Navigating policy making in a complex health system landscape: insight from Iran's health ministers

Health ministers play a central role in policymaking and governance within any country's health system, each bringing unique strategies to address health challenges. In the health system, where policymaking and governance dynamics are particularly complex, understanding the factors shaping this process is crucial. This study explores the experiences and perspectives of Iran's health ministers, offering valuable lessons for improving health systems and governance both nationally and globally.

A qualitative approach was employed, including a review of 2,328 published and unpublished documents, local media sources, and speeches from local and international events. In-depth interviews were conducted with 12 of the 13 Iranian health ministers who served after the 1979 Islamic Revolution. One minister held office for two terms. Thematic analysis was used to analyze the data.

Health ministers' priorities varied depending on the duration of their tenure and the prevailing political context in which they operated. Across different administrations, key concerns for health ministers consistently included addressing systemic challenges and crises within the health system, implementing policies aimed at reducing corruption, effectively managing conflicts of interest among stakeholders, and enhancing the overall effectiveness and impact of policy interventions. During each term, health ministers' priorities were influenced not only by the immediate pressures facing the health system but also by broader political considerations, societal expectations, the demands of diverse organizational stakeholders, and limitations in available resources.

Policymaking in Iran's health system is shaped by multiple factors including competing stakeholder demands and evolving threats and opportunities. Understanding these complexities highlights the need for an adaptive and holistic governance approach to achieve effective health system outcomes. This study provides empirical insights crucial for strengthening governance in Iran's health sector and similar contexts.