Designing District Health Management Framework in the Iranian Healthcare System

Abstract

Abstract: Background: A district health system is a self-contained segment of the national health system; however a comprehensive framework has not currently been developed and implemented to manage the district health network. Aim: The study aimed to design a framework for district health management and develop a program to empower district health managers and indicators to assess management performance based on management framework in the Iranian healthcare system. Methods: This mixed-method study was carried out using qualitative and quantitative methods for data collection in Tabriz University of Medical Sciences between August 2014 and May 2016., Through various steps of the study, its target population was comprised of managers of districts health networks, managers of expert teams attributed to health departments in universities of medical sciences located in Tabriz, Ardabil, Zanjan and Maraghe as well as health vice chancellors of Medical Sciences Universities in Iran. Result: The district health management framework contains five strategic foundation namely leadership, organizational culture, organizational design, political context and intersectoral collaboration and community participation. Also six building blocks as; human resources, financing, resources generation, performance management, information technology and infrastructures were considered the structural parts of district health management framework. Strategic goals of district health management as equity, responsibility, safety and quality, accessibility, financial protection, and chronic care management were considered to provide integrated services including health promotion, prevention, treatment, rehabilitation and palliative care in order to provide, maintain and promote population health. Districts health management training program consisted of 11 modules with 54 educational topics. Based on the results, the validities of 53 indicators, classified in 11 categories, validated and confirmed them as final indicators for district health management performance assessment framework in. Derived from posttest, the highest scores were obtained by district health system management (77 out of 100) as well as planning and evaluation (69 out of 100). Conclusion: The district health network management is required to consider strategic goals and managing the building blocks of health system through conducting strategic foundation of health system in order to achieve health system objectives along with provision of comprehensive services. In this regard, district health managers need to participate in educational plans and have access to management support system.