Iran's Health Transformation Plan; Main Issues and Opportunities for Improvement: A Systematic Review.

Background: The Health Transformation Plan (HTP), as the latest reform of Iran's health system, has been implemented gradually in several phases to facilitate the achievement of universal health coverage. We aimed to identify the achievements and challenges of the HTP from the beginning of its implementation in Iran health system. Methods: In this qualitative systematic review, English papers were searched in PubMed, Scopus, Web of science, and Google Scholar search engines in addition to Persian databases such as Magiran and SID from 2014-2020. The Mixed-Methods Appraisal Tool (MMAT) checklists were used to assess the quality of the studies. Study selection, quality assessment, data extraction, and data analysis were done independently by two people. For analyzing the data, the Framework Analysis Method, based on the health system function framework of the WHO, was used. Results: Overall, 32 papers were included based on the inclusion criteria. The results were divided into four main themes: stewardship, financing, resource generation and service delivery, and 20sub-themes in the form of achievements and challenges. Regulatory and standardization, service packages, medical equipment and supplies, and the quality of health services were more repetitive. Considering the challenges of HTP, purchase process, motivational factors, and health services capacity were more repetitive. Conclusion: The administrative challenges in the implementation of the HTP have prevented the sustainability of the outcomes and their main goals. The use of strategic dynamic planning, anticipating sustainable financial resources, and strengthening the monitoring mechanisms could lead to further achievements.