Exploring policy processes against microbial threats in Iran: a qualitative policy analysis.

Objectives: Microbial threats pose a growing concern worldwide. This paper reports the analysis of Iran's policy process against microbial threats.

Design: This is a qualitative study.

Participants: We interviewed 16 purposefully identified key informants selected through snowball sampling.

Setting: Through the lens of stages heuristic framework, we analysed the interviews by using thematic content analysis. We used MAXQDA V.2020 software for data analysis, identified key themes and subthemes and discussed our findings to validate the results.

Results: We extracted four main categories in accordance with the stages heuristic domains. Through content analysis of the agenda-setting process, we identified three main themes: magnitude of the problem, actors' power and priorities. Participants highlighted the significant impact of microbial threats, the influence of powerful stakeholders and the underprioritisation of infectious diseases based on perceived urgency and resources. In the process of policy formulation, we explored three main themes, related to governance, coherence and integration of policies and barriers to effective policy formulation. Governance issues included transparency, engagement with stakeholders, conflict of interest and use of evidence, while coherence and integration of policies focused on insufficient coherence and integration of plans as well as temporary and defensive policymaking. Barriers to effective policy formulation encompassed delay in policymaking, policy gap in response to public needs, weakness in policy feasibility, risk assessment and management. For policy implementation, we extracted governance and coordination, and health system capacity. Effective implementation of policies was hindered by fragmented governance, inadequate communication and accountability and systemic barriers, while health system capacity was limited in terms of infrastructure and human resources. Finally, content analysis of monitoring and evaluation (M&E) resulted in identification of two main themes: discrepancies in M&E and barriers to effective M&E. The discrepancies in M&E varied, with some programmes having regular evaluations and others lacking compliance with international standards. Barriers to effective M&E included inadequate data access, limited information-sharing and inefficiencies in the M&E system.

Conclusions: Iran needs to prioritise infectious diseases, invest in preventive measures, improve governance and coordination, strengthen health system capacity, enhance M&E and so on, to combat microbial threats effectively. Learning from successful experiences of other countries can help Iran develop more effective strategies to address microbial threats and strengthen global public health in the country.