Good Governance in Primary Health Care Centers: Real-life evidence from Iran

Abstract Introduction: Primary Health Care (PHC) plays a crucial role in promoting equitable health outcomes by improving access and addressing the diverse needs of populations. Evaluating good governance at the level of primary health care center is vital to identify managerial strengths and weaknesses, thereby informing policies aimed at enhancing system performance. This study aims to assess the status of good governance in Comprehensive Health Care Centers (CHCCs) affiliated with Tehran University of Medical Sciences (TUMS) in Tehran Province. Methods This cross-sectional study was conducted between October 2024 and March 2025 across 30 CHCs. Data were collected using a researcher-developed, validated Good Governance Assessment Checklist through face-to-face interviews with key stakeholders. Stratified sampling was employed drawing on their service area and administration type to ensure proportional representation across three district health networks. In addition, documents such as organizational charts, job descriptions, and performance reports were reviewed. Quantitative data were analyzed using SPSS26 and descriptive statistics. Results The average score of 34.39 (out of 100), indicates a fairly low level for good governance in the centers. The conscience dimension scored the highest (66.00), while professional ethics and rights received the lowest score (6.66). The superior governance scores of urban–rural centers suggest that hybrid management models may better accommodate local diversity and resource variability. Moreover, the outsourced CHCCs showed better performance in key areas such as Conscience, Monitoring and Evaluation, Rule of Law, Transparency, and Strategic Planning. However, in such areas as Responsiveness, Information Management, and Service Quality, the differences were trivial or slightly favored toward non-outsourced centers. Conclusion The CHCCs affiliated to TUMS face significant governance challenges, particularly in the areas of ethics, transparency, and accountability. Despite strengths in the conscience and equity, overall governance remains weak, impeding possibly the healthcare quality and responsiveness. The higher performance of urban–rural and outsourced centers highlight the potential of flexible, community-based governance models. Strengthening governance will thus require evidence-based policy-making, professional capacity building, robust monitoring systems, inclusive participation, political commitment, and cross-sector collaboration.