نوع مقاله : مقاله پژوهشی
نویسندگان
1 دکترای تخصصی مدیریت خدمات بهداشتی درمانی، گروه مدیریت خدمات بهداشتی درمانی، دانشگاه آزاد اسلامی واحد شیراز، شیراز، ایران
2 دانشیار، گروه مدیریت خدمات بهداشتی و درمانی، دانشگاه آزاد اسلامی واحد تهران شمال، مرکز تحقیقات سیاست گذاری اقتصاد سلامت، دانشگاه علوم پزشکی آزاد اسلامی تهران، تهران، ایران
3 دانشیار، مرکز تحقیقات بهره‌برداری از دانش سلامت، مرکز تحقیق و توسعه سیاستهای داشگاه، دانشگاه علوم پزشکی تهران، تهران، ایران
4 استادیار، موسسه ملی تحقیقات سلامت، دانشگاه علوم پزشکی و خدمات بهداشتی و درمانی تهران، تهران، ایران
چکیده
مقدمه: ﺗﻤﺮﻛﺰ ﭘﺰﺷﻜﺎن در ﻣﻨﺎﻃﻖ ﺷﻬﺮی و ﻛﻤﺒﻮد ﭘﺰﺷﻚ ﻣﺘﺨﺼﺺ در ﻣﻨﺎﻃﻖ محروم ﻳﻚ چالش جهانی است. اﺗﺨﺎذ ﺳﻴﺎﺳﺖﻫﺎی ﻣﺸﺨﺺ، ﻋﻠﻤﻲ و ﻣﺒﺘﻨﻲ ﺑﺮ ﺷﻮاﻫﺪ در راﺳﺘﺎی اﻓﺰاﻳﺶ ﻣﻨﺎﺑﻊ ﺑﺨﺶ ﺳﻼﻣﺖ و ﻛﺎﻫﺶ ﻧﺎﺑﺮاﺑﺮی در ﺗﻮزﻳﻊ و ﺗﺨﺼﻴﺺ اﻳﻦ ﻣﻨﺎﺑﻊ در ﻣﻨﺎﻃﻖ ﻣﺨﺘﻠف ﻛﺸﻮر ﺿﺮوری است. وزارت بهداشت درمان و آموزش پزشکی به عنوان مهمترین متولی برنامه ریزی و سیاستگذاری در زمینه توزیع نیروی انسانی متخصص در ایران، سیاستهایی را طراحی نموده است. این تحقیق با هدف تحلیل سیاستهای تشویقی ماندگاری پزشکان در مناطق محروم کشور انجام گردید.
روش‌ها: این مطالعه، بصورت کیفی و گذشتهنگر در قالب تحلیل سیاستگذاری با استفاده از چارچوب مفهومی مثلث سیاستگذاری والت و گیلسون انجام گردید. برای تحلیل سیاستها از روشهای مختلفی ازجمله مرور متون و بررسی اسناد و مدارک استفاده شد.
یافته ها: یافتههای مطالعه براساس زمینه یا بافت سیاست، محتوای سیاست، فرآیند سیاستگذاری و نقشآفرینان در چهار قانون (سیاست یا طرح) خدمت پزشکان و پیراپزشکان، طرح پزشک خانواده، طرح تحول سلامت، و دستورالعمل نحوه توزیع فارغالتحصیلان رشتههای تخصصی پزشکی طبقهبندی گردید. پنج گروه عوامل قانونی، سیاسی، اقتصادی اجتماعی فرهنگی، بینالمللی و عوامل ساختاری به عنوان زمینهساز سیاستها شناسایی شدند. توجه به اسناد بالادستی و استفاده از شواهد در سیاستگذاریها به عنوان نقاط قوت و نادیدهگرفتن ذینفعان و رویکرد بالا به پایین در برنامهریزی از نقاط ضعف مشترک سیاستها، شناسایی شدند.
نتیجه گیری: در تدوین و اجرای سیاستها و مداخلات، توجه به اولویت نیازها، تامین منابع و الزامات، تعامل سازنده نقشآفرینان و ارزیابی مستمر برنامهها ضروری است.
کلیدواژه‌ها
عنوان مقاله [English]
Analysis of Physicians' Retention Policies in Deprived Areas of the Islamic Republic of Iran
نویسندگان [English]
- Fereshte Davari 1
- Khalil Alimohammadzadeh 2
- Hanieh Sadat Sajadi 3
- Elham Ehsani-Chimeh 4
1 Ph.D. of Health Care Management, Department of Health Services Management, Shiraz Branch, Islamic Azad University, Shiraz, Iran
2 M.D., Ph.D., Department of Health Services Management, North Tehran Branch, Islamic Azad University, Economics Policy Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
3 Ph.D., Associate Professor, Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
4 Ph.D., Assistant Professor, National Institute for Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
چکیده [English]
Introduction: The concentration of physicians in urban areas and the lack of specialist physicians in deprived areas is a global challenge. It is necessary to adopt specific, scientific and evidence-based policies to increase the health sector’s resources and reduce inequality in the distribution and allocation of these resources in different regions of the country. The Ministry of Health and Medical Education, as the most important custodian of planning and policy-making for distribution of specialized manpower in Iran, has designed policies.
Methods: This study aimed to analyze the incentive policies for the retaining physicians in deprived areas of the country. This study has a qualitative – retrospective design to analyze the most effective policies using the Walt and Gilson policy model. Various methods were used to analyze the policies, including reviewing texts and documents.
Results: Findings of the study were classified based on the policy context, policy content, policy-making process and role makers in the four law (policies or plan) of service of physicians and paramedics, family physician plan, health transformation plan, and instructions on how to distribute the Specialized medical graduates. Five legal, political-economic, socio-cultural, international and structural factors were identified as policy making factors. In addition, attention to upstream documents and the use of evidence in policy-making were identified as strong points, and stakeholder ignorance and a top-down approach to planning were identified as common weak points of policies.
Conclusion: Considering the priority of needs, provision of resources and requirements, constructive interaction of planners, and continuous evaluation of programs are required to formulate and implement policies and interventions.
کلیدواژه‌ها [English]
- Policy analysis
- Survival
- Physicians
- Deprived areas
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