Volume 24, Issue 2 (March - April 2025)
Payesh 2025, 24(2): 165-183 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Raoofi A, Haghighi H, Khanjankhani K, Ggholami M, Takian A. Good governance: Challenges and opportunities of Iran's context in achieving sustainable health development. Payesh 2025; 24 (2) :165-183
URL: http://payeshjournal.ir/article-1-2336-en.html
URL: http://payeshjournal.ir/article-1-2336-en.html
1- Center of Excellence for Global Health, Department of Global Health, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
2- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
3- Non-Communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
3- Non-Communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Abstract: (464 Views)
Objective(s): Sustainable development entails a meaningful integration of economic, social, and environmental goals with human well-being, without harming the capacities of future generations to meet their needs. Good governance mechanisms are crucial for fostering sustainable development, which in turn contributes to creation, maintenance, and promotion of individuals and communities’ health. This study aims to provide a comprehensive definition of governance and its components, with a focus on health, and provide an overview of the challenges and opportunities of good governance and sustainable health development in Iran.
Methods: This is a review study. We considered all published articles in Scopus and PubMed in Farsi and English, regardless of time limit until September 22, 2023.
Results: According to the World Bank, governance includes "traditions and institutions" by which authority is established in a country. So far, many frameworks, models and components have been introduced for governance. For health system studies, the five-component model of governance, which was first introduced in 2018, is one of the most widely used models. Participation, accountability, rule of law, equity and equality, transparency, corruption control, effectiveness and efficiency are among the recurring components of governance in different models. Besides, the improving trends in indicators such as the Neonatal Mortality Rate, Infant Mortality Rate, Under-Five Mortality Rate, Maternal Mortality Rate, and human development indices represent opportunities for good governance in Iran. Conversely, the increasing trends in deaths caused by accidents, deteriorating air quality, soil pollution and erosion, unemployment, and inflation have been posing challenges to good governance in the country. Moreover, several factors have hindered the promotion of good governance in Iran’s health system. These include the lack of an efficient monitoring and evaluation system, inadequate transparency and accountability, insufficient participation of relevant stakeholders, weak management of conflicts of interest and corruption, insufficient coordination and cooperation between and within departments, inadequate use of scientific information and solid evidence in policies, and fragile acceptance of good governance concept as a fundamental value.
Conclusion: It appears that the health system needs to implement the principles of good governance in order to successfully respond to the needs and expectations of the people. We suggest that, while creating an enabling environment for the effective implementation of good governance in line with the sustainable development goals, managing conflict of interest situations in the health system, transparency, and the use of institutional approach need be used to create executive structures and the necessary tools for monitoring and evaluating these measures. We advocate these items to be placed on the policy makers’ agenda.
type of study: Descriptive |
Subject:
Public Health
Received: 2023/11/12 | Accepted: 2025/04/7 | ePublished ahead of print: 2025/04/22 | Published: 2025/05/5
Received: 2023/11/12 | Accepted: 2025/04/7 | ePublished ahead of print: 2025/04/22 | Published: 2025/05/5
References
1. Pan American Health Organization. Pathway to sustainable health Regional Office for the Americas of the World Health Organization: Health in the Americans; 2020 [cited 2023 29 Augest ]. Available from: https://www.paho.org/salud-en-las-americas-2017/?tag=five-ps
2. Takian A, Akbari-Sari A. Sustainable Health Development Becoming Agenda for Public Health Academia. Iranian Journal of Public Health 2016;45:1502
3. Mensah J. Sustainable development: Meaning, history, principles, pillars, and implications for human action: Literature review. Cogent Social Sciences 2019;5:1653531 [DOI:10.1080/23311886.2019.1653531]
4. Dhaoui I. Good governance for sustainable development: University Library of Munich, Germany; 2019 [updated Jan 2019; cited 2024 Jan 11]. Available from: https://EconPapers.repec.org/RePEc:pra:mprapa:92544
5. Haghighi H, Takian A, Raoofi A. Institutionalization of Health System to Combat the COVID-19 Pandemic in Iran. International Journal of Public Health 2023;68:1606197 [DOI:10.3389/ijph.2023.1606197]
6. Siddiqi S, Masud TI, Nishtar S, Peters DH, Sabri B, Bile KM, et al. Framework for assessing governance of the health system in developing countries: Gateway to good governance. Health Policy 2009;90:13 [DOI:10.1016/j.healthpol.2008.08.005]
7. Gisselquist R-M. Good Governance as a Concept, and Why This Matters for Development Policy: World Institute for Development Economic Research (UNU-WIDER); 2012 [cited 2024 Jan 11]. Available from: https://EconPapers.repec.org/RePEc:unu:wpaper:wp-2012-030
8. Takian A. [Health governance and the interaction of government, nation and civil society] Tehran: Donya-e Eghtesad; 2022 [updated 20 Sep 2022; cited 2024 Jul 24]. Available from: https://donya-e-eqtesad.com/fa/tiny/news-3901546.
