مروری نظام مند بر راهبردهای بهبود مشارکت سازمان‌های غیردولتی ایران در سیاستگذاری نظام سلامت
محورهای موضوعی : مدیریت دولتی
شهلا فتحی
1
,
حسن گیوریان
2
*
,
محمدرضا ربیعی مندجین
3
,
مینا جمشیدی اوانکی
4
,
وحید آرایی
5
1 - رشته مدیریت دولتی گرایش تصمیم گیری وخط‌مشی گذاری عمومی
2 - دانشیار گروه مدیریت دولتی، واحد تهران مرکز، دانشگاه آزاد اسلامی ، تهران ، ایران .
3 - دانشیاروعضوهیات علمی گروه مدیریت دولتی دانشکده مدیریت دانشگاه ازاداسلامی واحدتهران مرکزی
4 - گروه آموزشی مدیریت دولتی دانشکده مدیریت دانشگاه آزاد اسلامی واحد تهران مرکزی
5 - عضو هیأت علمی گروه مدیریت دولتی و خط مشی گذاری عمومی، دانشگاه آزاد اسلامی واحد تهران مرکزی، تهران، ایران
کلید واژه: سازمان‌های غیردولتی, سیاستگذاری سلامت, مشارکت, مرور نظام‌مند, متاسنتز,
چکیده مقاله :
سازمان‌های غیردولتی فعال در حوزه سلامت ایران به‌عنوان بخش مهمی از جامعه مدنی، نقش اساسی در شناسایی نیازهای واقعی مردم، نظارت و مشارکت در سیاستگذاری سلامت دارند، اما مشارکت اثربخش آن‌ها با چالش‌هایی همچون نبود ساختارهای قانونی شفاف، محدودیت‌های توانمندسازی، کمبود اعتماد و ضعف در نظام‌های ارزیابی مواجه است. این مطالعه با هدف شناسایی راهبردهای ارتقای مشارکت، به‌صورت مرور نظام‌مند کیفی بر اساس دستورالعمل PRISMA 2020 انجام شد؛ جستجو در پایگاه‌های Web of Science، Scopus، Embase و PubMed در جولای 2025 انجام گرفت و از میان ۱۷۶۴ مطالعه شناسایی‌شده، ۲۴ مطالعه واجد شرایط با روش توماس و هاردن و نرم‌افزار MAXQDA 2022 تحلیل شدند. کیفیت مطالعات با چک‌لیست SRQR ارزیابی شد و برای افزایش اعتبار، از مثلث‌سازی و نظرات گروه مشورتی متشکل از صاحب‌نظران و فعالان NGOها بهره گرفته شد. یافته‌ها نشان می‌دهد مشارکت مؤثر سازمان‌های غیردولتی در سیاستگذاری سلامت مستلزم تحقق هفت راهبرد کلیدی و به‌هم‌پیوسته است: نهادینه‌سازی مشارکت از طریق تعریف جایگاه قانونی شفاف و کاهش موانع بوروکراتیک؛ توانمندسازی سازمانی با ارتقای مهارت‌های تحلیل سیاست، مدیریت و حکمرانی؛ استقرار ارتباطات ساختاریافته و مبتنی بر اعتماد از طریق کانال‌های رسمی گفت‌وگو و شفافیت؛ توسعه شبکه‌سازی و همکاری‌های چندبخشی برای ایجاد هم‌افزایی؛ تأمین مالی پایدار از طریق سازوکارهای شفاف و قراردادهای بلندمدت؛ استقرار نظام پایش و ارزیابی مبتنی بر شواهد برای یادگیری سازمانی؛ و ترویج فرهنگ مشارکت و اعتماد عمومی از طریق آگاه‌سازی اجتماعی و مسئولیت‌پذیری نهادی. تحقق این راهبردها نیازمند رویکردی یکپارچه و چندبعدی است که تقویت زیرساخت‌های قانونی، توانمندسازی فنی و مدیریتی، شکل‌گیری ارتباطات نهادی مبتنی بر شفافیت و اعتماد، توسعه شبکه‌های همکاری، تأمین مالی پایدار، استقرار نظام‌های ارزیابی و گسترش فرهنگ مشارکت را شامل می‌شود و زمینه را برای نهادینه‌سازی مشارکت و حرکت به‌سوی حکمرانی سلامت مشارکتی و اثربخش فراهم می‌سازد.
