Strategic Management Thought

Evaluation of Primary Health Care Strategies (PHC) in the Health System of the Islamic Republic of Iran: A Research Based on Strategic Control

Document Type : Research Paper

Authors

1 MA Student in Islamic Studies and Business Administration, Imam Sadiq (PBUH) University. Tehran

2 Faculty Member at Imam Sadiq university, Tehran, I.R. Iran.

3 Faculty member of Tehran University of Medical Sciences, Tehran, I.R. Iran.

4 Imam Sadiq University (a.s)

Abstract

At the end of the Almaty Conference,primary health care(PHC)was introduced as a basic approach in the field of health and the key to achieve the goals of "health for all", and member states agreed to formulate their health system strategies on that basis.In the health system of the Islamic Republic of Iran,various strategies were adopted in this field, including the establishment of health centers in rural areas and their development plans,the employment of health workers to activate services in urban centers,and family medicine plan.The main purpose of this study is to evaluate the strategies adopted to expand primary health care services in the health system of the Islamic Republic of Iran.In this regard, using the strategic control methods called"adapted balanced scorecard(BSC)to evaluate PHC strategies",the initial conceptual framework was extracted and presented to the experts. Finally, these strategies were evaluated by thematic analysis method.In order to achieve the research purpose, five different dimensions including macro-orientation,stakeholder,financial, growth and learning, and internal processes perspectives were evaluated as comprehensive themes in the thematic network. Although the centrality of PHCservices in the system is one of the strategic levers of these services, but the adopted strategies have led to the marginalization of these services in service delivery of the health system; therefore, they are evaluated as weak in terms of macro-orientation.The important point is that the weakness of PHC strategies in this component also affects other components.The conclusion is that despite the proven importance ofPHCservices in the world, unfortunately,the strategies for expanding primary health care in the IslamicRepublic of Iran according to core values of these services are evaluated as extremely weak and these services are considered as a forgotten necessity of the health system.

Keywords

Main Subjects

  1. آصف‌زاده، سعید و رضاپور، عزیز (1395). مدیریت بهداشت و درمان. انتشارات دانشگاه علوم پزشکی قزوین.

    باقری، پ. (1393). بررسی ارتباط عوامل مؤثر با ارزیابی عملکرد در بیمارستان فیاض‌بخش بر اساس کارت امتیازی متوازن. دانشکده مدیریت. دانشگاه آزاد اسلامی. تهران. ایران.

    باقیانی مقدم، محمدحسین؛ احرام‌پوش، محمدحسن و وکیلی، محمود (1390). اصول و کلیات خدمات بهداشتی. تهران: آثار سبحان.

    حاتمی، حسین؛ رضوی، سید منصور؛ افتخار اردبیلی، حسن؛ مجلسی، فرشته؛ سید نوزادی، محسن؛ پریزاده، محمدجواد و با همکاری اساتید دانشگاه­های علوم پزشکی (1398). کتاب جامع بهداشت عمومی. بهداشت برای همه و مراقبت‌های اولیه سلامت. تهران: ارجمند.

    چپمن، کریستوفر (1395). کنترل استراتژی (وحید خاشعی و انسیه شریف­محسنی، مترجمان) تهران: به‌پویش (نشر اثر اصلی 2005).

    خنیفر، حسین و مسلمی، ناهید (1396). اصول و مبانی روش‌های پژوهش کیفی. تهران: نگاه دانش.

    شادپور، کامل (1372). شبکه مراقبت‌های اولیه بهداشتی در ایران. تهران: وزارت بهداشت، درمان و آموزش پزشکی.

    کردنائیج، اسداله (1396). تفکر و مدیریت استراتژی؛ تئوری و عمل. تهران: دانشگاه تربیت مدرس.

    مجیدی، محمود (1395). استفاده از کارت امتیازی متوازن در ارزیابی عملکرد صنعت داروسازی مطالعه موردی: داروسازی زهراوی. (پایاننامه کارشناسی ارشد). مؤسسه آموزش عالی تاکستان، قزوین. ایران.

    محمدپور، احمد (1392). روش تحقیق کیفی ضد روش یک و دو. تهران: جامعه شناسان.

    مرندی، سیدعلیرضا؛  عزیزی، فریدون؛  لاریجانی، باقر و جمشیدی، حمیدرضا (1377). سلامت در جمهوری اسلامی ایران. بهداشت، درمان و دارو، آموزش، پژوهش و امور فرهنگی. تهران: اطلاعات.

