Iran's health system

7000 patients with diabetes registered at the Center for Control and Prevention of Diabetes in Iran

2011-08-18T11:46:00.000-07:00

The center is in Mashad, northeast of Iran. The CEO of the center Javad Jahani Mehr says that this center was established in 2005 with the mission to provide care to patients with diabetes and control the disease. He emphasizes that such infrastructure will be coming along soon in other major cities of Iran. He stressed the point that more than half of patients with diabetes in Iran are not aware of their high blood sugar. On the other hand 99 percent of those who know they have diabetes are under poor blood sugar control he added. The major policy intervention to be implemented is to educate people how to deal with the condition , which is the core policy intervention devised for such clinical centers , he said.

My comment: It’s very promising that targeted interventions for high-cost /high mortality diseases and risk factors are getting attention by Iranians. It would be great if the clinical effects of such interventions could be measured and compared with traditional care being received by the rest of patients with diabetes.

Link to the news: http://www.irna.ir/NewsShow.aspx?NID=30525826

Source: Irna, online, Accessed on August 18,2011. News Code: 30525826

Inadequate insurance and shortage in providers to support patients with burn

2011-08-17T11:42:00.000-07:00

"Tehran Province has the highest burn-related mortality among all provinces in the country" says the officials of the Forensic Medicine Center. It is claimed that Tehran has only one hospital (Shahid Motahhari) that deals with burn cases at sub-specialty level. There are handful of other private hospitals giving care to patients with mild to moderate burns but not to severe cases. The ILNA's journalist reports that 2,690 people with burns die annually [in the country]. However, the number of beds per capita for burn cases has been going down in recent years. The CEO of the Motahhari Inpatient Burn Center (Hospital) says that insurance plans do not cover all costs of patients with significant burns and charities have to be more active to collect money to support these patients. He says that adding one Burn-ICU bed to the hospital costs some 60,000 dollars and the hospital is struggling with economic barriers to expand its facilities to provide adequate care to patients with burn.

My comment: The highest mortality may be due to the fact that cases with severe burn may be constantly referred to hospitals in Tehran.

Reference: Iranian Labor News Agency, online , accessed on August 17, 2011. News Code:202485

Link: http://www.ilna.ir/newsText.aspx?ID=202485

High utilization of pharmaceutical in Iran

2011-03-19T06:10:00.000-07:00

According to the report of the Ministry of Health and Medical Education Iran is among the top 20 countries whose people utilize the highest amount of pharmaceuticals. Iran ranks second after China among Asian countries on pharmaceutical utilization. The report also explains that 46% of the medicines used are injection drugs while this figure for the globe is only 11%.

My note: From my practice long time ago in Iran I can tell that the figures can be all true. A dominant belief among people regarding medicine is that injection drugs are much stronger than oral medications. I have seen evidence from India and Pakistan that a large fraction of population in theses countries think the same way. I hope the Family Physician Program started a few years ago is able to change the false paradigms and help regulate the outpatient healthcare.

Source: http://techdaily.ir/?p=324 , accessed on March 19, 2011

Family Physician Plan starts today Feb 12, 2011

2011-02-12T10:49:00.000-08:00

The plan is to be started functioning in 3 provinces Sistan & Baloochestan, Charmahal, and Khozestan as of today, Feb 12, 2011. In brief the plan focuses on a referral system involving 3 levels. General practitioner level, Specialty level, and subspecialty level. The primary level of care is given by a team that includes at least a General practitioner, a Community Health Worker (Behvarz in Farsi), and a trained nurse or obstetrics assistant (Mah-Mah in Farsi). The team is in charge of the patients' health. The plan assumes that all people registered are insured. The consultations provided by the first layer of referral is free of charge for people and the team are reimbursed by the insurance company. The distribution of the first-level services are equal such that 4 physician and 17 other medical staff provide services for every 10,000 population.

The hope is that the plan increases quality of care and reduces the costs. It is said that there are so many obstacles toward the end of the plan. One important one is that around 20 million of the country's population are uninsured and that around 20 million of the insured hold dual insurance coverage (quoted from Sadegh Mahsooli, the current Welfare Minister) .

It's worthy noting that the centers executing the plans are equipped with Electronic Health Record system.

My comment: Outpatient health services in Iran have been historically in the private sector and quite unregulated. It's really hard to put the doctors under a unique gate keeper system. Subspecialty level doctors are powerful agents. Their income is super high. Also, many of them have high political leverage. Having said that, expecting a full collaboration across different levels of the system may be achieved only based on some crude evaluations. General practitioners , on the other hand, are the weakest (both in terms of income, and the political power) among the physician population. The plan is revolutionary on many fronts and its full implementation is hard to achieve.

Reference: http://www.bbc.co.uk/persian/iran/2011/02/110212_l19_dastjerdi_mahsoli_doctor_family.shtml

'Health Houses' in Iran is getting attraction!

2011-01-13T09:55:00.000-08:00

It's not long ago that Mississippi has decided to plan for establishing health houses model to serve its medically undeserved areas. They picked the Iranian model and I would say it was just a right pick. Iran started its primary preventive health care network more than 40 years back. The plan has shown a high degree of success. Although the model and its implementation has not been fully presented through international publications and media , the Mississippi's collaboration with Iranian health officials on building its counterpart in the US may help the plan get international recognition. Below is a link to a website through which you can find useful information on this collaborative effort.
http://www.fic.nih.gov/news/publications/global_health_matters/2009/1209_health-house.htm

Cesarian Section in Iran is 4 times world's standard

2010-04-26T07:38:00.000-07:00

According to a report published in Khabar Online, Iran scores second in the world in terms of number of cesarian section and cosmetic nose surgical operations. The report says that in many provinces the administrative statistics show that between 30 and 50 percent of deliveries are completed through cesarian section operation.