9. Commission on Global Governance. Our Global Neighbourhood: The Report of the Commission on Global Governance. 1st Edition, Oxford University Press: Oxford, UK, 1995 [DOI:10.1163/9789004637467]
10. The World Bank. Governance and development. 1992 [cited 2023 Oct 21]. Available from: https://documents.worldbank.org/en/publication/documents-reports/documentdetail/604951468739447676/governance-and-development
11. Kaufmann D, Kraay A. The Worldwide Governance Indicators (WGI) project 1996 [cited 2023 Oct 21]. Available from: http://info.worldbank.org/governance/wgi/
12. United Nations Development Programme. Governance for sustainable human development: a UNDP policy document. 1st Edition, United Nations Development Programme: New York, USA; 1997
13. Manafi F. Explaining the concept and evaluation Governance for Policy makingin of human resources of health in Iran [Doctoral Thesis]. Tehran, IR Iran: TUMS; 2019 [Persian]
14. Pourghaderi M, Omidvar N, Takian A. Collaborative Governance in Food Assistance for Vulnerable Groups: the Confluence of Synergy and Innovation. Iranian Journal of Culture and Health Promotion 2022;6:452 [Persian]
15. United Nations Fund for Women (UNIFEM). An Introduction to Governance, Good Governance and the process of Engendering Economic Governance [cited 2023 Oct 21]. Available from: https://www1.aucegypt.edu/src/engendering/good_governance.html
16. The World Bank. World development report 1993 : investing in health 1993 [cited 2023 Oct 21]. Available from: https://documents.worldbank.org/en/publication/documents-reports/documentdetail/468831468340807129/world-development-report-1993-investing-in-health
17. Haines A, Cassels A. Can the millennium development goals be attained? BMJ 2004;329:394 [DOI:10.1136/bmj.329.7462.394]
18. World Health Organization. Health in 2015: from MDGs, millennium development goals to SDGs, sustainable development goals. 1st Edition, Parsa Salamat Publications: Tehran, Iran, 2015 [Persian]
19. World Health Organization. Millennium Development Goals (MDGs) 2019 [cited 2023 Oct 21]. Available from: https://www.who.int/news-room/fact-sheets/detail/millennium-development-goals-(mdgs)
20. Kumar S, Kumar N, Vivekadhish S. Millennium Development Goals (MDGs) to Sustainable Development Goals (SDGs): Addressing Unfinished Agenda and Strengthening Sustainable Development and Partnership. Indian Journal of Community Medicine 2016;41:1 [DOI:10.4103/0970-0218.170955]
21. Takian A, Rajaeieh G. Peace, health, and sustainable development in the Middle East. Archives of Iranian Medicine 2020;23:S23 [DOI:10.34172/aim.2020.s5]
22. Manta O, editor. The 5 P of the 21st Century-People, Planet, Prosperity, Peace and Partnership. The 30th IBIMA conference, in Madrid, Spain; 2017
23. UN Sustainable Development Group. The 5Ps of the SDGs: People, Planet, Prosperity, Peace and Partnership. Thailand: United Nations in Thailand; 2022. https://unsdg.un.org/latest/videos/5ps-sdgs-people-planet-prosperity-peace-and-partnership
24. Buse K, Hawkes S. Health in the sustainable development goals: ready for a paradigm shift? Globalization and Health 2015;11:13 [DOI:10.1186/s12992-015-0098-8]
25. Kardos M. The Reflection of Good Governance in Sustainable Development Strategies. Procedia - Social and Behavioral Sciences 2012;58:1166 [DOI:10.1016/j.sbspro.2012.09.1098]
26. Biermann F, Stevens C, Bernstein S, Gupta A, Kabiri N. Integrating Governance into the Sustainable Development Goals Tokyo: UNU-IAS; 2014 [cited 2024 Jan 11]. Available from: https://edepot.wur.nl/315947
27. Haffeld J. Sustainable development goals for global health: facilitating good governance in a complex environment. Reproductive Health Matters 2013;21:43 [DOI:10.1016/S0968-8080(13)42734-9]
