A conceptual model for the governance of the health system in Iran; a qualitative study after the COVID-19 pandemic

Abstract Objective The governance of the health system has a significant impact on the performance of the health system and the achievement of sustainable health goals. However, conceptualizing its constituent elements is challenging, and there is no consensus regarding its dimensions and measurement tools. This research amid to redefine the governance of the health system in Iran after the COVID-19 pandemic and design a conceptual model for health system governance in the Iranian context. Method This qualitative study was conducted in 2023. The participants included 22 health system managers with at least five years of managerial experience, as well as policymakers and scientific experts familiar with health system governance in Iran. Data were collected through semi-structured interviews using purposive sampling, followed by snowball sampling until data saturation was reached. Questions focused on the concepts and dimensions of health system governance. All interviews were audio-recorded and transcribed verbatim. Subsequently, meaning units were identified, coded, and categorized based on similarities and patterns. Themes were then extracted and analyzed using the content analysis method. Results Analysis of the participants’ experiences yielded eight main themes and 25 sub-themes. The main themes were policy and planning, rules and regulations, communication and coordination, organization, information systems, effective leadership, monitoring and evaluation, and stakeholder participation. Conclusion Governance enhances the resilience and capacity of the health system to address challenges and crises, a need that has become more evident following the COVID-19 pandemic. Strengthening elements such as policy and planning, effective and efficient resource organization, interdepartmental collaboration, and stakeholder participation is crucial. To minimize conflicts and redundancies among health system stakeholders and to optimize the utilization of existing resources, it is recommended to review and redefine their roles and responsibilities.