title: Using an Analytical Framework to Explain the Formation of Primary Health Care in Rural Iran in the 1980s.
abstract: BACKGROUND
  In the 1980s, PHC implementation promoted the health care delivery and overall health status of the population in Iran. Identifying the crucial design and implementation aspects of the PHC program can highlight the way it was implemented in a difficult sociopolitical environment. Using a policy analysis approach unfolds the details of implementation in a context which was not overtly convenient for a great health system reform.
  
  
  METHODS
  We conducted semi-structured interviews with 35 key participants and collected relevant literature and documents. We used a policy triangle framework to conceptualize the study and used a thematic data analysis approach to analyze the verbatim transcribed texts and documents. Data were analyzed with regard to the context, content, process and actors of the policy.
  
  
  RESULTS
  Proper use of the conditions and opportunities, during the first years after a revolutionary political change resulted in the establishment of a PHC network in Iran. Talented actors, clear content with agreed objectives and a top-down approach to the implementation in a special sociopolitical context were the main influential factors to fulfillment of the PHC policy in Iran. However, full implementation of the policy was hampered by the failure of some main components like referral system.
  
  
  CONCLUSIONS
  The policy triangle framework helped us to separate the different components of the PHC policy denoting that successful implementation of a policy requires attention to all related elements. Policy actors should invest in the development of an effective advocacy coalition, while giving ample attention to the implementation concerns. National health policies can be materialized even during financial hardships, if they align with the wider expectations of the public and politicians.
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, Deputy for Health Affairs, Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Esmaeil
authors.initials: E
authors.lastname: Moshiri
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, 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.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Arab
authors.affiliation: Deputy for Public Health, Iranian Ministry of Health and Medical Education, Tehran, Iran.
authors.forename: Ardeshir
authors.initials: A
authors.lastname: Khosravi
mesh_terms: D006291:Health Policy; D049673:History, 20th Century; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007407:Interviews as Topic; D007492:Iran; D008017:Life Expectancy / Q000639:trends; D011050:Policy Making; D011320:Primary Health Care / Q000266:history* / Q000331:legislation & jurisprudence*; D036301:Qualitative Research; D019035:Rural Health Services / Q000592:standards*