Prerequisites for implementing accreditation in Iran's comprehensive healthcare centers: a qualitative study.

Background: The primary health care system is acknowledged as the essential entry point to health services. In Iran, primary health care has historically been a key focus for policymakers. However, the accreditation of these services has only recently gained attention as a significant consideration. This study aims to qualitatively examine the prerequisites necessary for the effective implementation of accreditation programs within the primary health care system.

Methods: This qualitative study was conducted using semi-structured interviews with a diverse group of participants, including specialists from the Iran Ministry of Health, managers of comprehensive health centers in Kerman, physicians, and representatives from the Deputy of Health at Tehran, Kerman, and Mashhad Universities of Medical Sciences. Purposive sampling was utilized through a snowball approach. Content analysis and MAXQDA12 software were used for data analyzing.

Results: The results showed that various factors are prerequisites for the accreditation program. These requirements were subthemes of the three major concepts introduced by Avedis Donabedian, i.e., structure, process, and outcome. Structural challenges encompassed programs, culture, accreditation platforms, evaluation teams, and motivation. Process challenges included program comprehensiveness, financial resource sustainability, implementation leveling, knowledge translation, implementation protocols, comprehensive training, accreditation standards, and system design. On the basis of the Donabedian model, the results section includes the outcome and expected output. With respect to the challenges of the accreditation program, most of the issues raised by the participants were related to the fundamental and structural defects of the country's healthcare system.

Conclusion: The challenges faced in the accreditation program are largely rooted in the fundamental and structural defects of the country's healthcare system. The prerequisites for effective accreditation are not limited to the process itself; rather, they are heavily influenced by broader systemic issues related to the program, culture, resources, and overall design of the healthcare infrastructure. Addressing these underlying structural problems is crucial for the successful implementation and sustainability of the accreditation program. In any case, without considering major challenges, the implementation of the accreditation program could face serious problems.