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Interests refer to the motivation of actors to take part in policy-making. They are group of opinions or attitudes which are perceived as relevant to the issue. In policy terms, this means that the interests of an actor could include rational as well as emotional interests and other non-rational interests [ 67 ]. Interests are usually interested in resisting or saving the existing problems, in preserving the status quo, and in satisfying their own interests rather than other matters [ 15 ]. Also, the interests change over time and may change and evolve as the context changes. In this study, we were interested in the interests of the policy actors, particularly the focus and content of the ideas. Policy ideas are often influenced by the interests of the policy actors [ 68 ].
Institutions refer to the rules, precedents, or customs or cultural or social norms of a group of people, that are relevant to specific policies, in accordance with the needs of the policy process [ 14 ].
The issue of health equity is reflected in the absence of population-based indicators in governmental health sector plans and strategies. This failure to estimate or address health equity raises the need for the state to form a policy to ensure that population-based health indicators be established [ 54 ]. “The state’s efforts to ensure that the particular needs of the marginalized populations are taken into account is essential in allocating limited budgetary resources,” the UN Human Rights Committee determined that it was legitimate for states to limit access to health services for vulnerable populations (e.g., ethnic and racial minorities, ethnic minorities, religious or social minorities, refugees, and women, prisoners or other marginalized populations) [ 55 ].
Theoretical frameworkThis study was based on the 3i framework consisting of three distinct and separate categories: ideas, interests, and institutions [ 56 ]. Each of the three categories is explained in detail in the following paragraphs. The present research is guided by the “realist-synthetic paradigm” [ 63 ]. It adopts an interpretive approach in which the main goal is to explain what has happened and to identify the causes. The contributions of this study are the following: first, this study demonstrates the role of policy ideas, interests and institutions in the formation of the DHN policy and the factors that shaped the policy process. Second, the policy entrepreneurs played an influential role in the policy initiation and formation by suggesting the policy concept to the policy makers. Third, the study highlights the role of ideas and interests in the formation of the policy. These can be used as evidence-based tools for developing evidence-based policies. Fourth, the study is the first to examine the role of ideas, interests and institutions in the formation of the DHN policy in Iran. Fifth, the findings show that the general framework is suitable to understanding the complex, long-term, and process-oriented nature of policy making in developing countries. Although there are many other policy-making frameworks, “realist-synthetic” paradigm has been considered as one of the alternatives that suit the context of developing countries [ 63 ]. Moreover, this framework might provide an opportunity to health policy makers in their efforts to develop health policies in the developing countries. Therefore, this framework would be useful in identifying a comprehensive pattern of health policies in developing countries.
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