Moradi Tayebeh, Kabir Mohammad Javad, Pourasghari Hamid, Ehsanzadeh Seyed Jafar, Aryankhesal Aidin
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
Med J Islam Repub Iran. 2023 Jul 17;37:80. doi: 10.47176/mjiri.37.80. eCollection 2023.
Efficient and effective management of budgets and financial resources is critical for health systems to achieve their goals; in this regard, countries may face budgetary and financial challenges owing to the weak prediction of resources and consumptions, and lack of prioritization for their budget. This study aims to identify the most critical policies and events that have affected public financial management and health budgeting and existing challenges in Iran.
We conducted the present study in 2022 using a 2-stage qualitative method. First, by reviewing upstream documents and laws, we identified evidence related to health budgeting. Then, we conducted 13 semi-structured interviews with informed people in the health budgeting field that led us toward the main challenges through thematic content analysis.
After reviewing 48 upstream documents related to health budgeting, we identified 85 policies. After reviewing the articles, we achieved 11 themes and 71 subthemes. The most critical challenges of the budgeting cycle were as follows: (I) budget formulation, including inappropriate budget structure, conflicts of interest and infringement, lack of financial sustainability, and transparency; (II) budget execution, including a nonexecutable approved budget, complicated allocation process, and ineffective allocations; and (III) monitoring, reporting, and evaluation (MR&E), including fragmentation of MR&E processes, ineffective monitoring and evaluation, weak evaluation of platforms, and inadequate transparency.
Most challenges in the health budgeting system are related to the budget formulation and approval stage that have their roots in implementation, monitoring, and reporting. In addition, Iran's macroeconomic and financial issues have also damaged the budgeting of the health sector. Budget problems affect the goals and outcomes of this sector, especially the health system.
高效且有效地管理预算和财政资源对于卫生系统实现其目标至关重要；在这方面，由于对资源和消耗的预测薄弱以及缺乏预算优先级划分，各国可能面临预算和财政挑战。本研究旨在确定影响伊朗公共财务管理和卫生预算编制的最关键政策和事件以及现有挑战。
我们于2022年采用两阶段定性方法开展本研究。首先，通过查阅上游文件和法律，我们确定了与卫生预算编制相关的证据。然后，我们对卫生预算领域的知情人士进行了13次半结构化访谈，通过主题内容分析使我们找到了主要挑战。
在查阅了48份与卫生预算编制相关的上游文件后，我们确定了85项政策。在审阅这些文章后，我们得出了11个主题和71个子主题。预算周期最关键的挑战如下：（一）预算编制，包括预算结构不当、利益冲突和侵权、缺乏财政可持续性以及透明度问题；（二）预算执行，包括经批准但无法执行的预算、复杂的分配过程以及无效的分配；（三）监测、报告和评价（MR&E），包括MR&E流程分散、监测和评价无效、平台评估薄弱以及透明度不足。
卫生预算编制系统中的大多数挑战与预算编制和批准阶段有关，其根源在于实施、监测和报告环节。此外，伊朗的宏观经济和财政问题也损害了卫生部门的预算编制。预算问题影响该部门的目标和成果，尤其是卫生系统。
