Retaining clinicians in suburban areas: An experience from Iran's primary health care system reform

In June 2014, the first Health Complex was established in the suburban area of Tabriz, a northwest city of Iran. Health Complexes, as one of the decentralized models, have been formed based on universal health coverage principles. However, nearly two years after commencing work in the province, Health Complexes experience a high turnover of health care workers. This study aims to explore why primary health care workers set aside their roles in the health system and leave their jobs in opposition to the planned objectives. In this qualitative research, purposive and snowball sampling techniques were used for participants' selection. Data were collected through semistructured interviews and documentary review. Interviews were conducted with health officials, health care specialists, and other health workers who had left their jobs in Health Complexes in the suburban areas of Tabriz. Inductive and deductive content analysis was used to analyse data. The leading causes for health care workers leaving a job were divided into four main categories including organizational policies and regulations, financial and economic factors, sociocultural, and personal factors. Developing evidence-informed interventions and strategies to improve payment systems, provide job security and opportunities for professional development, and adopt cooperative leadership are essential to decrease the turnover rate of health care workers at Health Complexes.