The Barriers to Implementation of New Public Management Strategies in Iran's Primary Health Care: A Qualitative Study

Abstract

INTRODUCTION: New Public Management (NPM) is a special management philosophy used by governments. OBJECTIVES: The aim of NPM is to increase efficiency, effectiveness and cost saving in public sector through employing private sector characteristics and market mechanisms. Therefore, objective of this study is to identify barriers and challenges to understand the limitations of implementing the NPM model. STUDY DESIGN: A qualitative study STUDY SETTING: Managers of primary health care (PHC), East Azerbaijan, Iran. METHODOLOGY: The researchers performed a series of semi-structured interviews with health managers (n=30) and three focus group discussions with policy makers and district health managers (n=9) in 2016. A questionnaire was used for collecting demographic characteristics and managers' perspectives. RESULTS: Lack of authority, executive bureaucracy, traditional budgeting system, poor payment systems, inadequate resources were considered to be the most common managerial barriers to the implementation of NPM. From the experts' view, the other factors that can affect poor implementation of NPM reforms in public health complexes are as follow: a shortage of trained managers, centralized decision-making process, organization's unwillingness to compete, lack of customer-oriented culture, lack of supervisor support and feedback, disharmony between employee needs and appraisal goals, absence of clear and independent performance dimensions, and biases in the process of evaluation. CONCLUSION: Designing and implementing an NPM reform need to be based on the operational reality and conditions of every country because most of the NPM programs in different countries are suffering from non-implementation syndrome. Therefore, before implementing this reform, identifying managerial barriers and challenges helps managers to execute the NPM in their desired sector properly.