28. Massey A. Sustainable Development Goals and their Fit with Good Governance. Global Policy 2022;13:79 [DOI:10.1111/1758-5899.13037]
29. Ndagijimana I. Leadership and Good Governance: The Rwandan Experience. International Journal of Research and Innovation in Social Science (IJRISS) 2019;3:2454
30. Leppo K, Ollila E, Pe˜na S, Wismar M, Cook S. Health in All Policies. 1st Edition, National Center for Health Insurance Research: Tehran, Iran, 2020 [Persian]
31. Melkas T. Health in all policies as a priority in Finnish health policy: A case study on national health policy development. Scandinavian Journal of Public Health 2013;41:3 [DOI:10.1177/1403494812472296]
32. Rasanathan K, Posayanonda T, Birmingham M, Tangcharoensathien V. Innovation and participation for healthy public policy: the first National Health Assembly in Thailand. Health Expect 2012;15:87 [DOI:10.1111/j.1369-7625.2010.00656.x]
33. Sakha MA, Bahmanziari N, Takian A. Population Coverage to Reach Universal Health Coverage in Selected Nations: A Synthesis of Global Strategies. Iranian Journal of Public Health 2019;48:1155
34. Doshmangir L, Bazyar M, Majdzadeh R, Takian A. So near, so far: four decades of health policy reforms in Iran, achievements and challenges. Archives of Iranian Medicine 2019;22:592-605
35. Soltanipour F, Damari B. The Situation of Sustainable Development in Iran. Journal of School of Public Health and Institute of Public Health Research 2017;14:1
36. Pourghaderi M, Omidvar N, Takian A. Collaborative Governance in Food Assistance Programs: From Wish to Reality. Iranian Journal of Culture and Health Promotion 2023;7:117-8
37. Pourghaderi M, Omidvar N, Takian A. Collaborative Governance in Food Assistance Programs: From Wish to Reality. Iranian Journal of Culture and Health Promotion 2023;7:117-8
38. Takian A, Khanjankhani K. The Need for Additional to Confilict of Interest. Iranian Journal of Culture and Health Promotion 2023;6:701
39. What is a 'conflict of interest'? 2009 [Available from: http://blog.transparency.org/2009/07/27/what-is-a-%E2%80%98conflict-of-interest%E2%80%99/. [DOI:10.1136/jnnp.2009.191767]
40. García LB, Fondevila RF, Muñoz ÒG, Higón MM, Safont ÒR, Pozo AC. Management of conflicts of interest in the public sector of Catalonia. 1st Edition, Anti-Fraud Office of Catalonia: Catalonia, 2017
41. Khanjankhani K, Takian A, Shamsi Gooshki E, Mohammadi SM, Arab M. Actors in conflict of interest in Iran's health system: Ranking and policy recommendations for conflict of interest management. World Medical & Health Policy 2023;15:476-88 [DOI:10.1002/wmh3.561]
42. Abdool Karim Q, Abdool Karim SS. Infectious diseases and the Sustainable Development Goals: progress, challenges and future directions. Nature Reviews Microbiology 2023;21:626 [DOI:10.1038/s41579-023-00954-7]
43. Luo M, Liu Q, Wang J, Gong Z. From SARS to the Omicron variant of COVID-19: China's policy adjustments and changes to prevent and control infectious diseases. BioScience Trends 2021;15:418 [DOI:10.5582/bst.2021.01535]
44. Transparency International. Transparency [cited 2023 Oct 21]. Available from: https://www.transparency.org/glossary/term/transparency
45. Vian T, Savedoff WD, Mathisen H. Anticorruption in the health sector. 1st Edition, Kumarian Press: Boston, USA, 2010 [DOI:10.1515/9781565493759]
46. Paschke A, Dimancesco D, Vian T, Kohler JC, Forte G. Increasing transparency and accountability in national pharmaceutical systems. Bulletin of the World Health Organization 2018;96:782 [DOI:10.2471/BLT.17.206516]
