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. 2017 Sep;46(9):1156–1166.

Table 1:

Iran’s PHC system’s status based on health system’s control knobs

Health system status Internal Status External Status
Control Knobs Organizing Strengths Weaknesses Opportunities Threats

  • -Wide PHC network in the country (11, 21, 25,33, 34, 35, 37, 39, 41, 75)

  • -Full access of rural population to PHC (26, 36, 38, 43, 51, 54)

  • -Transferring unenforceable programs from environmental levels to higher levels (40)

  • -Introducing Behvarz (20, 40, 79)

  • -Organizing health volunteers in health posts (9)

  • -Development of Family physician program and referral systems in villages (23, 29, 31, 41, 43)

  • -Integrating the management of non-communicable diseases in the villages (9, 52, 69, 80)

  • -Mechanical organizational structure at local level (50)

  • -Lack of change in PHC structure along with changes in health needs (8, 17, 18, 30, 32, 45–49)

  • -Formal structure of the system (17)

  • -inadequate development of PHC in urban areas (17,25,29,30,32 43, 51)

  • -Weakness in current information system (13, 16,22, 29–31,53,60)

  • -Lack of coherent strategy and adequate investment in electronic health (22)

  • -Lack of human resources planning (8,17,22,23,26, 30,31, 43,60,82)

  • -Lack of strategic management in healthcare organizations (8, 30,71)

  • -Instability of managerial life in system (10, 30)

  • -Lack of merit-based selection system in management (10, 30)

  • -Centralization and Lack of delegating authority to the local levels (10, 17, 18, 36, 39, 54)

  • -The weakness in terms of continuity and comprehensiveness of care (18, 22, 45, 63, 82, 83)

  • -Wide network of specialized services and outpatient services through hospitals (22)

  • -The presence of the strong private sector in the health care system (54)

  • -Separated componentsof health governance (22, 59)

  • -Providing health services by unrelated organizations (22)

  • -Lack of defined organizational structure for disaster management, elderly and health donors (22, 29, 30)

  • -Migration to urbanareas (12, 21, 34, 55)

  • -Rapid epidemiological transition and changes in lifestyle and increase in accidents rate (11, 41,55, 56)
Regulation Strengths Weaknesses opportunities Threats

  • -Appropriate regulation and programs in health and disease prevention (57, 58)

  • -Existence of evidence-based clinical practice guidelines in family physician program (41)

  • -Inconsistent of some current health laws (8,24)

  • -Lack of document regulations in some parts (8)

  • -No respecting to existing regulations (8)

  • -Lack of periodically monitoring of the implementation of policies (22)

  • -Lack of effective control over providing health services (8,22,53,61)

  • -Lack of proper legislation and super vision about private sector (8,29, 30, 43, 45, 59)

  • -Lack of legislation about Electronic Health (22)

  • -Weakness of pharmaceutical policies (22)

  • -Lack of updated and defined standards about medical equipment (22)

  • -Lack of executive and legal requirements about family physicians program (31)

  • -Accentuate to health andits determinants in upstream laws (60)

  • -Conflict of interest between policy-makers and managers (22)

  • -Low awareness of national managers and policy makers in some health projects (61)
Behavior Strengths Weaknesses opportunities Threats

  • -Close and intimate social relationships between Behvarz and local people (19, 20, 35,67)

  • -Promoting healthy attitudes and behavior in local communities (35)

  • -Satisfaction of communities about Behvarz performance (62, 63)

  • -Lack of the sense of ownership among community members towards health system (19)

  • -Low community involvement in solving health problems (31, 63)

  • -Lack of flexibility and accountability in the health system (30, 84)

  • -Health workers insufficient training in communication skills and counseling (85)

  • -High literacy rates of adults (64)

  • -Increased number of university students, especially woman (11, 21)

  • -importance of health in the Islam (21)

  • -long-term drug abuse habit in Iran (11, 66,67)

  • -Lack of comprehensive sexual relationship education for adults (68,69,70)

  • -High rate of traffic accidents (81,86)

  • -Incorrect lifestyle (65)
Financing Strengths Weaknesses Threats

  • Free of charge services (6, 18–21)*

  • Free medical insurance in some areas (60)

  • Parallel systems of financing in the system (8)

  • Lack of coordination in financing (54)

  • Lack of separation in financing and service delivery (54)

  • Inadequacy and lack of financial resources (22–24)

  • Lack of continuity in financial resources (22)

  • Unfair distribution of resources (8, 22)

  • Lack of coordination between the funding sources and required services package (22)

  • lack of complete insurance system to cover the entire community (8, 43, 54)

  • Economical problems (8, 11, 22, 26, 27)

  • The negative effects of the war with Iraq (8, 22,26, 27)

  • Dependency of state budget on oil revenues (8,22, 26, 27)

  • Inadequate investment by the private sector (22)

  • Spending more money on the second and thirdlevels of health care services (23)

  • Growth of health care costs (72)

  • Emerging new diseases in Iran (72)

  • a large refugee population (11)

  • Aging phenomenon (11, 24, 73, 74)

  • Non-uniform distribution of the rural population in remote areas (43)
Payment Strengths Weaknesses Threats
-

  • lack of motivation in used payment systems (29–31)

  • Inadequate capitation fee and inappropriate allocation of it (31)

  • The dominance of fee for services and salary payment (8, 22, 54)

  • Inequities in payments to providers (in different levels and same levels) (8,22)

  • Having part-time jobs, or more than one job by health workers (60, 63)

  • increased inflation rate (22)
*

The number in parentheses indicates the content references listed at the end of the article.