Source: Khabar Online, News Code: 57202
Accessed on Monday, April 26, 2010 at http://www.khabaronline.ir/news-57202.aspx

My comments: 1. To make this worse I would say that the majority of cesarian section operations are being performed under general anesthesia. Local (subdural) anesthesia that has a lower risk of complications is not the dominant mode of anesthesia in obstetrics in Iran 2. Based on a cross sectional study in Tehran , in private hospitals about 80% of all deliveries are done through cesarian section. Also, the results of this study show that the main reason to select cesarian section over normal vaginal delivery is pregnant mother's/ her husband's request for cesarian delivery.

Reference for the second tip: Garmaroudi G. et al. Cesarean section prevalence in Tehran, Iran. Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 2003; 19: abstract no. 16. Accessed on Monday, April 26, 2010 at http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102275934.html

ISNA: 80 Percent of Patients in Iran Ask for Complementary Curing

2009-02-24T06:43:00.000-08:00

"FROM OTHER WEBSITES":

"ISNA - Tehran
Service: Health

Tehran, Feb.19 (ISNA)-Experts' researches of Iranian Academic Center for Education, Culture and Research (ACECR) shows that 35 percent of patients affected by cancer use various methods of complementary curing.

"35 percent of patients affected by cancer use complementary curing methods that includes 81 percent supplication and 9 percent energy curing," said one of ACERC researchers.

According to the researches, 80 percent of patients ask physicians for complementary curing and 90 percent of them are satisfied by this method.

Among those who have used this method, 38 percent has used one curing method and 11 percent of them have used two methods of complementary method.

Complementary method consists of a collection of behaviors and believes that are used by patients for prevention and curing the disease and also betterment of health level.

End Item"

5 cancers get free treatment

2009-02-24T06:18:00.000-08:00

The Minister of Health , Dr. Bagher Lankarani, stated that breast cancer, prostate cancer, blood and lymphatic malignancies, and colon cancer will no longer pose any financial charges on people with these conditions. " Last year we allocated 75 billion Toman (roughly 75 million dollars) to the treatment of these malignancies. We continue this year with 50 billion Toman" he iterated.

My comment:
1.There has been a long debate in the country if cancers should be financially treated as long lasting disabling ill conditions such as chronic renal failure and thalssemia. The latter illnesses are called "bimari haye khas" which means 'exceptional diseases' and receive huge governmental subsidies. Patients with 'execeptional diseases" geneally utilize healthcare for these illnesses free of charge.
2. According to the literature stomach cancer ranks first among all type of cancers in Iran and I have no idea why this cancer is not included in the 'free treatment plan for cancers'.

Source: Gooya news quoted from ISNA news agency , http://news.gooya.com/technology/archives/084296.php, Feb 24, 2009

Health in the news: Some facts on pharamaceutical usage in Iran

2007-02-24T08:08:00.000-08:00

1-In 2005 (1384 Solar Calendar) pharmaceutical products average usage in Iran was 386 items per each Iranian (monetary value of the total usage: 169.4 Rials not taken into account the direct and indirect subsidies and the share of the pharmacist per prescription(Haghe Fanni in Persian)).
2-Total items of medicines sold in 2005 amounted to 16.5 billions (monetary equivalence: 11,526,602,000 Rials).
3-Average item prescribed per encounter was 3.5 in 2005 (3.6 in 1997).
4-Probable reasons for irrational drug utilization: Lack of systematized structure for pharmaceutical usage, absence of adequate control over drug utilization, unrealistic medical tariffs, inefficiency of medical insurers, adverse interests of pharmaceutical companies, and high financial benefits of drug distributors.
5-Mr. Davood Madadi, CEO of the Social Security Organization adds to the above list the tendency of people to visit doctors prescribing more than standard drug items.
6- Patients generally expect doctors to prescribe parenteral forms of medicines. They don't put believe in physicians who do not satisfy these expectations, a bitter fact of our health system.
7-Dr Mojdehi Azar stresses that low income of physicians in Iran encourage them to follow patients requests instead of concentrating on what the real needs of patients are.
8- Dr. Hassan Hovida, director of the General Physicians Association in Iran, says that patients are the main inducers of over-prescription of medicines in Iran.

[Extracted from a report by Ali Akhavan Behbahani]

Source: Jamejamonline, www.jamejamonline.ir, Feb 21, 2007
Code: 27N

Possible rise of out-of-pocket health expenditures in 2007-8

2007-02-16T12:23:00.000-08:00

A number of health officials in Iran forecast a sharp rise in out-of-pocket health expenditures (OOP) in the coming year (2007-8). They all say that pre-decided 4300 Toman (approximately 5 dollars) per capita healthcare share of the government (Saraneye darman in Farsi) for the year 2007-8 may cause a sharp 15% increase of the OOP payments. Then people will have to pay up to 70% (even 80%) of medical care expenses out of their pocket. They all concern about the bankruptcy of the private hospitals as a direct consequence of high OOP payments. Their suggestion is to increase the per capita share of the government to 7000-8000 Toman (8.5 -9 dollars) so that people directly pay much less than what they currently pay for healthcare services . Currently, OOP payments constitute 55% to 60% of total health expenditures in Iran. Private sector is the main provider of the outpatient health care. Inpatient care is provided chiefly by the government in most parts of the country. However, in big cities like Tehran, Isfahan, Tabriz, Shiraz, and Mashad, private hospitals are providing an important portion of the population's needs to inpatient care.
Sources:
1-http://pezeshkan.ir/ .Feb 3, 2007 (original reference: Mehr News interview with Dr. Bijan Shahbazkhani, and Dr. Jahanbakhsh Aminia , members of the Health Commission of the Parliament)
2-http://pezeshkan.ir .Feb 4, 2007 (original reference: Mehr News interview with Dr. Ahmad Reza Jamshidi, the Vice Chairman of the I.R.Iran's Medical Council)
3-http://pezeshkan.ir . Feb 3, 2007 (original reference: Fars News interview with Dr. Mohammad Hossein Tarighat, the Vice Chaiman of the Welfare Ministry)
Code:5A

