Stewardship Challenges in Long-Term Care for the Elderly Adults: A Qualitative Study of the Iranian Health System

Abstract

Background and Aim: With the emergence of demographic shifts and the growth of the elderly population in Iran in recent decades, there is a need to reform and revise health policies to improve service delivery and better address the needs of older adults. Establishing and developing a sustainable and equitable care system to meet long-term needs and achieve universal health coverage is a priority for many countries worldwide. The aim of this study was to identify the challenges associated with long-term care within the Iranian health system.

Materials and Methods: In this study, 17 health system managers and experts (14 males and 3 females), were interviewed. This qualitative study was conducted in 2021 to explore the perspectives of 17 experts and senior managers from the Ministry of Health, the Ministry of Cooperatives, Labor, and Social Welfare, as well as from Universities of Medical Sciences and health services. Participants were selected through purposive sampling. Data were collected via semi-structured interviews, which continued until data saturation was achieved. The Braun and Clarke content analysis method was employed to analyze the findings.

Results: In this study, 17 health system managers and experts were interviewed (14 men and 3 women). The challenges of long-term care stewardship in the Iranian health system were categorized into two main areas: policy-making and evidence generation, intra-sectoral governance, and inter-sectoral leadership. These were further divided into seven sub-themes: conflict of interest in policy-making; lack of comprehensiveness in aging- related policies; weaknesses in evidence-based policy-making; discontinuity in long-term care stewardship; inappropriate organizational structure; health system infrastructure problems; and weak inter-sectoral relationships. Key challenges included the prioritization of acute and hospital-based care, a treatment-oriented perspective in health policy formulation, inadequate intelligent and forward-looking planning to address demographic changes, lack of transparency in elderly and long-term care, unclear designation of long-term care custodianship within the Ministry of Health, limited national scientific evidence on long-term care and economic efficiency, intra-sectoral conflicts, and unstructured, weak relationships among various actors involved in long-term care.

Conclusion: For the effective development of long-term care systems, it is essential to prioritize policy-making and planning within the long-term care framework. To clearly define the roles and responsibilities of each level of government and to strengthen the accountability of public institutions at the national, regional, and local levels. This approach can help improve the quality of services, better address the needs of the elderly population and patients with chronic conditions, and prompt a review of long-term care management.