A qualitative study of challenges affecting the primary care system performance: Learning from Iran's experience

Area of Science:

• Healthcare Management
• Public Health Policy
• Qualitative Research Methods

Background:

• Primary care and referral systems are foundational to effective health systems.
• Investigating challenges within Iran's primary health-care system is essential for its improvement.

Purpose of the Study:

• To identify and analyze the key challenges impacting the performance of Iran's primary health-care system.
• To provide insights for policymakers and planners to address systemic issues.

Main Methods:

• A qualitative study involving 14 in-depth interviews with primary care experts.
• Purposive and snowball sampling techniques were employed for participant selection.
• Conventional content analysis using MAXQDA-11 software for data analysis.

Main Results:

• Identified 72 initial codes, categorized into 7 main themes and 18 subthemes.
• Key challenge areas include governance, manpower, resources, financial management, service delivery, and socio-cultural factors.
• Governance and human resources were identified as the most significant challenges facing Iran's PHC.

Conclusions:

• Iran's primary care system, particularly governance and human resources, faces critical challenges affecting performance.
• Fundamental reforms, especially enhancing governance, are recommended over superficial changes.
• Strengthening intersectoral collaboration is suggested to improve the overall system.