Health in the news: Last updates on the number of medical human resources in Iran

2007-02-11T15:45:00.000-08:00

Dr. Shahab Al-din Sadr, director of Iranian Medical Council (IMC), gives an update on the number of medical human resources (all are a member of the IMC)in Iran as follows:

70,000 General Practitioners(completed 7-year medical school)
25,000 Medical Specialists and Subspecialists
20,000 Dentists (General and specialist)
13,000 pharmacists
3500 Laboratory Medicine Specialists (either 7-8 year and 10-11 year educational programs)
40,000 Midwifes (all has a formal 4-year university education).
Total: 170,000
My comment: This total does not include nurses and theyare I guess all members of the IMC and should be counted in.

Source: http://aftabnews.ir/vdciw3at1wa35.html , http://www.aftabnews.ir/ August 13, 2006
Code:26N

Health in the news: establishing provincial hemophilia clinics

2007-02-11T15:35:00.000-08:00

For about 6,000 hemophilia cases in Iran need to get required health services provided by especial medical centers in the province in which hemophiliacs live Dr. Alavian, the Deputy of Health of the Ministry of Health(MOH), says. To prevent the patients from going to Tehran to receive their needed medical services we are going to establish in each province a center providing especial care for these patients he added. Five billion Toman (900 Toman is equal to one dollar) subsidy has been allocated for hemophilia care by the MOH.
Source: www.aftab-yazd.com , No: 2002, Feb, 6 2007
Code: 25N

Health in the news: 75,000 new annual cancer cases in Iran

2007-02-11T15:26:00.001-08:00

Dr Mohagheghi, the chief of Tehran University Institute of Cancer, said that 200,000 patients with cancer live in the currently and each year 75,000 new cases are diagnosed as having a type of cancer. 30,000 cancer patients die in Iran each year he added.
Source: www.aftabeyazd.com , No: 2005, Feb, 10 2007
Code: 24N

Health in the news: If approved, people won't pay for expensive medicines

2007-02-11T14:55:00.000-08:00

The medical care deputy of the Social Security Organization (SSO), Mr. Ali Fattahi, said that if the Supreme Insurance Concil (Shoraye Ali Bimeh) approves a suggested official plan to financially protect the cost of treatment for patients undergoing hemodialysis, hemophiliacs, and thalassemia patients (so called privileged medical conditions or Bimari-haye Khas in Farsi), these patients will not have to pay for expensive medicines. The SSO now pays the total cost of medicines for 8,153 of such payments he added. The plan says that patients should pay a co-payment for cheaper drugs while the insurers pay 100% of costs of expensive medicines. The SSO covers 85% of costs of medicines for patients with cancers although cancers have not been listed as so called privileged medical conditions , Mr. Fattahi said. 3,562 patients with multiple sclerosis (MS) are being financially protected by the SSO he said but he did not specify the percentage of medical cost coverage by the SSO for these patients.
Source: www.jamejamonline.ir , Feb, 7 2007
Code: 23N

Health in the news: 18 million illegal use of the SSIO's health insurance plan in one year

2007-01-27T10:48:00.000-08:00

The executive director of the Social Security Insurance Organization (SSIO) , Mr Davoud Madadi, annouced that while we have issued 28 million health insurance plans, 40 million people used SSIO insurance plans in the last year (1384=2004,5). Mr. Madadi believes that electronic medical record is an effective measure to prevent from the illegal utlization of health insurances. Evaluations show that 86% of patients only need a medical/health consultation at the time of visit and over-administration of medicines by physicians just to satisfy patitients is a problem of our medical society he said.

Source: www.baztab.ir, Aug 31,2006
Code:22N

Health in the news: It's not true to say the poor pay 10 times more than the better-off for health!

2007-01-27T10:20:00.000-08:00

Mr. Shahriari, a member of the Health Commission of the Parliament says that claiming that the poor pay 10 times more than the better-off for health has not been proved by any evidence. He added that those with lower income usually utilize public health services and cannot afford private health facilities. According to the law uninsured people receive a compulsory health insurance plan at the point of hospitalization and are able to use their policy right after the first encounter Shahriari reiterated. Some doctors/centers even waive the co- payments for poor patients he continued.
Source: www. aftabyazd.com, Jan 7, 2007 ; No: 1980

My Comment: I agree with Mr. Shahriari that this number (10 times) cannot be true (You can find the estimated values from the National Statistical Center) but I believe that in general the poor receive services of lower qualities. Residents of hard to reach areas, those who reside in ghettos, and pensioners have a poor access to quality healthcare.

