Challenges of Budgeting and Public Financial Management in Iran's Health System: A Qualitative Study

Tayebeh Moradi; Mohammad Javad Kabir; Hamid Pourasghari; Seyed Jafar Ehsanzadeh; Aidin Aryankhesal

doi:10.47176/mjiri.37.80

Challenges of Budgeting and Public Financial Management in Iran's Health System: A Qualitative Study

Med J Islam Repub Iran. 2023 Jul 17:37:80. doi: 10.47176/mjiri.37.80. eCollection 2023.

Authors

Tayebeh Moradi¹, Mohammad Javad Kabir², Hamid Pourasghari³, Seyed Jafar Ehsanzadeh⁴, Aidin Aryankhesal¹

Affiliations

¹ Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
² Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
³ Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
⁴ English Language Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Abstract

Background: Efficient and effective management of budgets and financial resources is critical for health systems to achieve their goals; in this regard, countries may face budgetary and financial challenges owing to the weak prediction of resources and consumptions, and lack of prioritization for their budget. This study aims to identify the most critical policies and events that have affected public financial management and health budgeting and existing challenges in Iran.

Methods: We conducted the present study in 2022 using a 2-stage qualitative method. First, by reviewing upstream documents and laws, we identified evidence related to health budgeting. Then, we conducted 13 semi-structured interviews with informed people in the health budgeting field that led us toward the main challenges through thematic content analysis.

Results: After reviewing 48 upstream documents related to health budgeting, we identified 85 policies. After reviewing the articles, we achieved 11 themes and 71 subthemes. The most critical challenges of the budgeting cycle were as follows: (I) budget formulation, including inappropriate budget structure, conflicts of interest and infringement, lack of financial sustainability, and transparency; (II) budget execution, including a nonexecutable approved budget, complicated allocation process, and ineffective allocations; and (III) monitoring, reporting, and evaluation (MR&E), including fragmentation of MR&E processes, ineffective monitoring and evaluation, weak evaluation of platforms, and inadequate transparency.

Conclusion: Most challenges in the health budgeting system are related to the budget formulation and approval stage that have their roots in implementation, monitoring, and reporting. In addition, Iran's macroeconomic and financial issues have also damaged the budgeting of the health sector. Budget problems affect the goals and outcomes of this sector, especially the health system.

Keywords: Budget Evaluation; Budget Execution; Budget Formulation; Budget Monitoring; Budgeting; Public Financial Management; Universal Health Coverage.