The vital role of good governance in a public health crisis: the case of managing access to medicines in Iran during the COVID-19 pandemic

Abstract Background The COVID-19 pandemic has emphasized the vital role of good governance in managing public health crises, particularly in Low and Middle-Income Countries (LMICs) that faced considerable difficulties exacerbated by pre-existing vulnerabilities in their healthcare systems. The virus spread rapidly, affecting billions of citizens worldwide and revealing the interdependence of health and economic stability. Methods We conducted a qualitative study focusing on access to medicines to investigate the challenges faced by the healthcare system during the pandemic in Iran. Through the lenses of good governance, we conducted a virtual Focus Group Discussions (FGDs) with 10 purposefully identified experts representing diverse stakeholders in January 2022. We analyzed data through a deductive approach, facilitated by MAXQDA 20 software. Results Our analysis revealed significant challenges in various aspects of the healthcare system in Iran, including infrastructure, financing, governance, regulation, access, and quality. Two main themes emerged: "Good Governance" and "Access." We identified eight subthemes under good governance, highlighting issues such as effectiveness and efficiency, transparency, accountability, and stakeholder collaboration. Additionally, under access, we identified four subthemes defined as accessibility, affordability, acceptability, and availability. Conclusion Our findings revealed the critical role of good governance in response to crisis and highlighted areas for improvement in Iran's healthcare system. Despite challenges, the centralized healthcare system demonstrated agility in responding to medicine shortages during the pandemic. Yet, deviations from official protocols and insufficient evidence-based decision-making remain significant concerns. Lessons learned from Iran's experiences would offer, we envisage valuable insights for strengthening healthcare systems, improving governance, and increasing healthcare access globally, emphasizing stakeholder collaboration in crisis management.