Yazdi-Feyzabadi Vahid, Bazyar Mohammad, Ghasemi Sara
Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Department of Health Management and Economics, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran.
Arch Public Health. 2021 Nov 26;79(1):212. doi: 10.1186/s13690-021-00737-7.
District Health Network (DHN), one of Iran's most successful health reforms, was launched in 1985 to provide primary health care (PHC), in response to health inequities in Iran. The present study aims to use interrelated elements of the 3i framework: ideas (e.g., beliefs and values, culture, knowledge, research evidence and solutions), interests (e.g., civil servants, pressure groups, elected parties, academians and researchers, and policy entrepreneurs), and institutions (e.g., rules, precedents, and organizational, government structures, policy network, and policy legacies) to explain retrospectively how (DHN) policy in Iran, as a developing country, was initiated and formed.
A historical narrative approach with a case study perspective was employed to focus on the formation and framing process of DHN. For this purpose, the 3i framework was used as a guideline for data analysis. This study mainly searched and extracted secondary sources, including online news, reports, books, dissertations, and published articles in the scientific databases. Primary interviews as a supplementary source were also carried out to meet cross-validation of the data. Data were analyzed using a deductive and inductive approach.
According to the 3i framework, the following factors contributed to the formation of DHN policy in Iran: previous national efforts (for instance Rezaieh plan) and international events aiming to provide public health services for peripheral regions; dominant social discourses and values at the beginning of the Iranian revolution such as addressing the needs of disadvantaged and marginalized groups, which were embedded in the goals of DHN policy aiming to provide basic health services for deprived people especially living in rural and remote areas. Besides, the remarkable social cohesion and solidarity among people reinforced by the Iran-Iraq war were among other factors which contributed to the formation of participatory plans such as DHN (ideas). Main policy entrepreneurs including Minister of Health, his public health deputy and two planners of DHN with similar and rich background in the public health field and sharing the same beliefs (interests) which subsequently led to creation of tight-knit policy community network between them (institutions) also accelerated the creation of DHN in Iran to great extent. Political support of parliamentary representatives (interests), and formal laws such as principles of Iran Constitution (institutions) were also influential in passing the DHN in Iran.
The 3i framework constituents would be insightful in explaining the creation of public health policies. This framework showed that the alignment of laws, structures, and interests of the main actors of the policy with the dominant ideas and beliefs in the society, opened the opportunity to form DHN in Iran.
地区卫生网络（DHN）是伊朗最成功的卫生改革之一，于1985年启动，旨在提供初级卫生保健（PHC），以应对伊朗的卫生不平等问题。本研究旨在运用3i框架的相关要素：理念（如信念和价值观、文化、知识、研究证据和解决方案）、利益（如公务员、压力团体、当选政党、学者和研究人员以及政策企业家）和制度（如规则、先例以及组织、政府结构、政策网络和政策遗产），对伊朗作为一个发展中国家的地区卫生网络（DHN）政策是如何启动和形成进行回顾性阐释。
采用具有案例研究视角的历史叙事方法，聚焦地区卫生网络（DHN）的形成和构建过程。为此，3i框架被用作数据分析的指导方针。本研究主要搜索和提取二手资料，包括在线新闻、报告、书籍、论文以及科学数据库中发表的文章。还进行了初步访谈作为补充资料来源，以实现数据的交叉验证。数据采用演绎和归纳方法进行分析。
根据3i框架，以下因素促成了伊朗地区卫生网络（DHN）政策的形成：此前旨在为周边地区提供公共卫生服务的国家努力（如雷扎伊计划）和国际事件；伊朗革命初期占主导地位的社会话语和价值观，如关注弱势群体和边缘化群体的需求，这些被融入到地区卫生网络（DHN）政策旨在为贫困人口尤其是农村和偏远地区居民提供基本卫生服务的目标中。此外，两伊战争强化的民众间显著的社会凝聚力和团结，是促成地区卫生网络（DHN）等参与性计划形成的其他因素之一（理念）。主要政策企业家，包括卫生部长、其公共卫生副手以及地区卫生网络（DHN）的两名背景相似且在公共卫生领域经验丰富、秉持相同信念的规划者（利益），随后在他们之间形成了紧密的政策共同体网络（制度），这在很大程度上也加速了伊朗地区卫生网络（DHN）的创建。议会代表的政治支持（利益）以及伊朗宪法原则等正式法律（制度），在伊朗通过地区卫生网络（DHN）政策方面也具有影响力。
3i框架要素对于解释公共卫生政策的创建具有启发性。该框架表明，政策主要行为体的法律、结构和利益与社会中占主导地位的理念和信念保持一致，为伊朗形成地区卫生网络（DHN）创造了契机。
