How Iranian primary health care policies influenced equity: a historical critical analysis from policymakers’ perspectives

TL;DR

This study examines how Iranian primary health care policies have affected health equity over 50 years, based on insights from policymakers.

Contribution

The study provides a historical critical analysis of PHC policies in Iran from policymakers' perspectives, highlighting their impact on equity.

Findings

PHC and District-level Health Networks significantly promoted social equity and access to basic health services, especially in rural areas.

The policies were effective in addressing acute and communicable diseases but struggle with non-communicable diseases due to societal and technological changes.

A cultural shift toward preventive health and political support are needed to improve NCD care within the PHC system.

Abstract

This study aimed to explore how Iranian primary health care (PHC) policies have influenced equity in Iran’s health system over the last 50 years, from the perspectives of policymakers.

This qualitative research was conducted between 2019 and 2020. Following the identification, screening, and selection of the most relevant PHC policies through document analysis and expert consultation, 30 semi-structured interviews were conducted with various experts in Iran’s health system. The logical relationships among the data were analysed using the health policy triangle and thematic content analysis, facilitated by MaxQDA software.

Among the 28 identified PHC policies, five policy groups were recognised as the most significant in relation to health equity. These policies, particularly the PHC and District-level Health Networks (DHNs), have been instrumental in promoting social participation, intersectoral collaboration, and social equity, particularly in addressing acute and communicable diseases. The policies have also ensured equal access to basic health services, especially in rural areas, and have significantly impacted the delivery of care to the population across Iran when acute and communicable diseases were the primary health burden. However, in recent decades, the PHC and DHNs have struggled to keep pace with the dynamic societal changes, shifting disease patterns, and technological advancements.

While the policies have been successful in providing equitable care for acute and communicable diseases, improvements are required to address the rising burden of non-communicable diseases (NCDs). The integration of NCD care into Iran’s PHC and DHN requires a cultural shift towards preventive health and lifestyle changes. Political will and support from both the government and healthcare policymakers are essential to overcome barriers such as inherent conflicts of interest.

The online version contains supplementary material available at 10.1186/s12913-025-12736-3.

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