Good governance: Challenges and opportunities of Iran's context in achieving sustainable health development

Objective(s): Sustainable development entails a meaningful integration of economic, social, and environmental goals with human wellbeing, without harming the capacities of future generations to meet their needs.Good governance mechanisms are crucial for fostering sustainable development, which in turn contributes to creation, maintenance, and promotion of individuals and communities' health.This study aims to provide a comprehensive definition of governance and its components, with a focus on health, and provide an overview of the challenges and opportunities of good governance and sustainable health development in Iran.Methods: This is a review study.We considered all published articles in Scopus and PubMed in Farsi and English, regardless of time limit until September 22, 2023.Results: According to the World Bank, governance includes "traditions and institutions" by which authority is established in a country.So far, many frameworks, models and components have been introduced for governance.For health system studies, the five-component model of governance, which was first introduced in 2018, is one of the most widely used models.Participation, accountability, rule of law, equity and equality, transparency, corruption control, effectiveness and efficiency are among the recurring components of governance in different models.Besides, the improving trends in indicators such as the Neonatal Mortality Rate, Infant Mortality Rate, Under-Five Mortality Rate, Maternal Mortality Rate, and human development indices represent opportunities for good governance in Iran.Conversely, the increasing trends in deaths caused by accidents, deteriorating air quality, soil pollution and erosion, unemployment, and inflation have been posing challenges to good governance in the country.Moreover, several factors have hindered the promotion of good governance in Iran's health system.These include the lack of an efficient monitoring and evaluation system, inadequate transparency and accountability, insufficient participation of relevant stakeholders, weak management of conflicts of interest and corruption, insufficient coordination and cooperation between and within departments, inadequate use of scientific information and solid evidence in policies, and fragile acceptance of good governance concept as a fundamental value.Conclusion: It appears that the health system needs to implement the principles of good governance in order to successfully respond to the needs and expectations of the people.We suggest that, while creating an enabling environment for the effective implementation of good governance in line with the sustainable development goals, managing conflict of interest situations in the health system, transparency, and the use of institutional approach need be used to create executive structures and the necessary tools for monitoring and evaluating these measures.We advocate these items to be placed on the policy makers' agenda.