Code: 21N

Health in the news: Possible negative growth rate for per capita public health expenditure

2007-01-27T09:23:00.000-08:00

"Next year, per capita health expenditure share of the government will face a 2-percent negative growth" said the vice chairman of the Health Commission of the Parliament, Mr. Baghbanian. This may cause people to pay more out of their pocket to balance the total health expenditures.
According to the fourth National Development Plan (2005-2009) per capita health expenditure share of the government was determined to be 7000 Toman (approximately 7.5 USD) while the real allocated share of the government for the coming year is 3660 Toman (3.2 USD) for residents of urban areas and 1660 Toman (1.2 USD) for the rural dwellers he added.
Mr Baghbanian says that residents of rural areas cannot use their health plans to utilize urban health facilities.

Source: www.aftabyazd. com, Jan 25, 2007 No:1995

Code: 20N

Six principles of Iranian Health System

2007-01-24T06:38:00.000-08:00

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

Health in the news: Establishment of electronic registry network of health insurance plans cuts the costs by 30%

2007-01-21T08:44:00.000-08:00

The Health and Treatment Commission correspondent of the Parliament, Dr. Avaz Heidarpour Shahrezaei, rolled out that 80 million insurance plans does not match up with 70 million population of the country [Taking into account a great proportion of uninsured population, there would exist a considerable portion of the over-insured population in the country]. Consequently, it has been decided to employ a software to register all the insured . This way we may bring the problem of over-insurance under control and as a result we can expect an estimated 30% cut in the expenses he said.

Source: www.pezeshkan.ir, Jan 8,2007

My comment: I did not understand what kind of expenses might be cut following this intervention. E-registry sounds like an effective intervention though. In Iran less than one percent of the health insurances are private. So, the government has a good opportunity to put all the public information on health insurance plans together and make one huge data base. Over-insurance is a real problem. I used to see many people presenting more than one or even more than one insurance plans to doctors at the time of visit. Seems to me people tend to keep more than one insurance plans just to receive a better protection. Notwithstanding double and triple insurance , people are not protected by either of their plans in some occasions.

Code:19N

Health in the news: With 120 billion dollars annual income Iran should not be viewed as a poor coutnry

2007-01-20T18:28:00.000-08:00

The Ministry of Welfare (Refah in Persian) , Mr. Mesri, made it clear that 2 million vulnerable individuals in the country should be cprotected by a health insurance plan. We are now in the second year of the fourth five year development plan (2005-2009) in which health promotion and equity has been considered as the most important focus of national development he said. Mr. Mesri declared that the country has 120 million dollars annual revenue from selling oil and oil products. A reason for high unemployment rate is that Iranians handed over tons of job opportunities to Afghan labor force he stated. Mr. Mesri reiterated that 97 percent of the total population will benefit from one kind of health insurance in the next year.

Source: www.aftabyazd.com, Jan 17,2007 No:1988

My comment: In addition to insurance coverage one would think of the efficiency of the health insurance plans. Healthcare Utilization Survey 2003 showed a 75% self reported health insurance coverage in the country which differs from the official reports.

Code: 18N

Health in the news: Iran needs 500 more medical diagnostic laboratories

2007-01-20T18:05:00.000-08:00

Dr. Alavian, the Vice Chancellor of Health of the Ministry of Health and Medical Education, stated that 500 more medical diagnostic laboratories need to be constructed in the country to keep up with the population needs. Utilization frequency of the laboratories is 60 million times per year he added. Dr. Alavian told that the laboratories played a critical role in the 65% of thalassemia case reduction in recent years. Without the help of the laboratories reducing the incidence of hemophilia and PKU in the country will not happen he pointed out.
Source: http://pezeshkan.ir , Jan 19 , 2007
Code: 17N

Health in the news: Some facts on Road Traffic Accidents in Iran

2007-01-20T16:37:00.000-08:00

Here are some facts on road traffic accidents (RTI) in Iran appeared in a letter Mr. Ali Zadsar , a Member of the Parliament, wrote to the President titled bitter statistical facts about 330,00 annual road traffic victims in Iran (The shortened version of the letter was brought to public notice by baztab online website):
1-Annual number of road traffic victims is 330,000.
2-Each year, 30,000 death are registered due to RTI.
3-Most accidents take place within 30 kilometers of urban areas.
4-Total length of roads is 180,000 kilometers from which only 31,000 km is either highway or main road(rahe asli in Persian). The remainder are 44,000 km of hazardous side roads (rahe far'ee in Persian) and 100,000 km rural roads.
5-Unexpectedly, the police patrol only 23,000 km(13%) of the entire roads.
6- 90% of travels travel through the ground while rail and air travels comprise 7% and 3% of the grand total respectively.
7-14 million out of 65 million daily travels happen in the capital (Tehran).
8- In Tehran 45% of travelers use public transportation. The remnant use their own private vehicle.
9- With a growth rate of 17%, two million four-wheeler vehicles and motor bikes per year (one million each) are being produced in the country while the growth rate for the road network is only 2%.
10-The government needs 1000 billion Toman (more than a billion dollar) to fix 1500 unsafe points already made known by the experts.
11-20 billion Toman per day (more than 20 million dollars) are spent on RTI.
12-70% of RTI deaths in the country are attributed to violation of the rules by drivers.
13-Nearly all the cars have not equipped with airbag or ABS (Anti-lock Braking System) which are reported as a safe measure to prevent fatal events in RTIs.
Source: www.baztab.ir , Jan 18, 2007, Code: 58295
My comment: I have no insight into the cost of RTI. It sometimes happens that an inadvertently placed extra zero in the reported numbers makes a huge difference. You need to use caution when you want to cite the above mentioned numbers. They may give us a sense of what the problems are but in my opinion the numbers need to be checked over. For example I am not certain about the extent to which the roads are patrolled by the police.

