Abstract
Background: Health policy analysis as a multi-disciplinary approach to public policy illustrates the need for interventions that highlight and address important policy issues, improve the policy formulation and implementation process and lead to better health outcomes. Various theories and frameworks have been contributed as the foundation for the analysis of policy in various studies. This study aimed to analyze health policies during the historical period of the almost last 30 years in Iran using policy triangle framework.
Method: To conduct the systematic review international databases (PubMed / Medline, Scopus, Web of Sciences, CINAHL, PsycINFO, Embase, The Cochran Library) and Iranian databases from January 1994 to January 2021 using relevant keywords. A thematic qualitative analysis approach was used for the synthesis and analysis of data.
Results: Out of 731 articles, 25 articles were selected and analyzed. Studies used health policy triangle framework to analyze policies in the Iranian health sector has been published since 2014. All the included studies were retrospective. The main focus of most of studies for the analysis was on the context and process of polices as the elements of the policy triangle.
Conclusion: The main focus of health policy analysis studies in Iran over the last thirty years was on the context and process of polices. Although range of actors within and outside the Iran government influence health policies but in many policy processes the power and the role of all actors or players involved in the policy are not recognized carefully. Also, Iran's health sector suffers from lack of a proper framework for evaluating various implemented policies.
References
Gilson L, Raphaely N. The terrain of health policy analysis in low and middle income countries: a review of published literature 1994-2007. Health Policy Plan. 2008;23(5):294-307.
Balane MA, Palafox B, Palileo-Villanueva LM, McKee M, Balabanova D. Enhancing the use of stakeholder analysis for policy implementation research: towards a novel framing and operationalised measures. BMJ Glob Health. 2020;5(11):e002661.
Koduah A, Agyepong IA, van Dijk H. Towards an explanatory framework for national level maternal health policy agenda item evolution in Ghana: an embedded case study. Health Res Policy Syst. 2018;16(1):76.
Allen P, Pilar M, Walsh-Bailey C, Hooley C, Mazzucca S, Lewis CC, et al. Quantitative measures of health policy implementation determinants and outcomes: a systematic review. Implement Sci. 2020;15(1):47.
Browne J, Coffey B, Cook K, Meiklejohn S, Palermo C. A guide to policy analysis as a research method. Health Promot Int. 2019;34(5):1032-44.
Lowe M, Hooper P, Jordan H, Bowen K, Butterworth I, Giles-Corti B. Evidence-Informed Planning for Healthy Liveable Cities: How Can Policy Frameworks Be Used to Strengthen Research Translation? . Curr Environ Health Rep. 2019;6(3):127-36.
Kavaliunas A, Ocaya P, Mumper J, Lindfeldt I, Kyhlstedt M. Swedish policy analysis for Covid-19. Health Policy Technol. 2020;9(4):598-612.
Cheung KK, Mirzaei M, Leeder S. Health policy analysis: a tool to evaluate in policy documents the alignment between policy statements and intended outcomes. Aust Health Rev. 2010;34(4):405-13.
Casey M, Rohde D, Brady AM, Fealy G, Hegarty J, Kennedy C, et al. Developing a new health-related policy analysis tool: An action research cooperative inquiry approach. J Nurs Manag. 2019;27(6):1233-41.
Uneke CJ, Sombie I, Johnson E, Uneke BI, Okolo S. Promoting the use of evidence in health policymaking in the ECOWAS region: the development and contextualization of an evidence-based policymaking guidance. Global Health. 2020;16(1):73.
Defor S, Kwamie A, Agyepong IA. Understanding the state of health policy and systems research in West Africa and capacity strengthening needs: scoping of peer-reviewed publications trends and patterns 1990-2015. Health Res Policy Syst. 2017;15(Suppl 1):55.
Uneke CJ, Sombie I, Keita N, Lokossou V, Johnson E, Ongolo-Zogo P. An assessment of policymakers' engagement initiatives to promote evidence informed health policy making in Nigeria. Pan Afr Med J. 2017;27:57.
Montenegro Martínez G, Carmona Montoya A, Franco-Giraldo Á. Modelos para el análisis de políticas públicas en salud reportados en publicaciones científicas [Models for public health policy analysis reported in scientific publications]. . Gac Sanit. 2021;35(3):270-81.
Jones CM, Gautier L, Ridde V. A scoping review of theories and conceptual frameworks used to analyse health financing policy processes in sub-Saharan Africa. Health Policy Plan. 2021:czaa173.
Walt G GL. Reforming the health sector in developing countries: the central role of policy analysis. Health Policy Plan. 1994;9(4):353-70.
Mokitimi S, Schneider M, de Vries PJ. Child and adolescent mental health policy in South Africa: history, current policy development and implementation, and policy analysis. Int J Ment Health Syst. 2018;12:36.
