Policy Responses to the COVID-19 Pandemic: A Qualitative Case Study from Iran

Background: The impact of the COVID-19 crisis is highly heterogeneous, with significant implications for crisis management. This study aimed to assess how policies to respond to COVID-19 were formulated, implemented, and evaluated. Methods: This qualitative, in-depth study was conducted through semi-structured interviews with 31 experts from January to April 2021. The study focused on all relevant stakeholders responsible for the COVID-19 response in Khuzestan Province, Iran. Purposive sampling was employed to select participants, and data collection continued until data saturation was reached. Several related theories, frameworks, and concepts guided the data analysis process. Contextual factors, including structural, economic, situational, cultural, and climatic aspects, were emphasized. Actors were assessed based on their interests and power to influence the COVID-19 response. Kingdon’s multiple streams framework and the Advocacy Coalition Framework (ACF) were utilized to analyze the policy process and implementation, respectively. Data were analyzed using content analysis. Results: The findings provide significant insights into critical measures regarding contextual factors, policy content, and the roles of key actors and processes. Contextual factors played a dual role, acting as both facilitators and inhibitors of policy making against COVID-19. The main measures guiding the policy content in Khuzestan Province included increasing hospital bed capacity, establishing army hospitals, collaborating with private hospitals to utilize 10% of their capacity, repurposing hotel spaces for patients in recovery, leveraging charitable donation volunteers and medical students, deploying health workers on short-term contracts to work in 16-hour COVID-19 centers, conducting specialized training courses for nurses in intensive care units (ICUs), and launching COVID-19 diagnostic laboratories. The results showed that situational factors, governance structures, decision-making processes, and the influence and power of coalitions significantly affected the effectiveness of policy measures. Conclusion: Investment in infrastructure and fostering integration among different health service providers are fundamental to managing pandemics effectively. Moreover, it is essential to identify understudied aspects of the policy sciences that warrant further attention in the aftermath of the pandemic.