Code:16N

Health in the news: Per capita insurance premium for diabetics

2007-01-15T05:29:00.000-08:00

The executive director (Modir Aamel in Persian) of the Iranian Advocate Association for Diabetics ("anjomane hemayat az bimarane diabeti" in Persian , Shakour Omidi, announced that patients with diabetes can purchase an insurance policy at the price of 60,000 Toman(70 dollars) [for one year]. The association pays the insurance premium of patients who cannot afford to pay for the premium he said. The annual cost of treatment of seven million patients with diabetes in Iran is estimated to be 900 billion Toman (approximately 1 billion dollars) Shakour Omidi reported.

Source: www.jamejamonline.ir, Jan 12 , 2007
Code: 15N

Health in the news: Total Health Expenditure as a percent of GDP in Iran is less than that of comparable countries

2007-01-14T16:01:00.000-08:00

Dr. Amini , member of the Health and Treatment Commission of the Parliament says that in recent years while gross domestic product (GDP) has been gone up, the health expenditure percent of GDP has not been proportionately increased. In Iran, this ratio is approximately 5.6% while 7%-8% is that of comparable countries . Amini added that now the budget deficit of the Ministry of Health is 350 billion Tomans (approximately 380 million dollars) and university hospitals are heavily indebted to pharmaceutical companies for unpaid purchase of medicines. As a result, patients have to pay out of their pocket for prescription medicines in many occasions.
Source: http://www.aftabyazd.com/ , Jan 13, 2007 No: 1984
Code:14N

Health in the news: Third wave of HIV infection is on the way

2007-01-14T10:11:00.000-08:00

"Sexual transmission of HIV infection is gradually showing up in Iran" Dr Mohammad Mehdi Gooya, the director of the Center for Disease Control of the country said. "This warrants an immediate intervention and if does not take place, we will witness a huge and sudden rise in the frequency of new HIV positive patients" he added. Dr. Gooya recognized three waves of HIV infection. Transfusion of infected blood products to hemophiliacs led to the first wave of infection in 1987. The second wave was diagnosed in 1996-7 by detection of a large number of IV drug abusers within and outside the jails affected with the virus. Dr. Gooya says that although the second wave is now predominant, we have been seeing the signs of the appearance of the third wave since 2 years ago.Third episode of the infection is because of sexual transmission of the virus. Seaking optimistically about a comprehensive interventions program for fighting with HIV with an accent on prevention, he stresses that both governmental and non-governmental organizations are serious in educational programs for people at greatest risk of the infection.
Source: www.jamejamonline.ir , Jan, 10 2007
Code: 13N

Health in the news: Updates on HIV/AIDS in Iran

2007-01-14T09:21:00.000-08:00

Below is the latest update on the number of people with HIV/AIDS in Iran according to the MOH periodical report on the incidence of HIV/AIDS.
The latest HIV/AIDS statistics (December 20, 2006) show:
1- HIV positive or AIDS: 14,090 diagnosed cases (13,308 (94.4%) male and 782(5.6%) female).
2-From the total mentioned above, 789 male and 75 female have diagnosed as AIDS.
3-4407 of them are in the age range of 25-34 years (most frequent affected age group) followed by the age group of 35-44 years with 3338 cases. Among cases with AIDS: 25-34 years:298 cases, and 35-44: 296 AIDS patients.
4-Most frequent route of the infection transmission was IV drug abusing (64.9%) followed by unknown (25.5%), Sexual (7.5%), blood and blood products transfusion(1.7%) and finally vertical (maternal) transmission(0.5%). Among those died of AIDS: IV drug abusing (72.1%), unknown (10.5%),sexual(9.1%),blood and blood products transfusion(7.1%), and vertical transmission(0.6%).
5-Mortality: 1760 deaths (96.3 % male) up to the date of this report.

Source: http://pezeshkan.ir, Jan 6 2007
My comment: According to different sources some 2 (an official report) to 6 (WHO estimates) million individuals in Iran are opium addict. A considerable majority of the addicts are IV drug abusers. If drug addiction continues to be this high, IV drug abusing will remain the main route of HIV transmission in Iran. It seems that the contribution of sexual contacts (mostly heterosexual) as a route of HIV transmission in the total number of HIV positives will considerably rise in near future.
Code:12N

Health in the news: physician per population

2007-01-10T10:31:00.000-08:00

Dr. Gholamreza Heidari, the director of the health promotion and health network expansion center of the MOH says: according to the latest updates in our policies we need 1 physician per 4000 individuals to build up a health team.
Source: Jamejamonline, Jan 6, 2007
Code:11N

Health in the news: Lack of hospitals in some districts of the coutnry

2007-01-10T04:46:00.000-08:00

Dr. Lankarani, the Minister of Health, reported that only less than 10% of 300 districts (shahrestan in Persian) in the country lack any hospital. This indicates the main problem of our healthcare is not the number of hospitals but rather the quality of healthcare. Improving the quality of health insurance policies will lead to a drastic improvement of quality of care he stressed.

