A decade of implementing comprehensive child development services in Northwest Iran: a qualitative study of provider perspectives on barriers and facilitators

Early childhood development (ECD) is a critical determinant of lifelong health and well-being, yet integrated service delivery remains challenging in many low- and middle-income countries. In response, Iran’s Ministry of Health established Comprehensive Child Development Centers (CCDCs) in selected universities in 2014 to promote screening, referral, and intervention services. This study aimed to document and analyze the first decade of CCDC implementation (2011–2022) in Tabriz, Northwest Iran—a period during which the programme operated as a pilot across selected provinces—from service providers’ perspectives, identifying key barriers and facilitators for integrated ECD services. This qualitative exploratory study employed a phenomenological framework and was reported according to the COREQ 32-item checklist. Purposive sampling was used to recruit 14 service providers (11 females, 78.6%) from primary healthcare centers ( n = 7) and the specialized Child Development Unit at Mardani Azar Hospital ( n = 7). Participants included general practitioners, health workers, and specialists (pediatrician, psychologist, audiologist, speech therapist, occupational therapist, physiotherapist, nutritionist). Semi-structured individual interviews were conducted between February and April 2026 (up to 1 h each; 12 in-person, 2 by telephone). Audio-recordings were transcribed using automated tools with manual verification. Data were analyzed using framework-guided content analysis through six stages. Trustworthiness was ensured via Lincoln and Guba’s criteria, including member checking, peer debriefing, dual coding, and audit trail. Five overarching themes characterised the barriers to implementation: (1) systemic referral and communication failures; (2) organisational and structural deficits; (3) financial and economic barriers; (4) parental and cultural factors; and (5) service quality and workforce challenges. Facilitators were also identified and are reported systematically, including the previous liaison arrangement, multidisciplinary staffing secured through an academic contract, the availability of Bayley testing, provider commitment, and university–deputyship collaboration. Providers additionally perceived a regression in service quality and coordination relative to the earlier, liaison-based model; this finding is based on retrospective accounts and should be interpreted as a perception of decline rather than a measured comparison. Despite a decade of investment, providers perceived a regression in service quality and coordination compared to earlier, less technologically dependent models. Technology alone proved insufficient without corresponding attention to organizational structure, communication infrastructure, and financial accessibility. Re-establishing liaison systems, expanding insurance coverage for developmental services, developing culturally adapted screening tools, formalizing the center’s organizational status, and implementing public awareness campaigns are urgent priorities for policy and practice. These findings offer a transferable framework for restructuring ECD services within Iran’s healthcare system and contribute to the growing evidence base on ECD implementation in low- and middle-income countries.