47. Gholami M, Takian A, Kabir MJ, Olyaeemanesh A, Mohammadi M. Transparency interventions to improve health system outcomes in low and middle-income countries: a narrative systematic review. BMJ open 2024;14:e081152 [DOI:10.1136/bmjopen-2023-081152]
48. Gholami M, Takian A, Kabir MJ, Olyaeemanesh A, Mohammadi M. Financial Transparency and Access to Health Information in Iran: Analysis of Related Laws and Documents. Iranian Journal of Culture and Health Promotion 2023;7:303
49. Center for Presidential Strategic Studies. Explanatory report on draft of transparency bill. Tehran: Center for Presidential Strategic Studies; 2018. Available from: https://discuss.tp4.ir/uploads/default/original/2X/1/13515f6f76e4a245aefcc7285132e142feb614dd.pdf
50. To amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; 2009 [updated 10 Jul 2009; cited 2024 Jul 22]. Available from: https://www.congress.gov/bill/111th-congress/house-bill/3138
51. Zafarghandi MR. [Guideline of professional ethics of medical profession and affiliated employees in the health system of Islamic Republic of Iran]. Tehran, Iran: Medical Council 2018. Available from: https://irimc.org
52. United Nations, Department of Economic and Social Affairs Sustainable Development. The 17 Goals [cited 2023 Oct 21]. Available from: https://sdgs.un.org/goals
53. Hosseinizade S-M-A. From institutionalism to discourse: A prelude to the function of theories of institutionalism in politics. Political Science 2013;15:83
54. Azizi F, Entezari A, Momtazmanesh N, Pezeshkian M, Tabrizchi N. Impact of Integration of Medical Education in the Health System of Islamic Republic of Iran. Strides in Development of Medical Education 2024;21:1-10
55. Marandi SA. The Integration of Medical Education and Health Care Services in the I.R. of Iran and its Health Impacts. Iran Journal of Public Health 2009;38:4-12
56. Kiani MM, Mostafavi H, Ebrahimi F, Majdzadeh R, Mohamadi E, Kraemer A, Olyaeemanesh A, Takian A. The experiences and perceptions of people with chronic and rare diseases during political-economic sanctions in Iran: a qualitative study. BMC Health Services Research 2024;24:276 [DOI:10.1186/s12913-024-10786-7]
57. Doshmangir L, Bazyar M, Majdzadeh R, Takian A. So Near, So Far: Four Decades of Health Policy Reforms in Iran, Achievements and Challenges. Archives of Iranian Medicine 2019;22:592-605
58. Bahmanziari N, Takian A. Health system stewardship in Iran: Far from perfect! Medical Journal of the Islamic Republic of Iran 2020;34:996 [DOI:10.47176/mjiri.34.144]
59. Bahmanziari N, Mohammadi SM, Takian A, Arab M, Harirchi I. Applying ethical theories to the Iranian health system governance: a critical empirical assessment. Journal of Medical Ethics and History of Medicine 2021;14:23 [DOI:10.18502/jmehm.v14i23.8183]
60. Dehnavieh R, Rahimi H. Basic Health Insurance Package in Iran: Revision Challenges. Iranian Journal of Public Health 2017;46:719-720
61. Doshmangir L, Bazyar M, Majdzadeh R, Takian A. So Near, So Far: Four Decades of Health Policy Reforms in Iran, Achievements and Challenges. Archieves of Iranian Medicine. 2019;22:592-605
62. Hsu J, Majdzadeh R, Harichi I, Soucat A. Health system transformation in the Islamic Republic of Iran: an assessment of key health financing and governance issues. 1st Edition, World Health Organization: Geneva, Switzerland, 2017
63. Nyaranga MS, Hao C, Hongo DO. The Role of Public Participation in Governance towards Achieving Sustainable Development. Part 1. RUDN Journal of Public Administration 2021;8:395-404 [DOI:10.22363/2312-8313-2021-8-4-395-404]
64. Nyaranga MS, Hao C, Hongo DO. The Role of Public Participation in Governance towards Achieving Sustainable Development. Part 2. RUDN Journal of Public Administration: PA 2022;9:29 [DOI:10.22363/2312-8313-2022-9-1-29-41]
