Underlying factors and challenges of implementing an urban family physician program in Iran

Background: the family physician program was launched in 2005 in rural areas, and also as a pilot in 2012 in cities of Fars and Mazandaran provinces due to insufficient coverage of health system in these cities. However, despite its pivotal role in the health system programs, it has not progressed according to its initial policies. Therefore, the purpose of this study was to explain the underlying factors and challenges of implementing an urban family physician program in Iran. Methods: : This is a qualitative study, which was conducted on 44 policymakers and managers at national and provincial levels who entered the study with snowball and purposeful sampling with maximum variation. MAXQDA-2020 software was used to manage the data, which were analyzed by directed content analysis. For this purpose, a triangulation method was used. Results: : Data analysis resulted in the formation of 10 main categories, 18 sub-categories and 29 codes. Most challenges in the dimension of underlying factors included precipitancy, economic sanctions, believing in traditional medicine, believing in the expertise of previous physician, and global ranking of countries. Also, in the dimension of program implementation, most challenges included diversity of insurance organizations, budget allocation, referral system, electronic file, educational system and culture building. Conclusions: : the findings showed that the most important challenge in the dimension of underlying factors included international pressure for reforms and precipitancy in the implementation of programs due to changes in management. Also, these challenges in the dimension of program implementation included budget provision and interaction with insurance organizations. Therefore, for the expansion of program to other provinces in Iran, the factors identified in this study should be carefully considered so that, sufficient confidence, commitment and guarantee would be created for all stakeholders.