Table 3 The weaknesses of the Primary Health Care Expansion Program

Outsourcing model in PHC

The private sector does not take the responsibility

Service outsourcing model is not clear for stakeholders

Outsourcing implementation method has weaknesses

Employing with different contract and payment methods

The outsourcing model is not appropriate

Not using previous experiences and models implemented in the system

Performance monitoring and evaluation

There is no standard evaluation tool to measure professional performance

Private companies aim at profit and do not pay attention to performance

Basis of payment is the service registration. The services have not been properly defined

Monitoring and evaluation do not affect the salaries which are not based on performance

Companies do not have the ability to perform specialized monitoring

Due to the large movement of employees, proper monitoring can’t be done

Recruitment models and delays in payments impact the evaluation negatively

Human resource management

Incorrect mechanism of recruitment and distribution of human resources

There is no balance between workload, manpower and pay scale

Lack of promotion system and job security and the stress of dismissal

Delays in payment reduce the motivation to improve performance

Inadequate response to human resources needs

Lack of amenities and space for providing services

Payment mechanisms

The payment mechanism is not proportional to the type and load of services

The payment mechanism is not based on performance

The payment mechanism does not motivate the provision of prevention services

Using two different payment models in health centers

Delays in payment of salaries and irresponsibility of the private company

The payment mechanism is not fair and does not include incentives

Referral system

Weakness in providing patient care due to the lack of communication between level one and two of health network

Disconnection between electronic patient record systems in private and public sectors

Weak connection of medical specialists with PHC

Problems in patient care due to the weak patient referral system

lack of a proper referral system

Project Management

Implementation of the program without pilot and evaluation phase

The purpose of outsourcing has gone from productivity to human resources supply

Legislative challenges

Unequal distribution of resources

Focus on the design and implementation methods and not actual performance

Failure to delegate authority to the private sector

Not introducing PHC to the target population

Efficiency and effectiveness

Failure to achieve the goals

Low productivity

Low efficiency of private employees

The cost-benefit ratio is low and the resources do not have the necessary efficiency

Choosing an inappropriate outsourcing model in PHC

Not using past experiences and opportunities such as the rural family doctor model