Healthcare transparency in Iran: anticipated benefits, risks, opportunities and barriers

Transparency is a key component of good governance but remains underdeveloped in Iran's healthcare system. This study aims to identify and prioritize the benefits, risks, opportunities and barriers (BROB) of transparency to guide policy reform.

A modified Delphi approach was used, beginning with a scoping review, followed by in-depth interviews with 35 experts and three panels involving 16 participants to contextualize the BROB framework. These inputs were evaluated over three Delphi rounds with 70 participants.

About 70 initial propositions were developed from the review and interviews regarding the potential BROB of transparency in Iran's healthcare system. Of these, 54 were validated (=75% agreement) and 16 were excluded in Delphi rounds. All proposed benefits were confirmed, while only three risks - such as misinformation and transitional instability - were acknowledged. Additionally, 55 opportunities and barriers were assessed, with 52 confirmed. Five were related to facilitators and the remainder were categorized into political, managerial, social and technical barriers.

Transparency in Iran's healthcare system could reduce corruption, improve access and service quality and promote innovation and cost control. However, systemic challenges and political resistance remain substantial. The few available opportunities - such as public demand and digital infrastructure - can drive change if supported by long-term, multi-stakeholder collaboration and commitment. These findings offer a roadmap for policymakers in Iran and similar settings to design tailored transparency strategies and overcome structural constraints.