Enhancing Transparency: Core Principles for a Developing Health System

ABSTRACT Transparency has come to be considered one of the most crucial elements of good governance. However, many developing countries, including Iran, suffer from a lack of it. Moreover, enhancing transparency without adhering to its principles can lead to unintended consequences or fail to achieve the desired outcomes. Therefore, this study identifies the principles for enhancing transparency in Iran's health system, which can also be applicable to other developing countries. This study utilized a modified Delphi method. Initially, a scoping review was conducted to enumerate the principles of transparency. Subsequently, interviews with 35 individuals and an expert panel with 16 members were conducted to localize these outcomes for Iran. Finally, the outcomes were validated by experts through three rounds of Delphi with the participation of 70 individuals. Seventy principles of transparency were identified, of which only one was rejected. These principles are divided into seven general categories, representing a comprehensive and multidimensional perspective on transparency, ranging from strategic to tactical and technical principles. The most important principle is the existence of a strong political and social commitment that begins at the higher levels of management and permeates all sectors of the healthcare system. This requires the cooperation of all stakeholders, including officials, employees, and the public. These results can serve as a model for Iran and other countries in enhancing the transparency of health systems.