Innovative pathways for sustainable health financing for migrants and refugees in Iran: a stakeholder and social network analysis approach

Objective: Financing health services for migrants and refugees remains challenging in settings with constrained fiscal space, fragmented governance and protracted displacement. This study aimed to identify existing, underused and potential mechanisms for financing migrant and refugee health services in Iran and to map the stakeholders involved in revenue raising, pooling, purchasing and policy-making. Design: A multi-source qualitative policy analysis combining a scoping review, desk review of national documents, semistructured interviews, stakeholder analysis and social network analysis (SNA). Setting: National and subnational actors involved in financing, regulating, purchasing, delivering or supporting health services for migrants and refugees in Iran, with particular relevance to Afghan migrants and refugees. Participants: 44 purposively selected participants took part in the interviews, including representatives of governmental bodies, insurance organisations, international agencies, non-governmental organisations, healthcare providers and Afghan migrants with different legal and insurance statuses. Of these, 15 professional and institutional participants completed the SNA questionnaire. Methods: The scoping review covered literature published from 2010 to 2026 and searched PubMed, Scopus, Web of Science, Google Scholar and relevant grey-literature sources. National document findings from the broader project were re-examined from a health-financing perspective. Interview data were analysed using qualitative content analysis. Stakeholders were assessed according to their interest, capacity to mobilise or generate financial resources and authority to influence financing policy. Results: The updated review identified 43 eligible studies. Current financing arrangements rely on a fragmented combination of public insurance for eligible groups, donor assistance, non-governmental organisations and charitable support, disease-specific programmes and out-of-pocket payment. Additional mechanisms included employer-based contributions, earmarked public revenues, religious and philanthropic funds, corporate social responsibility, community-based pooled support, regional cooperation, concessional financing and digital financing tools. These mechanisms differed in current use, feasibility and required policy action. SNA highlighted the central roles of Ministry of Health and Medical Education, Iran Health Insurance Organization, Social Security Organization, Parliament, United Nations High Commissioner for Refugees, WHO and International Organization for Migration. Conclusion: Sustainable migrant and refugee health financing in Iran requires a coordinated multi-source strategy, stronger governance, improved pooling and purchasing arrangements and feasibility assessment of underused financing options.