Volume 24, Issue 5 (Dec - Jan 2021)                   2021, 24(5): 454-461 | Back to browse issues page

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Salary M R, Rahnavard F, Hamidi N, Memarzadeh Tehran G. Presenting an Optimization Model for Performing Health Care Tasks by the Iranian Government. Journal of Inflammatory Diseases. 2021; 24 (5) :454-461
URL: http://journal.qums.ac.ir/article-1-3146-en.html
1- Department of Public Administration, Qazvin Branch, Islamic Azad University, Qazvin, Iran.
2- Department of Public Administration, Institute for management and Planning Studies (IMPS), Tehran, Iran. , frahnavard@imps.ac.ir
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1. Introduction
Governments face a wide range of tasks. It is important to discuss what the duties of a government are, because it can determine whether the task should be performed by the government or can be delegated to non-governmental actors [1]. The complicated responsibilities of the governments are defined by the concept of “Governance” [2]. It refers to a set of institutions and actors that work effectively together to manage public affairs. In modern societies, governments delegate their responsibilities to other actors [3]. These interactions can create a best form of governance [4]. Ensuring health is one of the essential duties of governments [5]. Today, with the introduction of new models of governance, there is disagreement about the interaction of the government, the private sector, and the third actor for performing the major governmental tasks [6]. There is disagreement among management theorists in this regard, and they consider some of this interaction and governance level to have the best result of implementation [7]. Future developments in governmental management recognize different contributions and roles for the private sector, civil society and the public sector [8]. The relationship between the level of delegation, participation and governance has less been addressed in literature. Therefore, this study aims to determine the best level of interference and governance for each actor for having optimal performance in health care tasks.

2. Materials and Methods
This is an applied and descriptive study conducted from August 2019 to May 2020 in Iran. Participants were 350 managers and deputies of public, private and non-governmental organizations (5 from each organization selected using a convenience sampling method) as well as 8 governmental management experts whose opinions were used to identify the role of governmental actors in performing health care tasks. Other data were extracted from the Sixth National Socio Economic Cultural Development Plan. To determine the role of governmental actors (private sector, military organizations, government, and civil society) in performing health care tasks at three action levels of governance (individual, organizational, and systemic), we interviewed a panel of experts. The content of the focus group discussion was analyzed based on the frequency of responses. Quantitative data were collected using a researcher-made questionnaire. To build the quantitative model, a hierarchical fuzzy inference system in MATLAB 2016 software was used.

3. Results
First, the experts’ final comments on the role of governmental actors in performing health care tasks at the three action levels were collected. According to the hierarchical fuzzy inference system results, at the individual level, the role scores of government, private sector, and civil society were 8.37, 8.5, and 9.1, respectively with an overall score of 9.02. At the organizational level, the role scores of government and private sector was 7.15 and 7.3, respectively with an overall score of 7.47. At the systemic level, the role scores of government, private sector, and the military organizations was 7.89, 7.22, and 7, respectively with an overall score of 7.27. Considering the overall scores at three levels, the definite score for health care tasks was 8.3. The results of the output variable behavior analysis showed that the interference in health affairs at the individual action level of governance was more effective than other levels in having an optimal performance in health care tasks.

4. Discussion and Conclusion
In the present study, assessing the role of governmental actors in performing health care tasks showed that the public and private sectors and civil society had a role at the individual action level of governance, where the civil society had more important role. Given that, at the individual level, performing these tasks requires the highest level of contact with society and individuals play a critical role in this process, and considering that culturalization and the use of maximum public power is the basis for performing these tasks, delegating such tasks to civil society can be more effective. The public and private sectors had a role at the organizational action level, where the private sector had more important role for having optimal performance. Therefore, it can be said that, at the organizational level, the role of the private sector in the performance of governance tasks is more prominent. Since the main goal is to establish the necessary mechanisms to implement governance policies, it is worth delegating the work to the private sector, because this sector performs faster with higher productivity in creating the mechanisms required for implementing policies. At the systemic level, the public, private and military sectors had role in performing health care tasks; where the public sector had more important role for having optimal performance. Since the systemic level is the level of policy formulation, the government should formulate the policies to be accountable to them and monitor the implementation of affairs. The results of this study are consistent with the findings of Rahnavard [16] and Mcloughlin [17] in terms of the interaction of governmental actors to optimally perform of macro-tasks of the government. In line with the results of Lewis [18], the current study indicated to the equal role of the private sector and the government. Consistent with the results of Clark [19], the present study pointed to vital role of civil society in governance.
It is suggested that health affairs should be delegated to civil society at the individual level. In order for civil society to perform health care tasks effectively, non-governmental organizations should be strengthened through education, culturalization, and empowerment. It is better to delegate the health care tasks to the private sector at the organizational level. This requires strengthening management, participation and meritocracy in the private sector, and supervision by the government. At the system level, it is suggested that the health care tasks should be left to the government. The government should formulate appropriate policies through negotiations with other actors and organizations and monitoring the implementation in order to be able to implement them effectively. Optimizing the macro-tasks of the government in the field of health requires the government’s special attention to the interaction of civil society and the public, private, and military sectors.

Ethical Considerations
Compliance with ethical guidelines

All ethical principles were observed in writing this article. 

This study was extracted from the PhD. dissertation of the first author at the Department of Public Administration, Qazvin Branch, Islamic Azad University, Qazvin. 

Authors' contributions
All authors contributed equally in preparing this article. 

Conflict of interest
The authors declare no conflict of interest.

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Type of Study: Short communication | Subject: Health Care Management

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