    ملک‌افضلی، حسین  و صدری زاد، بیژن. (1397). 45 سال تجربه مراقبت‌های بهداشتی درمانی اولیه در جمهوری اسلامی ایران؛ فرصت‌ها، چالش‌ها و نقشه راه‌ آینده. نشریه فرهنگ و ارتقاء سلامت فرهنگستان علوم پزشکی جمهوری اسلامی ایران. 2 (4). 438-448.

    Aidemark, L.-G., & Funck, E. K. (2009). MEASUREMENT AND HEALTH CARE MANAGEMENT. Financial Accountability & Management. 25 (2). 253–276.

    Ansoff, H. I., & McDonnell, E. J. (1990). Implanting strategic management (2nd ed.).

    Attride-Stirling, J. (2001). Thematic networks: An analytic tool for qualitative research. Qualitative Research. 1 (3). 385–405.

    Atun R (2004). What are the advantages and disadvantages of restructuring a health care system to be more focused on primary care services ?

    Behrouzi, F., Shaharoun, A. M., & Ma’aram, A. (2014). Applications of the balanced scorecard for strategic management and performance measurement in the health sector. Australian Health Review : a Publication of the Australian Hospital Association. 38 (2). 208–217. https://doi.org/10.1071/ah13170

    Boerma, W. G.W., Groenewegen, P. P., & van der Zee, J. (1998). General practice in urban and rural Europe: The range of curative services. Social Science & Medicine. 47 (4). 445–453.

    Brand, J. L. (1989). THE UNITED STATES PUBLIC HEALTH SERVICE AND INTERNATIONAL HEALTH, 1945-1950. Bulletin of the History of Medicine. 63 (4). 579–598. http://www.jstor.org/stable/44451124.

    Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology. 3 (2). 77–101.

    1. Ham, R. Robinson, M. Benzeval (Ed.). 1990. Health Check: Health Care Reforms in an International Context.

    Cantor, J. (1993). Primary Care: Concept, Evaluation, and Policy. Starfield B, New York, NY, Oxford University Press, Inc. Journal of Physical Therapy Education. 7 (2). 80–81.

    https://journals.lww.com/jopte/Fulltext/1993/07000/Primary_Care__Concept,_Evaluation,_and_Policy_.24.aspx.

    Curtright, J. W., Stolp-Smith, S. C., & Edell, E. S. (2000). Strategic performance management: Development of a performance measurement system at the Mayo Clinic. Journal of healthcare management / American College of Healthcare Executives. 45 (1). 58–68.

    David, F. R. (2011). Strategic management: Concepts and classes /  Fred R. David (13th ed.). Upper Saddle River, N.J.: Prentice Hall.

    Franken, M., & Koolman, X. (2013). Health system goals: A discrete choice experiment to obtain societal valuations. Health Policy. 112 (1-2). 28–34.

    Franks, P., Clancy, C. M., & Nutting, P. A. (1992). Gatekeeping revisited—protecting patients from overtreatment. The New England journal of medicine. 327 (6). 424–429.

    Kaplan, S. R. (2020). Using the Balanced Scorecard for Successful Health Care M&A Integration. NEJM Catalyst.

    https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0286.

    Lamarche, P., Beaulieu, M., Pineault, R., Contandriopoulos, A., Denis, J., Haggerty, J., et al. (2003). Choices for Change: The Path for Restructuring Primary Healthcare Services in Canada.

    Leape, L. L. (1990). Does Inappropriate Use Explain Small-Area Variations in the Use of Health Care Services? JAMA. 263 (5). 669.

    Learned, E. P., Andrews, K. R., Christensen, C. R., & Guth, W. D. (1969). Business Policy: Text and Cases: R. D. Irwin.

    MacCormack, C. P. (1983). Community participation in primary health care. Tropical doctor. 13 (2). 51–54.

    Macinko, J., Starfield, B., & SHI, L. (2003). The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998. Health services research. 38 (3). 831–865.

    Martin, D. P., Diehr, P., Price, K. F., & Richardson, W. C. (1989). Effect of a gatekeeper plan on health services use and charges: A randomized trial. American journal of public health. 79 (12). 1628–1632.

    Mills, A., & Drummond, M. (1987). Value for money in the health sector: The contribution of primary health care. Health policy and planning. 2 (2). 107–128.

    Mintzberg, H. (1998). The strategy process: Concepts, contexts, cases (4th ed.). Upper Saddle River NJ: Prentice Hall.

    Moore, S. (1979). Cost containment through risk-sharing by primary-care physicians. The New England journal of medicine. 300 (24). 1359–1362.

