مطالعه تطبیقی مکانیزم تمرکز زدایی درارایه خدمات سلامت کشورهای مختلف و ارائه الگو برای ایران

Introduction: Iran's health system is encountered with a variety of challenges and problems due to the issues of quality, relevancy, and effectiveness. The main reason of inefficacy in health system is unnecessary centralization. In the latest decade, health sector decentralization polices have been implemented on a broad scale throughout world especially in developing countries. Decentralization is transfer of decision making authority from central ministry of health (MOH) to preferable units or alternate institutions to Improve productivity. The main objectives of this research were to review in decentralization at provision of services and presenting a model for Iran. Methods: In this comparative research, mechanisms of decentralization in England, Turkey, Zambia, Ghana, Mexico, Thailand, France, Chile, Sweden, and Philippines were reviewed in order to prepare an appropriate model for Iranian health system. The valid mechanisms in function of delivering services proposed in a model for Iran. The developed model in the form of a questionnaire using Delphi techniques was distributed among informant and experts such as health management professors, heads of medical universities and authorities of MOH and vice chancellors. Results: Analysis of 35 collected questionnaire indicated that all participated subject agreed with appropriate this new developed model. Also the model was statically confirmed the significant of results (P<0/05). Conclusion: Constituents of the model are: Decentralizing in provision of services to provincial level and delegating of social services for aged people, disabilities and un- attended children to ministry of welfare and social security or municipalities.