Exploring the Challenges and Potentials of Outsourcing Suburban Health Centers in Mashhad and Redesigning an Efficient Model through a Grounded Theory Approach

Background: The use of outsourcing in health care has grown as a strategy to improve both efficiency and equity. However, implementing this approach in suburban health centers faces multiple challenges and opportunities that require thorough and systematic examination. Objective: This study aimed to explore the barriers and enabling factors of outsourcing in suburban health centers in Mashhad, with the goal of developing a model for efficient implementation grounded in empirical data. Methods: A qualitative design employing grounded theory was utilized. Data collection involved semi-structured interviews with health policymakers, service providers, and community representatives. Analysis was conducted through thematic coding and constant comparison to identify core categories and relationships. Results: Analysis revealed key challenges, including limited financial resources, insufficient regulatory frameworks, and low community trust. At the same time, facilitating factors such as the availability of local private providers, active community participation, and supportive policy guidance were identified. Based on these findings, a conceptual framework for effective outsourcing was proposed, emphasizing stakeholder collaboration, transparent governance, and adaptation of services to local contexts. Conclusion: Outsourcing in suburban health centers of Mashhad entails both challenges and opportunities. A grounded theory based model can assist policymakers in leveraging local capacities while mitigating systemic barriers, ultimately enhancing the effectiveness and equity of health service delivery.