    Nurs, N.Z. (2003). Four pillars for primary health care nurses. Nursing New Zealand (Wellington, N.Z. : 1995). 9 (8). 14.

    Parker, A. W., Walsh, J. M., & Coon, M. (1976). A normative approach to the definition of primary health care. The Milbank Memorial Fund quarterly. Health and society. 54 (4). 415–438.

    Pearce, J., Robinson, R. (2010). Strategic Management. United States: McGraw-Hill Education .

    Pearce, J. A., & Robinson, R. B. (2012). Strategic management: Formulation, implementation, and control /  John A. Pearce II, Richard B. Robinson, Jr (12th ed.). New York: McGraw-Hill Higher Education; London: McGraw-Hill [distributor].

    Romanow, R. J. (2002). Buildings on values: The future of health care in Canada: final report. Saskatoon: Commission on the Future of Health Care in Canada.

    Ryan, G., & Bernard, H. (2000). Data Management and Analysis Methods. In: Handbook of Qualitative Research, 2nd ed. Norman Denzin and Yvonna Lincoln, eds. Sage Publications. 769-802

    Saltman, R. B., & Ferroussier-Davis, O. (2000). The concept of stewardship in health policy. Bulletin of the World Health Organization. 78 (6). 732–739.

    Sarti, T. D., Lazarini, W. S., Fontenelle, L. F., & Almeida, A. P. S. C. (2020). Qual o papel da Atenção Primária à Saúde diante da pandemia provocada pela COVID-19? [What is the role of Primary Health Care in the COVID-19 pandemic?]. Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil. 29 (2). e2020166 .

    Shea, S., Misra, D., Ehrlich, M. H., Field, L., & Francis, C. K. (1992). Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population. The New England journal of medicine. 327 (11). 776–781.

    Shi, L., Macinko, J., Starfield, B., Wulu, J., Regan, J., & Politzer, R. (2003). The relationship between primary care, income inequality, and mortality in US States, 1980-1995. The Journal of the American Board of Family Practice. 16 (5). 412–422.

    Siu, A. L., Leibowitz, A., Brook, R. H., Goldman, N. S., Lurie, N., & Newhouse, J. P. (1988). Use of the hospital in a randomized trial of prepaid care. JAMA. 259 (9). 1343–1346.

    Starfield, B. (2006). Atenção primária: Equilíbrio entre necessidades de saúde, serviços e tecnologia.

    Starfield, B., & SHI, L. (2002). Policy relevant determinants of health: An international perspective. Health Policy. 60 (3). 201–218.

    Tangye, C. E. (1920). The Dawson report. Public Health. 34. 42–44.

    Teklehaimanot, H. D., Teklehaimanot, A., Tedella, A. A., & Abdella, M. (2016). Use of Balanced Scorecard Methodology for Performance Measurement of the Health Extension Program in Ethiopia. The American journal of tropical medicine and hygiene. 94 (5). 1157–1169. From

    https://www.ajtmh.org/view/journals/tpmd/94/5/article-p1157.xml.

    Voelker, K. E., Rakich, J. S., & French, G. R. (2001a). The balanced scorecard in healthcare organizations: A performance measurement and strategic planning methodology. Hospital topics. 79 (3). 13–24.

    Voelker, K. E., Rakich, J. S., & French, G. R. (2001b). The balanced scorecard in healthcare organizations: A performance measurement and strategic planning methodology. Hospital topics. 79 (3). 13–24.

    Vuori, H. (1986). Health for all, primary health care and general practitioners. The Journal of the Royal College of General Practitioners. 36 (290). 398–402.

    Welch, W. P., Miller, M. E., Welch, H. G., Fisher, E. S., & Wennberg, J. E. (1993). Geographic variation in expenditures for physicians’ services in the United States. The New England journal of medicine. 328 (9). 621–627.

    White, K. L. (1967). Primary medical care for families—organization and evaluation. The New England journal of medicine. 277 (16). 847–852.

    WHO (2021). what is PHC? World Health Organization (1978 -1983). Primary health care: Report. Health for all series: N. 1. Geneva: World Health Organization. from https://www.who.int/activities/what-is-PHC

    Zelman, W. N., Pink, G. H., & Matthias, C. B. (2003). Use of the balanced scorecard in health care. Journal of health care finance. 29 (4). 1–16.

Strategic Management Thought
Volume 16, Issue 3 - Serial Number 33
September 2022
Pages 97-126
  • Receive Date: 12 March 2022
  • Revise Date: 12 December 2022
  • Accept Date: 16 February 2023