Introduction: The role of non-governmental organizations (NGOs) as representatives of civil society in health policymaking is crucial for identifying the real needs of the people, monitoring, and participating in decision-making. However, the effective participation of these organizations in Iran faces numerous challenges, including the lack of transparent legal structures, empowerment limitations, a deficit of trust, and weaknesses in evaluation systems. This study was conducted to identify strategies for improving this participation.
Methods: This study is a qualitative systematic review (meta-synthesis) based on the PRISMA 2020 guideline. A systematic search was conducted in Web of Science, Scopus, Embase, and PubMed databases in July 2025. Out of 1,764 identified studies, 24 eligible qualitative studies were selected based on inclusion and exclusion criteria. Data were analyzed using the Thomas and Harden method and MAXQDA 2022 software. Study quality was assessed using the SRQR checklist, and credibility was enhanced through triangulation and input from an advisory panel consisting of experts and NGO activists.
Findings: Based on a qualitative systematic review, the effective participation of Iranian NGOs in health policymaking necessitates the realization of seven key, interconnected strategies: First, the institutionalization of participation through defining a clear legal status and reducing bureaucratic barriers. Second, organizational empowerment by enhancing skills in policy analysis, management, and governance. Third, establishing structured and trust-based communication through formal dialogue channels and transparency. Fourth, developing networking and multisectoral collaborations to create synergy. Fifth, ensuring sustainable financing through transparent mechanisms and long-term contracts. Sixth, establishing an evidence-based monitoring and evaluation system for organizational learning. Seventh, promoting a culture of participation and public trust through social awareness and institutional accountability.
Conclusion: Effective participation of NGOs in Iran's health policymaking requires an integrated and multidimensional approach. Strengthening legal infrastructures, technical and managerial empowerment of NGOs, establishing institutional communication based on trust and transparency, developing collaborative networks, ensuring sustainable financing, implementing monitoring and evaluation systems, and ultimately promoting a culture of participation at the societal level are key pillars for institutionalizing this participation and moving towards participatory and effective health governance.
1. Bonab MR, Rajabi F, Majdzadeh R. Barriers and facilitators to participatory governance in Iran health policymaking: a qualitative study. Medical Journal of the Islamic Republic of Iran. 2023;37:51.
2. Sanadgol A, Doshmangir L, Khodayari-Zarnaq R, Sergeevich Gordeev V. Role of non-governmental organizations in moving toward universal health coverage: A case study in Iran. Frontiers in Public Health. 2022;10:985079.
3. Cornwall A, Gaventa J. Bridging the gap: citizenship, participation and accountability. PLA notes. 2001;40(2001):32-5.
4. Miller NP, Milsom P, Johnson G, Bedford J, Kapeu AS, Diallo AO, et al. Community health workers during the Ebola outbreak in Guinea, Liberia, and Sierra Leone. J Glob Health. 2018;8(2):020601.
5. Greer S, Wismar M, Figueras J. Strengthening health system governance: better policies, stronger performance: McGraw-Hill Education (UK); 2015.
6. Curley MG. The role of civil society in East Asian region building. Advancing East Asian Regionalism: Routledge; 2012. p. 179-201.
7. Ekirapa A, Mgomella GS, Kyobutungi C. Civil society organizations: capacity to address the needs of the urban poor in Nairobi. Journal of public health policy. 2012;33(4):404-22.
8. Sørensen E, Torfing J. Co-initiation of collaborative innovation in urban spaces. Urban Affairs Review. 2018;54(2):388-418.
