Six principles of Iranian Health System

After the revolution in 1979, the health system was based on 6 basic principles as follows:

"1)priority of preventive care as a long-term asset, 2) priority of rural and underprivileged areas, with special attention to high-risk groups,3) priority of general practice over specialized medical care, 4) priority of outpatient over inpatient care, 5) maximum feasible integration of preventive and curative services,6) and decentralization, aimed at forming self-sufficient regional and local facilities."

Source: Shadpour K. Primary healthcare networks in the Islamic Republic of Iran. Eastern Mediterranean Health Journal.2000;6(4):822-825

My comment: I think the Ministry of Health has gone to a great length to make these happen but what we see now after almost 3 decades are somewhat different from the principles. I can see that the government has great achievements in fulfilling the first, the second , and the fifth principles but could not pave the way for the sixth principle. Iranian PHC system is a unique one and has contributed a lot in rapid decline of child and maternal mortality in spite of progressive drop of the economy for many years after the revolution. However, the system failed in decentralization of the services. The fourth principle remained untackled until the introduction of a national program to set up a family medicine network in recent years. I don't know what to say about the fourth principle but to me is not as important as the others. I know that the outpatient care consumes the most part of people's out-of-pocket payments for healthcare and more than 90% of the outpatient care is in private sector. I don't know for sure how the fourth principle facilitated the emergence of the poorly supervised outpatient care market.

Code: 4A