Table 1.
Contextual Factors of Public-Private Partnership in Primary Health Care Policy in East Azerbaijan Province, Iran.
| Factor | Description | Quotation of Participants | |
|---|---|---|---|
| 1 | Conditional factors | According to the participants in this study, conditional factors have no effect on the development and implementation of this policy. | — |
| 2 | Structural factors | a) Political issues: Simultaneously with the coming of the new government, with the slogan “Promoting people’s health”, the HEP was designed and launched. The plan started from the clinical sector and later was implemented in the PHC. Participants believed that the project was politically well supported. On the other hand, upstream documents supported the participation of the private sector in different areas. Participants believed that there were good political supports at the beginning at provincial and national levels (such as governors, parliament members), but then, the officials and policymakers forget the plan and provided poor support. | Participant No. 7: “We trusted the individuals and the
officials who supported the plan, but later . . . they did
not keep their words.” Participant No. 2: “. . . political forces sought people’s satisfaction that is the precursor of political consent . . .” Participant No. 9: “. . . In general policies of the regime and MOH emphasized the entry of private sector in the health sector because services should be provided actively and the government with limited resources is not able to provide active services to the entire population”. |
| b) Economic issues: The economic situation in the country has had a significant impact on the implementation of PPP policy. Participants believed that financial support was good at the beginning, but then faced some problems during the implementation. | Participant No. 1: “. . . the MOH failed to provide money for the health sector and the university was not able to give all the money to the VCH . . . It was like a melting snowball that had become very small when came to us.” | ||
| c) Technical issue: • Private sector: According to interviewees, since the low number it was difficult to attract private companies to participate in the bidding and HCs management. On the other hand, companies were reluctant to participate in and collaborate with the public sector due to their experience from health cooperatives in 1998. For this reason, the policy designer team had to give greater privilege to private companies by different incentives. • Public sector: According to the participants, there were no problems with the technical aspect on the public side. The health centers previously set up for public services were used, and in some areas where there were no public centers for provision of services, locations were provided with the help of the municipality, or buildings were rented by HCs. |
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| 3 | Cultural factors | a) People: Since people did not interfere in the design and development of this policy, they were indifferent to its implementation. The design team performed a wide notification to overcome these problems, and HCs had extensive public education in their areas. This led to people trust in these centers and, consequently, resulted in greater cooperation. Nonetheless there is still room for improvement. | — |
| b) Organizational culture: The managers of private companies believed that the lack of cooperation of public sector (including the headquarter staff or even VCH and district health networks managers) with this policy, and sometimes unawareness of other university’s vice chancellors of the policy’s implementation has created many problems and barriers in implementation. | Participant No. 3: “. . . The main obstacles were in our own system; there was no common language, especially at Intermediate levels and below . . .” | ||
| c) Public sector employees: According to one of the participants, one of the biggest cultural problems was that the body of the government has not grown intellectually in accordance with the PPP ideas. This means that public sector employees do not have a positive view of partnering with the private sector and sometimes see it as a threat to of their jobs security. | — | ||
| 4 | International or external factors | In their interviews, participants did not mention the international or external factors that underlie this policy, but it seems that encouraging to use of private sector capacity in international plans, including UHC,28 family practice,29 and strengthening health system programs,30 presented by the World Health Organization and the Eastern Mediterranean Regional Office (EMRO), have influenced the designers of this policy to use the power of the private sector. | — |
Abbreviations: HEP, health evolution plan; PHC, primary health care; PPP, public-private partnership; HC, health complex; MOH, Ministry of Health; VCH, Vice Chancellor for Health of University of Medical Sciences; UHC, universal health coverage.