9. Turner M, Kwon S-H, O’donnell M. State effectiveness and crises in East and Southeast Asia: the case of COVID-19. Sustainability. 2022;14(12):7216.
10. Gilson L, McIntyre D. The interface between research and policy: experience from South Africa. Social science & medicine. 2008;67(5):748-59.
11. Best A, Greenhalgh T, Lewis S, Saul JE, Carroll S, Bitz J. Large‐system transformation in health care: a realist review. The Milbank Quarterly. 2012;90(3):421-56.
12. Arnstein SR. A ladder of citizen participation. Journal of the American Institute of planners. 1969;35(4):216-24.
13. Sanadgol A, Doshmangir L, Majdzadeh R, Gordeev VS. Strategies to strengthen non-governmental organizations' participation in the Iranian health system. Frontiers in public health. 2022;10:929614.
14. Rajabi M, Ebrahimi P, Aryankhesal A. Facilitators of improving the function of nongovernmental organizations (NGOs) in Iran's health system. Journal of Education and Health Promotion. 2023;12(1):147.
15. Khodayari-Zarnaq R, Kakemam E, Arab-Zozani M, Rasouli J, Sokhanvar M. Participation of Iranian non-governmental organizations in health policy-making; barriers and strategies for development. International Journal of Health Governance. 2020;25(1):46-56.
16. Gholamzadeh Nikjoo R, Partovi Y, Joudyian N. Involvement of charities in Iran’s health care system: a qualitative study on problems and executive/legal/supportive requirements. BMC Health Services Research. 2021;21(1):181.
17. 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(3):30-49.
18. Mahdavi M, Khasraghi JS, Sajadi HS, Yazdizadeh B, Nikooee S, Ehsani-Chimeh E, et al. Developing framework and strategies for capacity building to apply evidence-informed health policy-making in Iran: mixed methods study of SAHSHA Project. International Journal of Health Policy and Management. 2021;11(10):2236.
19. Rajabi M, Ebrahimi P, AryanKhesal A. Identifying Solutions for Capacity Building of Health Sector Non-Governmental Organizations. Quarterly Journal of Management Strategies in Health System. 2024.
20. Sayarifard A, Nazari M, Rajabi F, Ghadirian L, Sajadi HS. Identifying the non-governmental organizations' activities and challenges in response to the COVID-19 pandemic in Iran. BMC Public Health. 2022;22(1):704.
21. Ebrahimi P, Rajabi M, Aryankhesal A. Participation of nongovernmental organizations in Iran's health-care system: challenges and suggestions for improvement. International Journal of Health Governance. 2021;26(4):397-407.
22. Jalilvand MA, Raeisi AR, Shaarbafchizadeh N. Hospital governance accountability challenges in Iran: a qualitative study. BMC Health Services Research. 2025;25(1):946.
23. Saghravan S, Moghimi SM. The relationship structure between Iranian NGOs and the government. Interdisciplinary Journal of Management Studies. 2023;16(1):259-76.
24. Mahami-Oskouei M, Nemati-Anaraki L, Panahi S, Asadzandi S. Iranian experts’ perspectives on facilitators and barriers influencing the infectious disease knowledge network: A qualitative study. BMC Health Services Research. 2024;24(1):1040.
25. Moeenian M, Khamseh A, Ghazavi M. Social innovation based on collaboration between government and non-governmental organizations in COVID-19 crisis: evidence from Iran. Infectious Diseases of Poverty. 2022;11(1):13.
26. Mosadeghrad AM, Tajvar M, Ehteshami F. Donors’ participation in Iran’s health system: challenges and solutions. International Journal of Health Policy and Management. 2021;11(11):2514.
27. Moradi T, Kabir MJ, Pourasghari H, Ehsanzadeh SJ, Aryankhesal A. Challenges of budgeting and Public Financial Management in Iran’s health system: a qualitative study. Medical Journal of the Islamic Republic of Iran. 2023;37:80.
