Embedding political economy in Iran’s health policy cycle: necessity and pathways

Abstract

Health policy is often presented as a technical process guided by scientific evidence and managerial expertise. However, policy decisions are equally shaped by political institutions, economic constraints, stakeholder interests, and power relations. In Iran, these political-economic dimensions remain insufficiently integrated into health policymaking despite their substantial influence on policy formulation, implementation, and sustainability. This viewpoint argues that political economy analysis (PEA) should be institutionalized throughout the health policy cycle as a core component of evidence-informed decision-making. Drawing on the characteristics of Iran’s health system, the article identifies four interrelated factors that underscore this need: institutional fragmentation, fiscal instability associated with a rentier economy and economic sanctions, discontinuity arising from political transitions, and the influence of organized interest groups. These factors illustrate why technically sound reforms may fail to achieve sustainable outcomes when political and institutional realities are overlooked. Building on this analysis, the article proposes four practical pathways for institutionalizing PEA: introducing a mandatory Political Economy Annex for major policy proposals, establishing a permanent Political Economy Advisory Unit, strengthening capacity through education and professional training, and promoting long-term policy–research partnerships. Collectively, these recommendations provide an operational framework for embedding political economy considerations into routine health policymaking. Institutionalizing PEA will not eliminate political conflict from health policy; rather, it will improve policymakers’ ability to anticipate competing interests, enhance the political legitimacy of reforms, manage implementation challenges, and design reforms that are both technically effective and politically sustainable.