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

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 th...

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Autores principales: Moradi, Tayebeh, Kabir, Mohammad Javad, Pourasghari, Hamid, Ehsanzadeh, Seyed Jafar, Aryankhesal, Aidin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Iran University of Medical Sciences 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10439693/
https://www.ncbi.nlm.nih.gov/pubmed/37600636
http://dx.doi.org/10.47176/mjiri.37.80
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author Moradi, Tayebeh
Kabir, Mohammad Javad
Pourasghari, Hamid
Ehsanzadeh, Seyed Jafar
Aryankhesal, Aidin
author_facet Moradi, Tayebeh
Kabir, Mohammad Javad
Pourasghari, Hamid
Ehsanzadeh, Seyed Jafar
Aryankhesal, Aidin
author_sort Moradi, Tayebeh
collection PubMed
description 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.
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spelling pubmed-104396932023-08-20 Challenges of Budgeting and Public Financial Management in Iran’s Health System: A Qualitative Study Moradi, Tayebeh Kabir, Mohammad Javad Pourasghari, Hamid Ehsanzadeh, Seyed Jafar Aryankhesal, Aidin Med J Islam Repub Iran Original Article 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. Iran University of Medical Sciences 2023-07-17 /pmc/articles/PMC10439693/ /pubmed/37600636 http://dx.doi.org/10.47176/mjiri.37.80 Text en © 2023 Iran University of Medical Sciences https://creativecommons.org/licenses/by-nc-sa/1.0/This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial-ShareAlike 1.0 License (CC BY-NC-SA 1.0), which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.
spellingShingle Original Article
Moradi, Tayebeh
Kabir, Mohammad Javad
Pourasghari, Hamid
Ehsanzadeh, Seyed Jafar
Aryankhesal, Aidin
Challenges of Budgeting and Public Financial Management in Iran’s Health System: A Qualitative Study
title Challenges of Budgeting and Public Financial Management in Iran’s Health System: A Qualitative Study
title_full Challenges of Budgeting and Public Financial Management in Iran’s Health System: A Qualitative Study
title_fullStr Challenges of Budgeting and Public Financial Management in Iran’s Health System: A Qualitative Study
title_full_unstemmed Challenges of Budgeting and Public Financial Management in Iran’s Health System: A Qualitative Study
title_short Challenges of Budgeting and Public Financial Management in Iran’s Health System: A Qualitative Study
title_sort challenges of budgeting and public financial management in iran’s health system: a qualitative study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10439693/
https://www.ncbi.nlm.nih.gov/pubmed/37600636
http://dx.doi.org/10.47176/mjiri.37.80
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