title: A conceptual framework for evaluation of public health and primary care system performance in iran.
abstract: BACKGROUND
  The main objective of this study was to design a conceptual framework, according to the policies and priorities of the ministry of health to evaluate provincial public health and primary care performance and to assess their share in the overall health impacts of the community.
  
  
  METHODS
  We used several tools and techniques, including system thinking, literature review to identify relevant attributes of health system performance framework and interview with the key stakeholders. The PubMed, Scopus, web of science, Google Scholar and two specialized databases of Persian language literature (IranMedex and SID) were searched using main terms and keywords. Following decision-making and collective agreement among the different stakeholders, 51 core indicators were chosen from among 602 obtained indicators in a four stage process, for monitoring and evaluation of Health Deputies.
  
  
  RESULTS
  We proposed a conceptual framework by identifying the performance area for Health Deputies between other determinants of health, as well as introducing a chain of results, for performance, consisting of Input, Process, Output and Outcome indicators. We also proposed 5 dimensions for measuring the performance of Health Deputies, consisting of efficiency, effectiveness, equity, access and improvement of health status.
  
  
  CONCLUSIONS
  The proposed Conceptual Framework illustrates clearly the Health Deputies success in achieving best results and consequences of health in the country. Having the relative commitment of the ministry of health and Health Deputies at the University of Medical Sciences is essential for full implementation of this framework and providing the annual performance report.
authors.forename: Nader
authors.initials: N
authors.lastname: Jahanmehr
authors.affiliation: 1 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2 Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 3 Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran. arashidian@tums.ac.ir.
authors.forename: Arash
authors.initials: A
authors.lastname: Rashidian
authors.forename: Ardeshir
authors.initials: A
authors.lastname: Khosravi
authors.forename: Farshad
authors.initials: F
authors.lastname: Farzadfar
authors.forename: Mohammad
authors.initials: M
authors.lastname: Shariati
authors.forename: Reza
authors.initials: R
authors.lastname: Majdzadeh
authors.forename: Ali
authors.initials: A
authors.lastname: Akbari Sari
authors.forename: Alireza
authors.initials: A
authors.lastname: Mesdaghinia
mesh_terms: D006304:Health Status; D006801:Humans; D007492:Iran; D011320:Primary Health Care / Q000592:standards*; D011634:Public Health / Q000592:standards*; D011787:Quality of Health Care