Health system barriers to cardiovascular disease prevention and control in Iran: a qualitative study

BACKGROUND: Several years have passed since the start of the provincial program for the prevention and control of cardiovascular diseases in Isfahan, but little progress has been observed in its indicators. Therefore, we decided to identify the barriers to implementing these programs and provide corrective solutions. METHODS: This exploratory descriptive qualitative study employed directed content analysis guided by the World Health Organization's health system building blocks framework. Data were collected through 16 semi-structured face-to-face interviews with purposefully selected key informants-including managers, decision-makers, implementers, and service providers-using a maximum variation sampling approach. To ensure trustworthiness, we applied Lincoln and Guba's criteria: credibility was enhanced through member checking and prolonged engagement; dependability and confirmability were supported by audit trails and peer debriefing; and transferability was addressed by providing thick descriptions. Data were analyzed using MAXQDA 2020 software. RESULTS: Analysis of interviews with 16 participants revealed six main themes and 23 sub-themes, aligned with the health system building blocks: governance and leadership, human resources, service delivery, financing, health information systems, and access to essential supplies and medications. The findings point to critical policy-level barriers, such as ineffective inter- and extra-sectoral collaboration, insufficient prioritization of cardiovascular diseases in national agendas, and inadequate financial and human resource planning. These insights underscore the need for strategic policy reforms, including improved intersectoral governance, workforce stabilization, rational drug regulation, and enhanced community-based education initiatives to strengthen the implementation of cardiovascular prevention and control programs. CONCLUSION: This study highlights systemic and policy-level barriers that hinder the success of cardiovascular disease prevention and control efforts in Isfahan. Addressing these challenges requires coordinated policy actions, including stronger governance mechanisms, strategic resource allocation, and culturally appropriate community engagement. The findings provide practical insights for health policymakers to design more responsive and sustainable interventions that improve cardiovascular health outcomes at the provincial and national levels.