Implementation challenges and operational solutions for people-centered health regulatory–operator systems: A systematic review of global experiences

The aim is to identify the key challenges in implementing a people-centered regulatory–operator system in public health and to provide operational solutions to enhance service quality and ensure equitable access for all. This study seeks to examine the prominent challenges and successful international experiences to propose a comprehensive framework for managing the implementation of the regulatory–operator health system. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A comprehensive search was and Web of Science, Scopus, and PubMed databases to identify peer-reviewed studies published between 2015 and 2025. Quantitative, qualitative, and mixed-method studies that addressed the challenges and operational solutions in the field of regulatory–operator health system management were included. Selection of studies and data extraction were independently carried out by two researchers. Out of 715 identified records, 32 studies met the inclusion criteria. The results indicate that countries faced multiple challenges in the implementation of the regulatory–operator health system, including interinstitutional misalignment, complexity in licensing processes, lack of necessary health data infrastructure, cultural and organizational resistance, scarcity of resources, marginalization of stakeholders, and weakness in continuous monitoring and evaluation. Analysis of international experiences underscores the significance of participatory approaches, regulatory transparency, and effective use of information technology in improving processes, people-centeredness, the utilization of clear data and information systems, and ongoing supervision and evaluation. Effective management of the implementation of the regulatory–operator health system necessitates a multifaceted approach that, while addressing structural and operational challenges, emphasizes increasing transparency, quality, and equitable access.