Infrastructures Required for the Expansion of Family Physician Program to Urban Settings in Iran

Following the implementation of Family Physician (FP) Program in rural areas and cities with populations under 20000 in 2005, the Iranian Ministry of Health and Medical Education in 2012 decided to implement urban FP in large cities with populations more than 20000. Along with the development and implementation of urban FP in Iran, local websites and newspapers reflected the viewpoints of experts in various levels of health system regarding the various stages of Family Medicine (FM) development (from agenda setting to initial stages of implementation). This study aimed to explore the major infrastructures perceived to be required to achieve desirable implementation of urban FP through analyzing experts' viewpoints reflected in the media and interviews.

In a qualitative study, we analyzed the contents of health related national websites as well as transcribed interviews with key informants. Documents were collected from December 2011 to January 2014 and interviews were conducted from February 2014 to June 2015. We used mixed thematic approach (inductive and deductive) for analysis that was assisted by MAXQDA 12 software.

Infrastructures needed for the implementation of FP were categorized in five main themes and 23 subthemes. The themes are: 'Stewardship/governance', 'Actors and stakeholders', 'structural infrastructure', 'technical infrastructure and needed resources', and 'information and communication infrastructure'.

Expansion of FP program to urban settings needs appropriate attention to the principles of policy implementation as well as provision of robust infrastructures. Well-defined stewardship, revised approach to financial regulation and payment system, stakeholder's commitment to collaboration, policy for conflict resolution, and universal insurance coverage are pivotal for the expansion of family physician program to the urban settings in Iran.