Structural challenges and strategic responses in Iran’s COVID-19 management: insights from healthcare experts

Abstract Background The COVID-19 pandemic has posed unprecedented challenges to healthcare systems worldwide, necessitating rapid adaptation and strategic responses. This article aims to explore the structural factors, challenges, and strategies in Iran’s COVID-19 response, from the opinion of health experts. By examining the multifaceted dimensions of Iran’s response, this study seeks to contribute to the understanding of how structural factors influence pandemic management and to identify potential strategies for improving health policy responses in similar contexts. Methods This qualitative study employed a framework analysis approach. Interviewees were purposefully selected with a maximum variation strategy in one of the biggest provinces of Iran, and Walt and Gilson policy triangle framework was applied to inform our data analysis. Results Key structural challenges emerged across three domains. (1) Management system infrastructure: Experts identified a lack of integrated decision-making, an organizational structure prioritizing treatment over prevention, and conflicting levels of autonomy for regional universities. (2) Economic factors: Severe financial constraints on both the government and society hindered the implementation of effective lockdowns and undermined public adherence to health protocols. (3) Political factors: The response was shaped by a dual influence of perceived political unity under a centralized task force and disruptive divergence from inter-ministerial conflicts and shadow power groups, which occasionally led to policy sabotage. Conclusion This study contributes valuable insights for future health policy responses in similar contexts. The findings underscore the critical role of integrated management, economic support, and political unity in shaping a successful pandemic response. The lessons learned from Iran’s experience emphasize that addressing structural factors is not only crucial for immediate crisis response, but also for building more resilient health systems capable of responding effectively to future crises.