Source: Jamejanonline, www.jamejamonline.ir January 10, 2007

Code: 10N

Private sector and advanced diagnostic healthcare

2007-01-07T10:03:00.000-08:00

Dr. Lankarani, the Minister of Health, says in 2005, Tehran had 38 MRI centers and 37 of them were in private sector (www.baztab.com , code: 56945, Jan 3,2007). MRI might be considered as a typical example of advanced diagnostic healthcare in developing countries with limited healthcare budget. Number of private MRI centers can serve as a good indicator of rapidly expanding expensive healthcare in private sector. A large number of people have financial obstacles to purchase advanced diagnostic and therapeutic healthcare from private sector. This is not only because a great majority of the patients are uninsured but also originates from the fact that insurance plans generally do not (fully) cover advanced healthcare services. Many of the advanced private medical diagnostic centers including medical imaging centers (MRI and CT Scan) are not willing to make a contract with public insurance companies just because it is a huge fear about not being reimbursed in a timely manner.
Now, the Ministry of Health has realized that inequality in healthcare utilization is going to be the most important challenge of Iranian healthcare.The MOH does not have effective means to take control over the expanding private sector and people have to pay most of the healthcare out of their pocket.
Code:4A

Health in the news: Therapeutic care for road traffic injuries is completely for free

2007-01-07T09:48:00.000-08:00

Dr. Lankarani, the Minister of Health, in a reaction to a Member of Parliament (MP) said that therapeutic healthcare for road traffic injury (RTI) victims is for free in public hospitals. The MP did not convince after listening to the Minister's remarks in regard to healthcare provision for RTI victims.

Source: Baztab,Jan 3, 2006, http://www.baztab.com/ news code: 56945

My comment: I don't know for sure what percent of RTI victims are being transferred to private hospitals but I suspect the majority of cases receive their advanced therapeutic care in public hospitals. Private hospitals are not willing to accept multiple trauma cases; hence, they have not expanded their capacity to admit these patients. All ,for example, know that Sina and Shohadaye Tajrish Hospitals are two hospitals in Tehran with advanced trauma care and their emergency trauma services providing free of charge services for RTI cases happening anywhere in the country.
Code:9N

Health in the news: Iranian physicians achieved the best possible survival rate for their patients with liver transplant

2007-01-07T08:17:00.000-08:00

Dr. lankarani, the Minister of Health said that Iranian patients who recieved liver transplant now have a one-year and five-year survival rate of 82% and 90% that is comparable with international standards. He added only 10 percent of 200 liver transplants were done for patients with hepatitis C as the cause of liver failure that depicts a completely different picture from that of the western countries where hepatitis C is the main reason for which liver transplant is performed. The main problem we are dealing with in relation to liver transplantation in Iran is patient followup he reiterated.
Source: http://pezeshkan.ir/, December 29, 2007
My comment: There is no doubt that the rate of successful liver transplantation is increasing in the country. However, comparing with kidney transplantation, this rate seems to be very small. The first liver transplantation surgery in Iran back to more than 20 years ago but it was limited to Shiraz Namazi Hospital for quite a lot of years. Recently, the country has expanded the capacity for liver transplantation surgery in Tehran and maybe some other big cities but I guess Iran has not enough expert liver transplant surgeons and hepatologists in order to increase this capacity in short term.
Code:8N

Health in the news: Health insurance organizations are not able to cover all health needs of the population

2007-01-07T07:43:00.000-08:00

Dr. Bagheri Lankarani, the Minister of Health remarked: Health inequality and lack of an comprehensive and uniform health insurance plan is the salient health problem in Iran. He added that without the establishment of an uniform, comprehensive public health insurance plan the Ministry of Health cannot help the system be more equitable. He admired the insurance organizations ,however, for increasing the public health insurance coverage from 75% to almost 90% in recent years.
Source: No: 1977, Jan 3, 2007 Aftab newspaper, http://www.aftabyazd.com/

My comment: I think this is quite understandable. We have at least 4 huge health insurance companies in Iran:Social Security Organization, Medical Treatment Insurance Organization, Imdad (relief) Committee Health Insurance for poor people, and Military Service Health Organization. Private insurance's coverage is around 1% . Many have double and even triple coverage while some (approximately 25% according to 2002 Household Healthcare Utilization Survey ) lack any. People who are working with a number of prestigious public, or private organizations benefit from a special coverage provided by complementary health insurance policy. Many attempts have failed so far in order to integrate the plans and build up a unified one. This remains, I believe, to be a major problem until the system makes an effective and simple policy to have one integrated health insurance plan for the entire population or alternatively implement a HMO-type policy.
Code:7N

Health in the news: Emergency service covers only 9% of road traffic accidents in Iran

2007-01-01T12:01:00.000-08:00

"While in developed countries emergency serivices cover more than 80% of road traffic injuries , this figure in Iran is only 9%"Dr. Shahram Alamdary chief of Relief and Rescue Organization (Sazemane emdad va nejat) said. Rec Crescent and Reilief and Rescue Oraganizations are two bodies responsible for providing emergency services with road traffic injury victims.
Source: Jamejanonline, December 31, 2006
Code:6N

