Managerial barriers and challenges in iran public health system: East Azerbaijan health managers’ perspective

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. conclusion: diverse challenges influenced the performance of health managers. © 2017,pakistan medical association. all rights reserved.