Presenting the policy framework for the participation of non-governmental organizations health in achieving the goals of universal health coverage in Iran

Abstract

Abstract Background: Most discussions in the health sector today imply achieving universal health coverage. In recent years, the idea and priority of achieving universal health coverage has led the World Health Organization to focus on different groups working in the health sector, with different programs. As one of these groups is non-governmental organizations, its role in the health sector has changed in recent years. In many countries, non-governmental organizations are tools for developing health services and part of national strategies to achieve universal health coverage. In Iran, the implementation of the health transformation plan and its goal to achieve universal health coverage has emphasized the involvement of non-governmental organizations, and the issue has drawn more attention to these organizations from health policy-makers from the past. Objective: This study is to develop a policy framework for the participation of health NGOs in moving towards universal health coverage in Iran. Method: This study is a mixed method conducted in 5 phases and 6 steps. The first phase was a scoping review. We systematically reviewed studies from five databases (PubMed, Web of Science (ISI), ProQuest, EMBASE and Scopus) that investigated NGOs interventions in public health-related activities. The quality of the selected studies was assessed using the mixed methods appraisal tool. PRISMA reporting guidelines were followed. The second phase took place in two phases with the method of document review and expert interview. We conducted 33 semi-structured interviews with health policymakers, NGO representatives at the national and provincial level, and other key informants and analysed using content analyses methods, using MAXQDA 12. The inductive-deductive approach was used for qualitative data analyses. The third phase was carried out through questionnaire made by the research team and after its psychometric analysis. We used a mixed-method sequential explanatory approach. The study was conducted from September 2021 to March 2022 in two major phases: the items' generation and the development of a psychometric instrument (NGO&UHC questionnaire). The fourth and fifth phases include the presentation of the framework for the participation of NGOs in achieving the goals of universal health coverage in Iran and the validation of the framework. To this end, under the sum of objectives 1, 2 and 3, a review of the tools and models of the health system related to universal health coverage and NGOs, and through a back-and-forth process and collecting input from an expert panel of members, the research team compiled the framework by combining the evidence. For framework validation, the expert panel method was used. Result: The results of the first objective showed, 78 studies met the eligibility criteria. NGOs main activities related to service and population coverage and used different strategies to move towards UHC. To ensure services coverage, NGOs provided adequate and competent human resources, necessary health equipment and facilities, and provided public health and health care services strategies. To achieve population coverage, they provided services to vulnerable groups through community participation. The main funding sources of NGOs were self-financing and grants from the government, international organisations, and donors. The results of the second objective were identified in two sections, including 13 themes and 122 sub-themes. The results of the third objective include 70 items in 8 subscales. CVR and CVI results indicated that all questions but one met the minimum acceptable values. In terms of construct validity, eight factors were identified. Based on Cronbach’s alpha reliability, items had good and excellent reliability. Based on internal consistency and reliability assessment and test-retest ICC values, all the items showed excellent stability and reliability. According to the fourth and fifth objectives of the thesis, the research team reviewed 9 frameworks and tools of the health system and identified 9 steps to build the framework, from which the framework was developed and approved at 2 meetings expert panel group. Conclusion: Along with the government and other key health players, NGOs can also play a significant role in countries’ progress towards UHC. The government should use strategies and interventions evidence-informedin supporting NGOs, accelerating their movement toward UHC. Recognizing the critical role of NGOs and their contribution in moving towards UHC is essential, particularly in the local context. Collaboration between NGO stakeholders and the government could facilitate moving towards UHC. On the other, the participation of NGOs in the Iranian health system is a complex process. All elements and dimensions of this process need to be considered when developing a platform for the appropriate participation of NGOs in the health system functions. Evidence-informed strategies for strengthening the participation of NGOs in the health system should be used to utilise NGOs potential to the fullest.