Background and Objective: The COVID-19 pandemic has highlighted the critical need for targeted collaboration between the health system and local institutions globally. Successful experiences of various countries in this crisis have shown that effective intersectoral collaboration can greatly improve crisis management. This study aimed to investigate the interaction between the Iranian health system and city councils to promote community health by relying on institutional collaboration in 2004.

Materials and Methods: This qualitative research was conducted using semi-structured interviews with key experts from the Ministry of Health, universities of medical sciences, and metropolitan city officials. Purposive sampling using the snowball method was used to select 15 participants to achieve a diversity of perspectives. To ensure the accuracy and validity of the data, the criteria of validity, reliability, transferability, and verifiability were systematically implemented. The interviews were transcribed and analyzed line by line, categorized through thematic content analysis, and codes were organized using MaxQDA 12 software based on common concepts.

Results: The analyses revealed two main themes of barriers to participation and partnership solutions, which included seven subthemes, 21 categories, 15 subcategories, and 9 sub-subcategories. The most important barriers to participation included a deterrent attitude, resistance to change, a weak culture of participation, lack of awareness, and parallel work. The suggested solutions included using existing capacities, creating permanent cooperation mechanisms, integrating public policies, improving citizen satisfaction, and facilitating joint planning.

Conclusion: The study findings showed that despite the existence of numerous structures and related laws, the partnership between the health system and municipalities still faces many challenges. Therefore, developing a practical framework to strengthen cooperation between health institutions and urban management seems essential. This framework should avoid creating new structures and controversial laws and focus on cultural alignment, utilizing existing resources, and strengthening infrastructure. Such a partnership model can reduce costs, improve population health, and increase the resilience of the country's health system against future crises.

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/