Zaidi S, Mayhew SH, Cleland J, Green AT. Context matters in NGO-government contracting for health service delivery: a case study from Pakistan. Health Policy Plan. 2012;27(7):570-81.
El-Jardali F, Bou-Karroum L, Ataya N, El-Ghali HA, Hammoud R. A retrospective health policy analysis of the development and implementation of the voluntary health insurance system in Lebanon: learning from failure. Soc Sci Med. 2014;123:45-54.
Haq Z, Hafeez A, Zafar S, Ghaffar A. Dynamics of evidence-informed health policy making in Pakistan. Health Policy Plan. 2017;32(10):1449-56.
Doshmangir L, Bazyar M, Majdzadeh R, Takian A. So Near, So Far: Four Decades of Health Policy Reforms in Iran, Achievements and Challenges. Arch Iran Med. 2019;22(10):592-605.
Rahimi SA, Alizadeh M, Légaré F. Shared decision making in Iran: Current and future trends. Z Evid Fortbild Qual Gesundhwes. 2017;123-124:52-5.
Sajadi HS, Majdzadeh R, Yazdizadeh B, Mohtasham F, Mohseni M, Doshmangir L, et al. A roadmap for strengthening evidence-informed health policy-making in Iran: protocol for a research programme. Health Res Policy Syst. 2019;17(1):50.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009;339:b2535.
Harrison JK, Reid J, Quinn TJ, Shenkin SD. Using quality assessment tools to critically appraise ageing research: a guide for clinicians. Age Ageing. 2017;46(3):359-65.
Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45.
Markazi-Moghaddam N, Aryankhesal A, Arab M. The first stages of liberalization of public hospitals in Iran: establishment of autonomous hospitals and the barriers. Iran J Public Health. 2014;43(12):1640-50.
Faraji O, Etemad K, Akbari Sari A, Ravaghi H. Policies and programs for prevention and control of diabetes in Iran: A document analysis. Glob J Health Sci. 2015;7(6):187-97.
Akrami F, Damari B, EB. The Policy Analysis of Iranian Children Play as A “Social Determinant of Heath”. Hakim Health Sys Res. 2016;19(2):89- 99.
Goshtaei M, Ravaghi H, Sari AA, Abdollahi Z. Nutrition policy process challenges in Iran. Electron Physician. 2016;8(2):1865-73.
Moshiri E, Rashidian A, Arab M, Khosravi A. Using an analytical framework to explain the formation of primary health care in rural Iran in the 1980s. Arch Iran Med. 2016;19(1):16-22.
Abolhassani N, Akbari Sari A, Rashidian A, Rastegarpanah M. The establishment of the drug naming committee to restrict look-alike medication names in Iran: a qualitative study. Int J Risk Saf Med. 2017;29(1-2):69-79.
Azami-Aghdash S, Gorji HA, Shabaninejad H, Sadeghi-Bazargani H. Policy analysis of road traffic injury prevention in Iran. Electron Physician. 2017;9(1):3630-8.
Yousefinezhadi T, Mosadeghrad AM, Arab M, Ramezani M, Sari AA. An Analysis of hospital accreditation policy in Iran. Iran J Public Health. 2017;46(10):1347-58.
Ansari M, Rassouli M, Akbari ME, Abbaszadeh A, Akbarisari A. Palliative care policy analysis in Iran: a conceptual model. Indian J Palliat Care. 2018;24(1):51-7.
Mehtarpour M, Tajvar M. Policy analysis of family physician plan and referral system in Iran using policy analysis triangle framework. Journal of Health Based Research. 2018;4(1): 31-49.
Mohamadi E, Olyaeemanesh AR, Rashidian A, Hasanzadeh A, Razavi M. Policy Analysis, Problem Identification and Proposing Policy Options for Health Insurance Benefit Package in Iran. Hakim Health Sys Res. 2018;21(3):153- 72.
Sajadi HS, Hosseini M, Dehghani A, Khodayari R, Zandiyan H, Hosseini SS. The Policy analysis of Iran’s health transformation plan in therapeutic services. Hakim Health Sys Res. 2018;21(2):71- 88.
Al-Ansari B, Thow AM, Mirzaie M, Day CA, Conigrave KM. Alcohol policy in Iran: policy content analysis. Int J Drug Policy. 2019;pii: S0955-3959(19):30210-5.
Doshmangir L, Moshiri E, Mostafavi H, Sakha MA, Assan A. Policy analysis of the Iranian Health Transformation Plan in primary healthcare. BMC Health Serv Res. 2019;19(1):670.
Edalati S, Omidvar N, Haghighian Roudsari A, Ghodsi D, Zargaraan A. Development and implementation of nutrition labelling in Iran: A retrospective policy analysis. Int J Health Plann Manage. 2019:1-17.
Gharaee H, Tabrizi JS, Azami-Aghdash S, Farahbakhsh M, Karamouz M, Nosratnejad S. Analysis of public-private partnership in providing primary health care policy: an experience from Iran. J Prim Care Community Health. 2019;10:2150132719881507.
