Decentralization in function of stewardship of health systems in different countries and propose appropriate model for Iran

ABSTRACT

The health system of Iran similar to other countries; faces variety of challenges and problems due to the issues of equity, quality, relevancy and effectiveness. In order to respond effectively to these fundamental issues, as sustainable, planed and purposeful reform is necessary. In the latest decade, health sector decentralization polices have been implemented on a broad scale throughout world especially in developing countries. Decentralization actually involves the transfer of variety of service provision mechanisms from central authority namely Ministry of Health [MOH] to preferable units or alternate institutions. Function of stewardship has a fundamental role in performance of health system. In the descriptive and comparative present research mechanisms of decentralization in England, Turkey, Zambia, Ghana, Mexico, Thailand, France, Chile, Sweden and Philippines has been reviewed in order to suggest an appropriate Model for Iran. A model of stewardship function for Iran was reviewed by 65 experts including health management professors, head of medical universities and ministries of MOH and vice chancellors of them with Delphi techniques. Obtained results from the analysis of 35 collected questioners indicated that all participated subject agreed with appropriate these developed model. Statically the module was also confirmed the significant of results [a=0.05 Z=3.14]. It was concluded that Developing and situating policymaking agency at MOH, situating and participating health councils in management of health. Managing hospitals through board of trusts with enough autonomy. Organizing the health enterprise [HE] and managing hospitals in the form of cluster. Organizing and situating national committes of decentralization and accreditation. Starting the decentralization process in the three next years