Road traffic injuries in Iran, a fast look on a disappointing report

2006-12-30T20:16:00.000-08:00

Each year 50 million road traffic injuries (RTI) take place around the globe. As a consequence 1.2 million people lose their life.Ninety percent of all RTI deaths happen in developing or middle income countries (Koptis 2003, Murray1996). While pedestrians, bikers ,motorcyclists, and bus and minibus occupants are reported as the main victims of RTI in developing countries, car occupants constitute the major subgroup of RTI death in developed countries. In some Asian countries motorcyclists comprise over 50% of RTI death. Estimated number of hospitalized cases after road traffic injuries and outpatient cases per one RTI death is 15, and 70 respectively(Gururaj, 2000, Varghese 2003,Mohan 2002, Martinez 1996,Mock 1999and 2003, Evans 1991, London 2002). It is believed that by the year 2020 RTI death will be considerably decreased in developed countries and increased among developing nations (Murray1996).
In 2003, RTI death rate in Iran was estimated to be 34.2 in 100,000 population while the world average was 28.8. RTI death seems to be higher in provinces with high travelling rate but low ratio of highway roads to non-highway roads. In some provinces RTI death in rual areas were higher than that of urban areas. RTI Death rate was consistently 3-5 times more in men than in women. 46.8% of RTI deaths happend on streets inside villages and cities. Rural roads oustside villages was the place of 19.5% of RTI deaths while 21.5% of death happened on intercity roads. Only 8.5% of RTI deaths took place on highways (inside or outside the cities). Motorcyclists constituted 51.7 % of RTI deaths. Pedestrains, four-wheeler occupants, and occupants of vehicles with more than four wheels comprised 17.5%, 14.9% and 11.3% of total RTI deaths. 49.1% of all RTI deaths happened immidiately after accident and on the accident scene, while 13.9% and 28.3% of them happened during transferring to hospitals and after hosptalization respectively. 95% of RTI deaths happened within 2 hours after accidents. Only 14% of RTI victims were transferred to hospitals by ambulance and just 40% of RTI victims were transferred to hospitals within 20 minutes after accident. In 2001, Iranian experts guesstimated that RTI causes 600 million US dollars loss in one year.

Source: Naghavi M, Ja'fari N, Alaeddini F, Akbari ME, Epidemiology of external causes of injuries in I.R. Iran. 2004, Ministry of Health and Medical Education, Tehran-Iran

My comment: I think the numbers in the report are self-expressing. Only 12 provinces were included in this study and all major provinces plus Tehran and its suburbs were excluded. If added, Tehran in itself with 13 million population and millions of motorcyclist can make major changes to the presented rates and propotions .
Code:3A

Health in the news: 50,000 annual mortality due to congestive heart failure in Iran

2006-12-28T07:12:00.000-08:00

Dr Hassan Radmehr, chief of the cardiovascular surgery department of Imam Hospital in Tehran, announced that 50,000 people die each year because of heart failure in Iran.
Source: www.pezeshkan.ir, December,28 2006

My comment: It shows that the health transition (from infectious disease to western disease pattern plus population aging) has already happend. You can find tabulate data on burden of disease in Iran from the book published by the Ministry of Health titled "Simaye Marg dar 18 Ostan) by Dr. Naghavi and his colleagues.
Code:5N

Health in the news: Who is responsible for patients with chronic mental disorders?

2006-12-27T06:59:00.000-08:00

In 2001, provinding healthcare for patients with mental disorders became a responsibility of the Sazemane Behzisti (Welfare Organization)* . According to the Article 97 of the Fourth Development Plan 75% of the target population should be covered during a five-year peiod beginnig from 2005.
Mr. Barati, chair of the committee for reorganizing chronic mental disorders of Sazemane Behzisiti says: over the last 4 decades the absolute number of hospital beds for mental patients has been increasing while the ratio of mental beds to total beds has been on the steady decrease. This ratio has been 10%, 8%, 7%, and 5% for the years 1968, 1973, 1984, and the current year respectively. Now, Sazemane Behzisti with 4200 beds is provinding standard care with patients affecting mental disorders. Barati claims that the MOH through focusing on preventive mental care has been deviated from investment for therapeutic mental care. He reiterates that in order for the people in the MOH to find a solution for problems with mental illnesses in the country they should see and analyze the facts instead of investing time in trasnlating foreign books and articles!
More statistics repoted by Barati:
1-21,100 mental patients are being serviced by Behzisti.
2-Cost per mental bed for Behzisti : 125,000 Tomans
3-Total hostpital beds in the coutnry: 109,000
* Welfare Organization is completely different from Vezarate Refah (formerly Sazemane Tamine Ejtemaei). Now, Iran has different bodies for providing welfare for the people, all acting at national level but are totally independent.

My comment: Well, it's not that easy to comment on this article. Behzisti is a typical example of decentralization of healthcare in Iran at all possible levels (from policymaking to provinding direct care). Reviewing 50 years history of healthcare in Iran, I can say we have had few successful decentralization examples in healthcare. We all know that standard mental wards staffed by university psychiatrists are under the MOH. In order for Sazemane Behzisti to act successfully in providing therapeutic care for patients with mental illnesses it may need to have kind of policies for integration into these wards in one way or another.

Source: Jamejam online: December 27, 2006
Code:4N

Health in the news:Per capita therapeutic health care should be increased to 10,000 Tomans (approx 11 USD) by 2007

2006-12-26T16:53:00.000-08:00

" To be in accord with the fourth National Development Plan the government should increase the therapeutic per capita health care to around 11 USD by the year 2007; as a result the out of pocket (OOP) payment will decrease from current 60% to 50%" Heidarpour Shahrezaei said to ISNA. He stressed that according to the fourth National Development Plan the share of out of pocket payment (people's share in health expenditure) is to be 30%.

Source: Aftabyazd online newspaper, www.aftabyazd.com, NO: 1973 , December 27, 2006

My comment: This may be considered an incredible jump. Now, the government pays 4.5 USD per person for therapuetic health care. I think 30% increase is what we can expect instead. I'd like to add that should the government accepts to pay this magic share, it will not guarantee the expected decrease in the share of out-of-pocket payments. Sudden increase in interest rate for expensive therapeutic services by private sector soon after the rise in the goverment's share might cause OOP to go up to some extent.
Code:3N

Health in the news: Differential scoring of provinces in Iran in terms of level of health

2006-12-25T12:29:00.000-08:00

According to the latest scoring of provinces in Iran in tems of health level by Mr. Nejat Amini , Tehran, Markazi, and Isfahan provinces were scored as having appropriate level of health, Golestan, Ardabil, and Ghom provinces were classified into the middle grade, and finally Sistan & Baloochestan, Khoozestan, and Kohgilouyeh & Boyerahmad were given the worst score. Thirty-five different health indices were employed by Amini and his colleagues to make up a composite index for scoring health level of provinces.
From 1990 up to 2003 the inflation rate in health care costs in urban areas of the country was reported to be consistently more than general infation rate. The only exception was said to be the year 1992.
In a ten-year period from1991 to 2001 permanent hospital beds increased from 85,810 to 109,863. The corresponding figures for the number of hospitals during this period was an incresase from 639 to721. For each 100,000 population Iran has 5.14 medical specialist in average. The distribution of medical specialists are not even across provinces.

