Agenda-Setting for Sustainable Financing of Medical Education: A Mixed-Methods Policy Analysis Using Multiple Streams and Policy Triangle Frameworks
4 affiliations
- 1Khomein University of Medical Sciences, Khomein, Iran
- 2Iran University of Medical Sciences, Tehran, Iran
- 3Kashan University of Medical Sciences, Kashan, Iran
- 4National Agency for Strategic Research in Medical Sciences Education, Tehran, Iran
Abstract
Introduction:: Sustainable financing of medical education is critical to health workforce development and health system performance. While existing research has largely examined financing mechanisms and expenditure patterns, less attention has been paid to the policy processes through which financing issues reach the governmental agenda. This study aimed to analyze the agenda-setting process for sustainable medical education financing using Kingdon's Multiple Streams Framework and Walt and Gilson's Policy Triangle.
Methods:: We conducted a mixed-methods policy analysis, including a scoping review, 15 semi-structured interviews with key stakeholders, and a four-round Delphi process with the same expert panel. Data were analyzed using framework analysis and interpreted through the two theoretical frameworks.
Results:: Economic pressures -including high inflation, international sanctions, declining public investment, and the very low share of education in GDP and health expenditure- dominated the problem stream (mean importance score=4.89/5, expert agreement=97.8%). Demographic shifts, technological demands, and social equity expectations further intensified these pressures. The political stream was characterized by tensions between commitments to free education and limited fiscal capacity, shaped by ideological orientations and external constraints. Although multiple financing alternatives circulated within policy networks, the policy stream remained fragmented, with limited institutionalization of diverse models. Convergence of the three streams indicated the emergence of a policy window, contingent upon effective policy entrepreneurship.
Conclusion:: Effective agenda-setting requires alignment of economic realities, political commitments, and viable policy options. The findings offer transferable insights for other low- and middle-income countries facing similar structural constraints.
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BibTeX
@article{amini2026agendasetting,
title = {{Agenda-Setting for Sustainable Financing of Medical Education: A Mixed-Methods Policy Analysis Using Multiple Streams and Policy Triangle Frameworks}},
author = {SAEED AMINI and MASOUD ABOULHALLAJ and ALI VALINEJADI and AMIR HOSSEIN AHSANIARANI and MEGHDAD RAHATI},
journal = {Journal of Advances in Medical Education \& Professionalism},
year = {2026},
month = oct,
doi = {10.30476/jamp.2026.111161.2400},
url = {https://doi.org/10.30476/jamp.2026.111161.2400},
note = {CC BY-ND 4.0},
}
RIS
TY - JOUR
TI - Agenda-Setting for Sustainable Financing of Medical Education: A Mixed-Methods Policy Analysis Using Multiple Streams and Policy Triangle Frameworks
AU - SAEED AMINI
AU - MASOUD ABOULHALLAJ
AU - ALI VALINEJADI
AU - AMIR HOSSEIN AHSANIARANI
AU - MEGHDAD RAHATI
PY - 2026
DA - 2026/10/01
JO - Journal of Advances in Medical Education & Professionalism
DO - 10.30476/jamp.2026.111161.2400
UR - https://doi.org/10.30476/jamp.2026.111161.2400
AB - Introduction:: Sustainable financing of medical education is critical to health workforce development and health system performance. While existing research has largely examined financing mechanisms and expenditure patterns, less attention has been paid to the policy processes through which financing issues reach the governmental agenda. This study aimed to analyze the agenda-setting process for sustainable medical education financing using Kingdon's Multiple Streams Framework and Walt and Gilson's Policy Triangle. Methods:: We conducted a mixed-methods policy analysis, including a scoping review, 15 semi-structured interviews with key stakeholders, and a four-round Delphi process with the same expert panel. Data were analyzed using framework analysis and interpreted through the two theoretical frameworks. Results:: Economic pressures -including high inflation, international sanctions, declining public investment, and the very low share of education in GDP and health expenditure- dominated the problem stream (mean importance score=4.89/5, expert agreement=97.8%). Demographic shifts, technological demands, and social equity expectations further intensified these pressures. The political stream was characterized by tensions between commitments to free education and limited fiscal capacity, shaped by ideological orientations and external constraints. Although multiple financing alternatives circulated within policy networks, the policy stream remained fragmented, with limited institutionalization of diverse models. Convergence of the three streams indicated the emergence of a policy window, contingent upon effective policy entrepreneurship. Conclusion:: Effective agenda-setting requires alignment of economic realities, political commitments, and viable policy options. The findings offer transferable insights for other low- and middle-income countries facing similar structural constraints.
SN - 2322-2220
SN - 2322-3561
ER -