title: Implementing family physician programme in rural Iran: exploring the role of an existing primary health care network.
abstract: BACKGROUND
  The primary health care (PHC) network contributed considerably to improving health outcomes in rural Iran. However, the health system suffers from inadequate responses to ever-increasing demands. In 2005, a reform comprised of a family physician (FP) programme and universal health insurance was implemented in all rural areas and cities with a population of <20 000. We explored the role of the pre-existing PHC network on the implementation of FP programme in rural Iran.
  
  
  METHODS
  We conducted a qualitative study involving 71 semi-structured interviews at national, provincial and local levels, and three focus group discussions at local level, plus a purposeful content analysis of documents of various types. We used a mixed inductive/deductive framework approach for data analysis.
  
  
  RESULTS
  We identified seven main aspects related to the existing primary health network, which contributed to the implementation of FP programme: 'a respected and functioning PHC network', 'accessibility and geographical coverage', 'efficient hierarchy', 'the only possible host', 'a remedy for chronic challenges in the rural PHC', 'FP as the gatekeeper?' and 'the role of the private sector'. The existence of a functioning PHC was pivotal in driving policy makers' decision to implement FP programme.
  
  
  CONCLUSIONS
  Implementing a new policy depends on its hosting context. In regards to FP programme and rural insurance in Iran, the existing PHC network proved to be a fundamental asset in facilitating the implementation of FP programme in rural areas.
authors.affiliation: Division of Health Studies, School of Health Sciences & Social Care, Brunel University London, Uxbridge, UK.
authors.forename: Amirhossein
authors.initials: A
authors.lastname: Takian
authors.forename: Leila
authors.initials: L
authors.lastname: Doshmangir
authors.forename: Arash
authors.initials: A
authors.lastname: Rashidian
mesh_terms: D017598:Efficiency, Organizational; D005194:Family Practice / Q000458:organization & administration*; D017144:Focus Groups; D020793:Gatekeeping / Q000458:organization & administration; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D007492:Iran; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D055818:Public-Private Sector Partnerships; D019035:Rural Health Services / Q000458:organization & administration*; D019472:Universal Health Insurance
keywords: Family medicine; Iran; family physician; policy implementation; primary  health care; primary care; universal health insurance.