ABSTRACT
Objectives@#The health system reform process is highly political and controversial, and in most cases, it fails to realize its intended goals. This study was conducted to synthesize factors underlying the failure of health system reforms. @*Methods@#In this systematic review and meta-synthesis, we searched 9 international and regional databases to identify qualitative and mixed-methods studies published up to December 2019. Using thematic synthesis, we analyzed the data. We utilized the Standards for Reporting Qualitative Research checklist for quality assessment. @*Results@#After application of the inclusion and exclusion criteria, 40 of 1837 articles were included in the content analysis. The identified factors were organized into 7 main themes and 32 sub-themes. The main themes included: (1) reforms initiators’ attitudes and knowledge; (2) weakness of political support; (3) lack of interest group support; (4) insufficient comprehensiveness of the reform; (5) problems related to the implementation of the reform; (6) harmful consequences of reform implementation; and (7) the political, economic, cultural, and social conditions of the society in which the reform takes place. @*Conclusions@#Health system reform is a deep and extensive process, and shortcomings and weaknesses in each step have overcome health reform attempts in many countries. Awareness of these failure factors and appropriate responses to these issues can help policymakers properly plan and implement future reform programs and achieve the ultimate goals of reform: to improve the quantity and quality of health services and the health of society.
ABSTRACT
Background: It is impossible to achieve universal health coverage [UHC] without an adequate, competent and motivated workforce.
Aims: The study aimed to describe how the Iranian health sector has formulated its human resources strategies to achieve UHC.
Methods: This was a qualitative study using a conceptual framework approach to content analysis. Primary data were gathered through expert focused group discussions and document analyses. Both transcribed discussions and the selected documents were analysed using in-depth thematic analysis. A conceptual framework from the Global Health Workforce Alliance was used for content analysis and to draft and develop the strategies. The framework suggested five human resources for health [HRH] pathways to achieve UHC aspects structured according to availability, accessibility, acceptability and quality.
Results: Thirty strategies were formulated for Iranian HRH. Eleven of the developed strategies were related to the field of education and training, such as development of new required academic disciplines; balancing university admissions based on workforce requirements; and enrolling local students from deprived and underserved areas. Ten of the developed strategies were structured under the workforce accessibility dimension.
Conclusions: Strategies for HRH were formulated by adopting a comprehensive, scientific and collaborative approach to ensure alignment with the country's health system priorities and Global Strategy on Human Resources for Health to overcome health workforce challenges.