Challenges and opportunities in financing urban primary healthcare in Iran: pathways to universal health coverage

Urban primary health care (UPHC) seeks to address the growing health needs of urban populations and improve public health outcomes. However, its implementation faces significant barriers, particularly in financing mechanisms, which often hinder the attainment of key policy goals. This study aims to identify these challenges and propose solutions. This qualitative study collected data through semi-structured interviews with twenty-six key informants between November 2023 and May 2024. A purposive sampling strategy, supplemented by snowball sampling, was used to identify participants. Data were analyzed using a directed content analysis approach guided by Kutzin’s framework on health financing sub-functions. All the data coding processes were conducted using MAXQDA 2020. Challenges in health financing were categorized under three core sub-functions: resource collection, pooling, and allocation and purchasing of healthcare services. Key issues included unsustainable financial resources, limited budgetary allocations for primary and preventive care, and an overall shortfall in available funds. Additionally, inefficiencies in basic health insurance systems, poorly regulated tariff structures, weak resource management, and non-strategic purchasing practices were identified as significant barriers. Addressing these challenges requires a prevention-oriented approach and the application of systems thinking to financing reforms. Strengthening UPHC depends on aligning financial reforms with preventive health priorities. policy actions are recommended to include securing dedicated funding through earmarked taxes for preventive services, reforming the basic health insurance structures, expanding coverage for preventive interventions, and adopting outcome-based purchasing models. These strategies can support the expansion of access to urban primary health care (UPHC), promote universal health coverage, and enhance population health outcomes.