1- Ph.D. student of Public Administration, S.R.C., Islamic Azad University, Tehran, Iran
2- Associate Professor, Department of Public Administration, S.R.C., Islamic Azad University, Tehran, Iran ,g.amirnejad@iau.ac.ir
3- Professor, Department of Economics and Social Sciences, Shahid Chamran University of Ahvaz, Ahvaz, Iran
4- Professor, Department of Public Administration, S.R.C., Islamic Azad University, Tehran, Iran
2- Associate Professor, Department of Public Administration, S.R.C., Islamic Azad University, Tehran, Iran ,
3- Professor, Department of Economics and Social Sciences, Shahid Chamran University of Ahvaz, Ahvaz, Iran
4- Professor, Department of Public Administration, S.R.C., Islamic Azad University, Tehran, Iran
Abstract: (16 Views)
Background: Health system governance, as one of the most critical domains of public health management, plays a decisive role in enhancing efficiency, transparency, accountability, and inter-institutional coordination. In many countries, the inclusion of civil institutions within the framework of health governance has been introduced as an effective mechanism for improving the legitimacy and effectiveness of decision-making processes. Despite the growing body of research on health governance, the specific role of civil institutions within an indigenous model has received limited scholarly attention. Therefore, the present study aimed to design a model of health system governance with an emphasis on civil institutions.
Methods: This study employed a mixed-methods approach using an exploratory sequential design, conducted between October 2024 and June 2025, in three stages. In the first stage, the Fuzzy Delphi Technique was applied through three iterative rounds to identify the principal dimensions and key components. The statistical population consisted of 15 experts from the fields of health and civil society, including senior policymakers, Ministry of Health consultants, NGO managers, senior experts in health insurance organizations, and representatives of patient associations, particularly support groups for individuals with chronic conditions. Participants were selected through the snowball sampling method. Data collection instruments included a Delphi questionnaire, an expertise checklist, and a researcher-developed questionnaire comprising five dimensions and 24 components in the quantitative phase. A stratified random sampling method was employed, and sample size included 386 individuals. Data were analyzed using structural equation modeling (SEM), path analysis, and confirmatory factor analysis (CFA) via SmartPLS 4 software.
Results: The results revealed that health system governance, focusing on civil institutions, consists of five major dimensions: network governance, collaboration and participation, financial resource management, transparent governance, and monitoring and evaluation. Furthermore, all components of the model showed statistically significant relationships with the main construct, with network governance demonstrating the highest factor loading, and public participation being identified as its key component.
Conclusion: According to the findings, civil-society–based health governance can substantially enhance transparency, improve efficiency, and strengthen inter-organizational collaboration. The novelty of this study lies in its emphasis on the role of civil institutions in health governance and the integrated use of the Fuzzy Delphi technique and structural equation modeling. It is recommended that policymakers promote the institutional position of civil organizations, increase the transparency of financial mechanisms, and establish continuous feedback systems to create the necessary conditions for achieving excellent health governance.
Methods: This study employed a mixed-methods approach using an exploratory sequential design, conducted between October 2024 and June 2025, in three stages. In the first stage, the Fuzzy Delphi Technique was applied through three iterative rounds to identify the principal dimensions and key components. The statistical population consisted of 15 experts from the fields of health and civil society, including senior policymakers, Ministry of Health consultants, NGO managers, senior experts in health insurance organizations, and representatives of patient associations, particularly support groups for individuals with chronic conditions. Participants were selected through the snowball sampling method. Data collection instruments included a Delphi questionnaire, an expertise checklist, and a researcher-developed questionnaire comprising five dimensions and 24 components in the quantitative phase. A stratified random sampling method was employed, and sample size included 386 individuals. Data were analyzed using structural equation modeling (SEM), path analysis, and confirmatory factor analysis (CFA) via SmartPLS 4 software.
Results: The results revealed that health system governance, focusing on civil institutions, consists of five major dimensions: network governance, collaboration and participation, financial resource management, transparent governance, and monitoring and evaluation. Furthermore, all components of the model showed statistically significant relationships with the main construct, with network governance demonstrating the highest factor loading, and public participation being identified as its key component.
Conclusion: According to the findings, civil-society–based health governance can substantially enhance transparency, improve efficiency, and strengthen inter-organizational collaboration. The novelty of this study lies in its emphasis on the role of civil institutions in health governance and the integrated use of the Fuzzy Delphi technique and structural equation modeling. It is recommended that policymakers promote the institutional position of civil organizations, increase the transparency of financial mechanisms, and establish continuous feedback systems to create the necessary conditions for achieving excellent health governance.
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