Ghasemyani Shabnam, Raoofi Samira, Hamidi Hadi, Khodayari-Zarnaq Rahim
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Department of English Language, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Iran J Public Health. 2022 Sep;51(9):1977-1989. doi: 10.18502/ijph.v51i9.10552.
The Health Transformation Plan (HTP), as the latest reform of Iran's health system, has been implemented gradually in several phases to facilitate the achievement of universal health coverage. We aimed to identify the achievements and challenges of the HTP from the beginning of its implementation in Iran health system.
In this qualitative systematic review, English papers were searched in PubMed, Scopus, Web of science, and Google Scholar search engines in addition to Persian databases such as Magiran and SID from 2014-2020. The Mixed-Methods Appraisal Tool (MMAT) checklists were used to assess the quality of the studies. Study selection, quality assessment, data extraction, and data analysis were done independently by two people. For analyzing the data, the Framework Analysis Method, based on the health system function framework of the WHO, was used.
Overall, 32 papers were included based on the inclusion criteria. The results were divided into four main themes: stewardship, financing, resource generation and service delivery, and 20sub-themes in the form of achievements and challenges. Regulatory and standardization, service packages, medical equipment and supplies, and the quality of health services were more repetitive. Considering the challenges of HTP, purchase process, motivational factors, and health services capacity were more repetitive.
The administrative challenges in the implementation of the HTP have prevented the sustainability of the outcomes and their main goals. The use of strategic dynamic planning, anticipating sustainable financial resources, and strengthening the monitoring mechanisms could lead to further achievements.
健康转型计划（HTP）作为伊朗卫生系统的最新改革举措，已分几个阶段逐步实施，以推动实现全民健康覆盖。我们旨在确定HTP自其在伊朗卫生系统实施之初以来所取得的成就和面临的挑战。
在这项定性系统评价中，除了2014年至2020年期间在波斯数据库（如Magiran和SID）中进行检索外，还在PubMed、Scopus、科学网和谷歌学术搜索引擎中检索了英文论文。使用混合方法评估工具（MMAT）清单来评估研究质量。研究的选择、质量评估、数据提取和数据分析由两人独立完成。为了分析数据，采用了基于世界卫生组织卫生系统功能框架的框架分析方法。
总体而言，根据纳入标准共纳入32篇论文。结果分为四个主要主题：管理、筹资、资源生成与服务提供，以及20个子主题，形式为成就和挑战。监管与标准化、服务包、医疗设备与用品以及卫生服务质量等方面的内容出现得更为频繁。考虑到HTP面临的挑战，采购流程、激励因素和卫生服务能力等方面的内容出现得更为频繁。
HTP实施过程中的行政挑战阻碍了成果及其主要目标的可持续性。采用战略动态规划、预期可持续的财政资源以及加强监测机制可能会带来进一步的成就。
