcare system, offering a framework for improving policymaking, management, and performance in this sector. The proposed model can be used as a strategic decision-making tool and improving management structures.
Nahid Chezani Sharahi, Seyed Mojtaba Hosseini, Khalil Alimohammadzadeh, Ali Hassan Shaban Khamseh, Mohammadkarim Bahadori,
Volume 28, Issue 6 (1-2026)
Abstract
Introduction: Health system planning, as a core function of health governance, plays a crucial role in resource allocation, performance improvement, and equity promotion. Despite recent reforms, evidence suggests that planning processes in Iran’s health system still face significant structural, managerial, and implementation challenges. This study aimed to identify and explain the key challenges of health system planning in Iran.
Methods: qualitative study was conducted using a thematic analysis approach. Seventeen participants—including senior and middle managers, faculty members, and health planning experts at national and university levels—were selected through purposive sampling with maximum variation. Data were collected via semi-structured interviews over eight months and analyzed using MAXQDA version 20. Credibility, transferability, dependability, and confirmability were ensured to strengthen the trustworthiness of the findings.
Results: Thematic analysis led to the identification of 160 initial codes, 36 organized themes, and 9 overarching themes. The main categories of challenges included: human resources, leadership and governance, processes and regulations, inter- and intra-sectoral coordination, budgeting and financing, physical infrastructure and equipment, health information and technology, service delivery, and sociopolitical–cultural–economic factors. Major issues were found in managerial transparency, cross-sectoral collaboration, financial constraints, and the lack of systematic monitoring and evaluation mechanisms.
Conclusions: The Iranian health planning system suffers from centralization, structural ambiguities, limited stakeholder participation, and weak information systems. Strengthening evidence-informed policymaking, enhancing transparency and accountability, and reforming governance structures are essential for improving the effectiveness and efficiency of health system planning.