65. Rajabi M, Ebrahimi P, Aryankhesal A. Developing a model for partnership of non-governmental organizations in Iran's health system. Journal of Health Administration 2022;25:30
66. Nejatian A, Arab M, Takian A, Ashtarian K. Social Accountability in Health System Governance: A Scoping Review. Iranian Journal of Public Health 2024;53:35 [DOI:10.18502/ijph.v53i1.14681]
67. Bueno de Mesquita J, Thomas R, Gauter C, Havkwist A, Hoddy R, Larasati A, et al. Monitoring the sustainable development goals through human rights accountability reviews. Bulletin of the World Health Organization 2018;96:627 [DOI:10.2471/BLT.17.204412]
68. Dusabe C, Abimpaye M, Kabarungi N, Uwamahoro MD. Monitoring, evaluation and accountability evidence use for design, adaptation, and scale-up of an early childhood development program in Rwanda. Frontiers in Public Health 2023;11:1165353 [DOI:10.3389/fpubh.2023.1165353]
69. Davidson AR. British Columbia's health reform: "new directions" and accountability. Canadian Journal of Public Health 1999;90 Suppl 1:S35 [DOI:10.1007/BF03403577]
70. Edalati S. Participatory Evaluation and governance analysis of Tehran municipality policies and programs in regard to obesity and overweight prevention [Doctoral Thesis]. Tehran, IR Iran: SBUMS; 2023 [Persian]
71. Ebrahimipour H, Vafaei Najjar A, Khani Jahani A, Pourtaleb A, Javadi M, Rezazadeh A, et al. Health system responsiveness: a case study of general hospitals in iran. International Journal of Health Policy and Management 2013;1:85 [DOI:10.15171/ijhpm.2013.13]
72. Malekzadeh R, Yaghoubian S, Hasanpoor E, Ghasemi M. Health system responsiveness in Iran: a cross-sectional study in hospitals of Mazandaran province. International Journal of Human Rights in Healthcare 2021;14:133 [DOI:10.1108/IJHRH-03-2020-0018]
73. Takian A, Bakhtiari A, Sadegh Tabrizi J, Raoofi A. The Islamic Republic of Iran: a primary health care case study in the context of the COVID-19 pandemic. 1st Edition, World Health Organization: Geneva, Switzerland; 2022
74. Doshmangir L, Ravaghi H. A review of support tools for evidence-informed health policymaking. Clinical Excellence 2016;4:100
75. Ebrahimi S, Danaei Fard H, Azar A, Faruzandeh L. Developing an Evidence-Based Policy Model for Iranian Public Health System (qualitative research). Public Management Research 2013;24:5
76. Namdarian L. Analyzing appropriate features of data for using in policy-making. Political Quarterly 2019;49:515
77. Ayoubain A, Nasiripour AA, Tabibi SJ, Bahadori M. Identification and Prioritization of the Effective Factors on Evidence-Based Decision Making in the Health Policy of Iran. Iranian Journal of Health Insurance 2019;2:76 [Persian]
78. Emami M, Shakeri H. Good governance and The constitution of the Islamic Republic of Iran. Comparative Law 2015;1:25-57 [Persian]
79. Bahrami MB, Akbarzadeh F, Shahabi R, Jalalpour S. Rule of law and legal consequences of good governance in Iran. Political Studies of the Islamic World 2020;10:29-47 [Persian]
80. Lotfi MH, Malekafzali H, Zare Abdollahi S, Shojaei P. Intervention and Measures Taken for a Comprehensive Health of the People Living in Yazd Eskan Neighborhood. Journal of Research & Health 2021;11:313-22 [DOI:10.32598/JRH.11.5.1892.1]
81. Overseas Development Institute. World Governance Assessment (WGA) Framework. London: ODI; 1999 [cited 2025 Apr 7]. Available from: https://odi.org/documents/1060/6863.pdf
82. United States Agency for International Development. Organizational Governance Assessment (OGA) Tool. Washington, DC: USAID; 2014 [cited 2024 Apr 7]. Available from: https://usaid.gov/
Send email to the article author
| Rights and Permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |