The vital role of good governance in a public health crisis: the case of managing access to medicines in Iran during the COVID-19 pandemic

The COVID-19 pandemic emphasized the vital role of good governance in managing public health crises, especially in Low- and Middle-Income Countries (LMICs) facing exacerbated challenges in accessing medicines. Iran with its pre-existing vulnerabilities provides a compelling case study. The authors conducted a qualitative case study focusing on access to medicines to investigate the challenges faced by the healthcare system during the pandemic in Iran. Virtual Focus Group Discussions (FGDs) were held in January 2022 with 10 purposefully identified experts representing diverse stakeholders. Using good governance frameworks to define themes, we applied a deductive content analysis facilitated by MAXQDA 20 software. This approach ensured a structured yet flexible examination of the research questions. The study revealed significant challenges in medication access in Iran, including financing, regulation, access, and quality. Two main themes emerged: “Good Governance” (with subthemes like effectiveness, transparency, accountability, and stakeholder collaboration) and “Access” (including subthemes such as accessibility, affordability, acceptability, and availability). The findings highlighted critical issues in medication accessibility during the COVID-19 pandemic in Iran, comparable to other LMICs. They emphasize the need for robust governance, evidence-based policies, and stakeholder collaboration to ensure essential medicine availability during crises. These strategies can better prepare governing bodies for future health emergencies, ensuring equitable medication access for all populations.