28. Pourbagher S, Bay A, Heidari A. Challenges of Non-Governmental Organizations to Promote Social Health in Iran: A Qualitative Study. Journal of Gorgan University of Medical Sciences. 2023;25(2):92-102.
29. Cheraghi MA, Ghiyasvandian S, Aarabi A. Iranian nurses’ status in policymaking for nursing in health system: a qualitative content analysis. The open nursing journal. 2015;9:15.
30. Eftekhari MB, Mirabzadeh A, Falahat K, Sajjadi H, Vameghi M, Harouni GG. Priorities of positive mental health promotion in the Iranian community: a qualitative study. Electronic Physician. 2018;10(7):7120.
31. Bastani P, Samadbeik M, Dinarvand R, Kashefian-Naeeini S, Vatankhah S. Qualitative analysis of national documents on health care services and pharmaceuticalspurchasing challenges: evidence from Iran. BMC health services research. 2018;18(1):410.
32. Gorji HA, Mousavi SMSP, Shojaei A, Keshavarzi A, Zare H. The challenges of strategic purchasing of healthcare services in Iran Health Insurance Organization: a qualitative study. Electronic physician. 2018;10(2):6299.
33. Manafi F, Takian AH, Sari AA. Assessing the governance of human resources for health in Iran: A qualitative study. Journal of education and health promotion. 2019;8(1):97.
34. Mohammadpour M, Bastani P, Brennan D, Ghanbarzadegan A, Bahmaei J. Oral health policymaking challenges in Iran: a qualitative approach. BMC Oral Health. 2020;20(1):158.
35. Mohamadi E, Takian A, Olyaeemanesh A, Rashidian A, Hassanzadeh A, Razavi M, Ghazanfari S. Health insurance benefit package in Iran: a qualitative policy process analysis. BMC health services research. 2020;20(1):722.
36. Cornwall A, Gaventa J. From users and choosers to makers and shapers repositioning participation in social policy1. IDS bulletin. 2000;31(4):50-62.
37. NS P, Kochupurackal Ulahannan S, Juneja A, Seshadri T, Mahadeva C, Venkategowda M, et al. Reimagining Innovation in Health Equity: Making a Case for a Community embedded Participatory Learning Site for Adivasi Health Research. Journal of Community Systems for Health. 2025;2(1).
38. Theobald S, Tulloch O, Crichton J, Hawkins K, Zulu E, Mayaud P, et al. Strengthening the research to policy and practice interface: exploring strategies used by research organisations working on sexual and reproductive health and HIV/AIDS. Health research policy and systems. 2011;9(Suppl 1):S2.
39. Bhandari M. Civil society and non-governmental organizations (NGOs) movements in Nepal in terms of social transformation. The Pacific Journal of Science and Technology. 2014;15(1):177-89.
40. Taylor M, Warburton D. Legitimacy and the role of UK third sector organizations in the policy process. Voluntas: International Journal of Voluntary and Nonprofit Organizations. 2003;14(3):321-38.
41. Mao Y. Combating COVID-19 through collaborative governance: lessons from East Asia. Chinese Public Administration Review. 2020;11(2):132-41.
42. Anheier H. Civil society: Measurement, evaluation, policy: Routledge; 2013.
43. Fontaine G, Cossette S, Maheu-Cadotte M-A, Mailhot T, Deschênes M-F, Mathieu-Dupuis G, et al. Efficacy of adaptive e-learning for health professionals and students: a systematic review and meta-analysis. BMJ open. 2019;9(8):e025252.
44. Baroudi M, Goicolea I, Hurtig A-K, San-Sebastian M. Social factors associated with trust in the health system in northern Sweden: a cross-sectional study. BMC Public Health. 2022;22(1):881.
45. Dougherty CN. Trust and transparency: Accreditation and impact reporting by Canadian charities. Canadian journal of nonprofit and social economy research. 2019;10(1).
46. Kyungyon M. South Korean civil society organizations, human rights norms, and North Korea. Critical Asian Studies. 2014;46(1):65-89.