title: How Health in All Policies are developed and implemented in a developing country? A case study of a HiAP initiative in Iran.
abstract: Population health is influenced by many factors beyond the control of health system which should be addressed by other sectors through inter-sectoral collaboration (ISC). Countries have adopted diverse initiatives to operationalize ISC for health such as establishment of Councils of Health and Food Security (CHFSs) and development of provincial Health Master Plans (HMPs) in Iran. The literature, however, provides meager information on how these initiatives have been moved into the top policy agenda, how and by whom they have been formulated and what factors enable or inhibit their implementation. In addressing these knowledge gaps, we employed a qualitative case study approach, incorporating mixed methods: in-depth interviews and a textual analysis of policy documents. Iran founded the Supreme Council of Health and Food Security (SCHFS) at national level in 2006 followed by provincial and district CHFSs to ensure political commitment to ISC for health and Health in All Policies (HiAPs). In 2009, the SCHFS mandated all provincial CHFSs across the country to develop provincial HMP to operationalize the HiAP approach and Kerman was among the first provinces which responded to this call. We selected Kerman province HMP as a case study to investigate the research questions raised in this study. The study revealed two types of leverage, which played crucial role in agenda setting, policy formulation and implementation of HMP including politics (political commitment) and policy entrepreneurs. The multiple streams model was found to be informative for thinking about different stages of a policy cycle including agenda setting, policy formulation and policy implementation. It was also found to be a useful framework in analyzing HiAP initiatives as these policies do not smoothly and readily reach the policy agenda.
authors.affiliation: Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran akhayatzadeh@kmu.ac.ir.
authors.forename: Akram
authors.initials: A
authors.lastname: Khayatzadeh-Mahani
authors.affiliation: Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Zeynab
authors.initials: Z
authors.lastname: Sedoghi
authors.affiliation: Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Mehrolhassani
authors.affiliation: Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.|Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Vahid
authors.initials: V
authors.lastname: Yazdi-Feyzabadi
mesh_terms: D003906:Developing Countries; D006291:Health Policy; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007492:Iran; D011050:Policy Making; D011057:Politics; D016730:Program Development
keywords: Health in All Policies; Iranian health system; Kingdon multiple streams model; inter-sectoral collaboration for health