Exploring health stakeholders' perceptions on moving towards comprehensive primary health care to address childhood malnutrition in Iran: a qualitative study
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Date
2009-02
Authors
Javanparast, Sara
Coveney, John David
Saikia, Udoy Sankar
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Rights
© 2009 Javanparast et al; licensee BioMed Central Ltd.
Rights Holder
Javanparast et al; licensee BioMed Central Ltd.
Abstract
Background: Due to the multifaceted aspect of child malnutrition, a comprehensive approach, taking social factors into
account, has been frequently recommended in health literature. The Alma-Ata declaration explicitly outlined comprehensive
primary health care as an approach that addresses the social, economic and political causes of poor health and nutrition.
Iran as a signatory country to the Alma Ata Declaration has established primary health care since 1979 with significant progress
on many health indicators during the last three decades. However, the primary health care system is still challenged to reduce
inequity in conditions such as child malnutrition which trace back to social factors. This study aimed to explore the perceptions
of the Iranian health stakeholders with respect to the Iranian primary health care performance and actions to move towards a
comprehensive approach in addressing childhood malnutrition. Health stakeholders are defined as those who affect or can be
affected by health system, for example health policy-makers, health providers or health service recipients.
Methods: Stakeholder analysis approach was undertaken using a qualitative research method. Different levels of stakeholders,
including health policy-makers, health providers and community members were interviewed as either individuals or focus
groups. Qualitative content analysis was used to interpret and compare/contrast the viewpoints of the study participants.
Results: The results demonstrated that fundamental differences exist in the perceptions of different health stakeholders in the
understanding of comprehensive notion and action. Health policy-makers mainly believed in the need for a secure health
management environment and the necessity for a whole of the government approach to enhance collaborative action.
Community health workers, on the other hand, indicated that staff motivation, advocacy and involvement are the main
challenges need to be addressed. Turning to community stakeholders, greater emphasis has been placed on community
capabilities, informal link with other social sectors based on trust and local initiatives.
Conclusion: This research provided a picture of the differences in the perceptions and values of different stakeholders with
respect to primary health care concepts. The study suggests that a top-down approach, which still exists among health policymakers,
is a key obstacle that delays, and possibly worse, undermines the implementation of the comprehensive strategy codified
by the Alma-Ata Declaration. A need to revitalise primary health care to use its full potential and to combine top-down and
bottom-up approaches by narrowing the gap between perceptions of policy makers and those who provide and receive healthrelated
services is crucial.
Description
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Citation
Javanparast, S., Coveney, J.D., & Saikia, U.S., 2009. Exploring health stakeholders' perceptions on moving towards comprehensive primary health care to address childhood malnutrition in Iran: a qualitative study. BMC Health Services Research, 9(36).