Journal of School of Public Health and

  Background and Aim : Equitable improvement of the national health situation in Iran requires a sufficient and logical balance between preventive and curative needs. Considering the profound changes that have occurred in disease patterns and the population over the last three decades, it is essential to review the ongoing preventive services with due consideration of the current and future needs of the population in an attempt to provide more effective and appropriate services. The provincial health deputies (PHDs, vice-chancellors of the universities of medical sciences), who are responsible for establishing and adjusting new preventive health services, are confronted with many challenges in this matter. A thorough knowledge of these challenges will help greatly in developing strategies aiming at improving the national preventive health services.

  Materials and Methods : The participants in this study were the PHDs throughout the country. Data were collected through interviews and focus-group discussions. The main question was "What are the challenges and procedures in the area of preventive health services in the Iranian universities of medical sciences in the stewardship/supervision, resources and services domains?".

  Results : Results of the study reveal that PHDs have various challenges that have increased over time because of their persistency and the additional burden of the family physician program and referral system, and the effects are quite apparent in both the staff domain and in the universities where the family physician program is being executed. Although the challenges in all the three domains of stewardship, resources and service provision are not equally distributed, service and resource provision domains suffer most. However, solutions to the problem proposed by the participants emphasize on improvement of stewardship in the domain of public health. The universities consider the Ministry of Health and Medical Education to be the main culprit for these problems.

  Conclusion : The existing challenges will prevent establishment of legal articles of the 5^th ational Development Plan in the health sector. In order to promote the health situation in Iran on an equitable basis (achievement of better health indices), at least ten actions to be taken in the universities of medical sciences at the national level are required: activation of the High Council of Health and Food Security and encouraging social accountability of all the governmental, private, and nongovernmental sectors developing a ten-year plan for preventive health and intersectoral collaboration specifying general and specific annual expectations from preventive health departments of medical universities in the form of memoranda of understanding (MoUs) and creating health oriented competition among provinces and cities adopting a model for provision of health services in cities and suburban areas in coordination with the family health program and the referral system evaluating and integrating the existing preventive health programs elimination of overlapping units in the organizational chart at the central level increasing funds for the national preventive health services programs and not letting use of these funds for other programs measuring general satisfaction of the preventive health managers and employees and maintaining and promoting human resources of the health sector expansion of preventive health services coverage down to the district level and, finally, better management of the facilities, equipment and standards of health centers.