Challenges in Managing Noncommunicable Diseases: Perspectives of Family Physicians Practicing in Public‒Private Partnerships: A Qualitative Study.

Background: Providing primary healthcare through a family physician team and referral system is an equitable and cost-effective model for preventing and managing noncommunicable diseases (NCDs). Aim: This study aimed to explore the challenges of managing NCDs from the perspective of family physicians practicing within the public-private partnerships (PPPs) model in the urban family physician program in Mazandaran Province, a region in northern Iran. Methods: This qualitative study was conducted using a conventional content analysis approach. A group of 17 general practitioners employed through PPPs was selected through purposive sampling and the snowball method to participate in the study. Semistructured in-depth interviews were conducted as the data collection method. Graneheim and Lundman's approach was utilized for data analysis. The coding process was performed via MAXQDA 2020 software. Results: The current challenges in managing NCDs were categorized into 8 main themes and 36 subthemes. Key themes including financing (poor financial management, lack of defined budget); equipment and infrastructure (lack of diagnostic tests and physical space); human resource (high workload, inadequate training, low motivation, and burnout); payment mechanism (issues related to per capita allocation, payment method, salary, and incentives); information system (multiple databases, poor data sharing, and low data quality); referral system (weak provider coordination, and electronic referral); health insurance (service coverage and low attention to the quality); and community engagement (weaknesses in implementing education initiatives and utilizing local capacities). Conclusion: The findings indicate significant obstacles in managing NCDs. Therefore, health policymakers and managers at the regional and national levels should develop and implement targeted plans to address key challenges in preventing and controlling NCDs through private family physician teams. Alternatively, the findings could provide insights into the private sector's participation in managing NCDs to health policymakers in other developing countries.