Public Policy Sapru Pdf Download
According to the 3i framework, the following factors contributed to the formation of DHN policy in Iran: previous national efforts (for instance Rezaieh plan) and international events aiming to provide public health services for peripheral regions; dominant social discourses and values at the beginning of the Iranian revolution such as addressing the needs of disadvantaged and marginalized groups, which were embedded in the goals of DHN policy aiming to provide basic health services for deprived people especially living in rural and remote areas. Besides, the remarkable social cohesion and solidarity among people reinforced by the Iran-Iraq war were among other factors which contributed to the formation of participatory plans such as DHN (ideas). Main policy entrepreneurs including Minister of Health, his public health deputy and two planners of DHN with similar and rich background in the public health field and sharing the same beliefs (interests) which subsequently led to creation of tight-knit policy community network between them (institutions) also accelerated the creation of DHN in Iran to great extent. Political support of parliamentary representatives (interests), and formal laws such as principles of Iran Constitution (institutions) were also influential in passing the DHN in Iran.
Public Policy Sapru Pdf Download
The 3i framework constituents would be insightful in explaining the creation of public health policies. This framework showed that the alignment of laws, structures, and interests of the main actors of the policy with the dominant ideas and beliefs in the society, opened the opportunity to form DHN in Iran.
The policy-making process moves forward through networks of stakeholders with their interests and motives . Different individuals, groups, and organizations were interested in the formation of the DHN policy in Iran. However, three groups were among the main stakeholders. These groups were classified into internal (inside the health sector) and external (outside of the health sector) stakeholders. The first group was the rural dwellers. At that time, about half of the population was living in rural areas . Rural dwellers benefited from the implementation of DHN as it improved health facilities in rural areas. At the same time they had an active and strong role in implementation of the policy. High participation and acceptability of DHN policy by the rural people shows that they supported and welcomed the implementation of the policy. The next influential group was the key founders of DHN. These were Dr. Pileroudi and Dr. Shadpour as the main designers of the DHN program and Dr. Marandi, the Minister of Health (from 1984 August 18 to 1989 August 29) and Dr. Malek Afzali as his public health deputy. They were the policy entrepreneurs and main actors in putting the DHN policy on the agenda. They had the same working experience in rural areas and were quite familiar with the common rural health problems [10, 50, 51].
The third group were those who supported the policy indirectly, such as representatives that approved the bill in the Parliament. However, there were groups from the ministry of health who were against the DHN policy. Some of these opposing actors were physicians who preferred treatment and hospital-based services over public health and preventive medicine and considered having physicians in rural areas more equitable and effective than having health workers [50, 52, 53].