title: Managerial barriers and challenges in Iran public health system: East Azerbaijan health managers' perspective.
abstract: OBJECTIVE
  To investigate managerial barriers and challenges facing East Azerbaijan Province health system.
  
  
  METHODS
  This qualitative study was conducted in Tabriz, Iran, from August 2014 to August 2015, and comprised professionals, experts and informants working at the East Azerbaijan Health Centre. Data was collected through focus group discussions and semi-structured, face-to-face, individual and group interviews were conducted. Interviews and focus group discussions were taped, transcribed and analysed using content analysis method..
  
  
  RESULTS
  Of the 46 participants, 29(63%) were male and 17(37%) were female. Moreover, 15(33%) participants were head of their respective units and 8(17%) were district health managers. Managerial barriers witnessed during the study period differed between the three managerial levels of interest, i.e., district health centres, provincial health centre departments and top levels of provincial health centre and macro-management systems outside the health centre. Lack of management training, inadequate resources, unclear duties and responsibilities were considered to be the most common barriers facing district health centres. Unclear budgeting mechanisms, instability of management positions and shortage of trained staff on provincial and district levels were reported to be managerial barriers in provincial health centre departments. Political interference in technical decisions, treatment-based approaches, lack of clear career paths on all levels of health system management, unnecessary bureaucracy lying within inter-organisational relationships and ineffective employment legislation were identified as managerial barriers on top levels of the provincial health system and in macro-management systems independent of the health system.
  
  
  CONCLUSIONS
  Diverse challenges influenced the performance of health managers.
authors.affiliation: Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Jafar Sadegh
authors.initials: JS
authors.lastname: Tabrizi
authors.affiliation: Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Kamal
authors.initials: K
authors.lastname: Gholipour
authors.affiliation: Research Center of Psychiatry and Behavioural Sciences, Razi Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Farahbakhsh
authors.affiliation: East Azerbaijan Provincial Health Centre, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Hasanzadeh
mesh_terms: D001382:Azerbaijan; D005260:Female; D006801:Humans; D007492:Iran; D007857:Leadership; D008297:Male; D009937:Organizational Objectives; D011634:Public Health / Q000592:standards / Q000706:statistics & numerical data; D011635:Public Health Administration
keywords:  Health system, District health management, Managerial barriers, Managerial challenges. 