Khodayari-Zarnaq R, Mosaddeghrad AM, Nadrian H, Kabiri N, Ravaghi H. Comprehensive analysis of the HIV/AIDS policy-making process in Iran. Health Res Policy Syst. 2019;17(1):69.
Loloei S, Pouraram H, Majdzadeh R, Takian A, Goshtaei M, Djazayery A. Policy analysis of salt reduction in bread in Iran. AIMS Public Health. 2019;6(4):534-45.
Mohseni M, Aryankhesal A, Kalantari N. Prevention of malnutrition among children under 5 years old in Iran: a policy analysis. PLoS One. 2019;14(3):e0213136.
Al-Ansari B, Noroozi A, Thow AM, Day CA, Mirzaie M, Conigrave KM. Alcohol treatment systems in Muslim majority countries: Case study of alcohol treatment policy in Iran. Int J Drug Policy. 2020;2020.
Behzadifar M, Azari S, Gorji HA, Martini M, Bragazzi NL. The hepatitis C virus in Iran: health policy, historical, ethical issues and future challenges. J Prev Med Hyg. 2020;61:E109-E18.
Doshmangir, Rashidian A, Kouhi F, Sergeevich Gordeev V. Setting health care services tariffs in Iran: half a century quest for a window of opportunity. Int J Equity Health. 2020;19:112.
Ramazanzadeh N, Azami- Aghdash S, Eskandari M, Alizadeh S. Policy Analysis of Natural Childbirth Promotion in Iran. Hakim Health Sys Res. 2020;23(1):23-32.
Raoofi A, Takian A, Akbari Sari A, Olyaeemanesh A, Haghighi H, Aarabi M. COVID-19 pandemic and comparative health policy learning in Iran. Arch Iran Med. 2020;23(4):220–34.
Heidari A, Arab M, Damari B. A policy analysis of the national phenylketonuria screening program in Iran. BMC Health Serv Res. 2021;21(1):120.
Khan MM, Van den Heuvel W. The impact of political context upon the health policy process in Pakistan. Public Health. 2007;121(4):278-86.
Onwujekwe O, Uguru N, Russo G, Etiaba E, Mbachu C, Mirzoev T, et al. Role and use of evidence in policymaking: an analysis of case studies from the health sector in Nigeria. Health Res Policy Syst. 2015;13:46.
Bakhtiari A, Takian A, Majdzadeh R, Haghdoost AA. Assessment and prioritization of the WHO "best buys" and other recommended interventions for the prevention and control of non-communicable diseases in Iran. BMC Public Health. 2020;20(1):333.
Thornton RL, Glover CM, Cené CW, Glik DC, Henderson JA, Williams DR. Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health. Health Aff (Millwood). 2016;35(8):1416-23.
Jackson SF, Birn AE, Fawcett SB, Poland B, Schultz JA. Synergy for health equity: integrating health promotion and social determinants of health approaches in and beyond the Americas. Rev Panam Salud Publica. 2013;34(6):473-80.
Williams DR, Costa MV, Odunlami AO, Mohammed SA. Moving upstream: how interventions that address the social determinants of health can improve health and reduce disparities. J Public Health Manag Pract. 2008;14 Suppl(Suppl):S8-S17.
Watt S, Sword W, Krueger P. Implementation of a health care policy: an analysis of barriers and facilitators to practice change. BMC Health Serv Res. 2005;5:53.
Doshmangir L, Bazyar M, Najafi B, Haghparast-Bidgoli H. Health Financing Consequences of Implementing Health Transformation Plan in Iran: Achievements and Challenges. Int J Health Policy Manag. 2019;8(6):384-6.
Behzadifar M, Shahabi S, Zeinali M, Ghanbari MK, Martini M, Bragazzi NL. A policy analysis of agenda-setting of Brucellosis in Iran using a multiple-stream framework: health policy and historical implications. J Prev Med Hyg. 2021;62(2):E544-E51.
Koduah A, van Dijk H, Agyepong IA. The role of policy actors and contextual factors in policy agenda setting and formulation: maternal fee exemption policies in Ghana over four and a half decades. Health Res Policy Syst. 2015;13:27.
Rosselli R, Martini M, Bragazzi NL, Watad A. The Public Health Impact of the So-Called ‘‘Fluad Effect’’ on the 2014/2015 Influenza Vaccination Campaign in Italy: Ethical Implications for Health-Care Workers and Health Communication Practitioners. Advances Experim Med Biol 2017;973:125—34.[ doi: 10.1007/5584_2017_39]
Siddiqi S, Masud TI, Nishtar S, Peters DH, Sabri B, Bile KM, et al. Framework for assessing governance of the health system in developing countries: gateway to good governance. Health Policy. 2009;90(1):13-25.