Source: Health level scoring in Iran. www.peikeiran.com, December 25, 2006. Code: 35935

My Comment: I wish I could publish the complete list of provinces along with their score in health level in English. I don't have access to it for the time being. Undoubtedly, Sistan & Baloochestan is the worst province in terms of poverty and consequently health indices. You can consider this province as a separate part of the whole picture. Portions of Sistan, especially areas close to Afghanistan-Iran border are extremely poor. Despite the fact that primary healthcare system with all its potential capacity is up and running in Sistan, other socio-economic factors prevent health indices to improve. Nowadays I hear that the government has particular plan for poverty reduction in poor areas of the coutnry but I am not optimistic about the short-term (and even long-term) results of these programs. According to many calculations the poverty gap has been getting bigger in the coutnry in recent decades.
Code:2N

Health in the news : 20,000 annual neonatal death in Iran

2006-12-25T11:46:00.000-08:00

"Following accidents and cardiovascular diseases, perinatal mortality is the third cause of premature loss of death in Iran. Annually, 20,000 neonates lose their life at birth and 5000 additional neonates die of other pregancy related causes before and after birth " Mohammad Esmaeil Motlagh , the chair of the Office for Population and Family Health of the MOH, said. Most cases of neonatal death occur in ghettos of towns and cities close to borders. Preeclampsia/eclampsia, postpartum bleeding, and pregnancy related infections are among the top causes of neonatal death.

Source: 20,000 annual neonatal death in Iran. JameJam online, December 25, 2006

My comment:
1- In a different source ( www.pezeshkan.ir, November 20, 2006) the perinatal mortality is reported to be 35,000/ year. In this report, the neonatal mortality rate is said to be 20,000 per year!
Having a look at trend of child mortality indices during the last decade, we can see that while under 5 mortality and infant mortality have been decreasing rapidly, neonatal death rate has been on slight increase. This is becuase the PHC network helped a lot in reducing mortality due to diarrhe and other infectious diseases via ORS therapy and immunization while neonatal deaths are being caused by multi-factorial causes in which interventions are to be expensive and multi-faceted. However, if maternal bleeding as a cause of neonatal death is reduced, we may expect a good decrease in neonatal death in poor areas of the coutnry as a result.
Code:1N

Overuse of injectable Diclofenc in Iran

2006-12-25T03:49:00.000-08:00

Surfing the internet, I came across a very nice paper written by Dr. Cheraghali on a very unique issue in Iran's healthcare system which is overuse of injectable Diclofenac. I remember exactly the time I was serving as a GP in Zanjan, northwest Iran, where people had a huge demand for injectable Diclofenac, Vitamin B Complex and even Vitamin B6. Many of them believed that Vitamin B6 vials contained a powerful substance like blood that helped them stay in a better health. Talking to my friends from other parts of the country rolled out that this was a commonplace problem.It Most doctors cannot resist against individuals' request for injectables . I know that the problem of injectable drugs is not limited to Iran and many people in developing countries like India and Pakistan has a great demand for them.

Here is the abstract of the paper from PubMed:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16782253
code:2A

Summary of major healthcare challenges in Iran

2006-12-25T02:08:00.000-08:00

HealthyIran is my first weblog created on December 25, 2006. I'd like to have your opinions on pros and cons of healthcare system in Iran. I try to write in brief but to the point.

I would like you to comment on the major challenges of healthcare in Iran, summarized as follows:

1- Healthcare delivery at primary (preventive) level is totally public and seems to be very efficient. Currently, more than 40,000 Behvarz (Community Health Workers) are working with the system. The system provides a number of basic level free of charge healthcare (mainly preventive) with rural people all over the country.

2- Higher level outpatient healthcare is in private sector and totally unregulated. This causes people to pay out of their pocket for healthcare. In fact, some 65% of healthcare expenditure is coming from people's pocket.

3-Inpatient care is mainly provided by governmental hospitals; however, 20-30% of hospitals are in private sector. Most of private hospitals are located in large cities like Tehran, Isfahan, Mashad, Shiraz, and Tabriz.

4-Ministry of Health and Medical Education supervises 40 Medical Universities. Medical university in each province is the core unit for local health policy making and supervising healthcare at provincial level.

5-Since the year 2005 the Ministry of Health has started a national program on referral healthcare delivery in outpatient care. Recruited General Practitioners are working as family physician and considered as gate keeper of the system.

6-The cost of healthcare is rapidly increasing.

7-Cardiovascular disease, Road traffic accidents, cancers, and addiction are conditions with the highest burden in the country . Other words, they are the main cause of mortality and morbidity. Like other (developing ) countries , and with increasing age, degenerative mental disorders (dementia) are increasing in Iran. Depression, and psychotic disorders are diseases with very high morbidity in the coutnry.

8-AIDS is increasing and is becoming a major challenge for the health system.

9- Micronutrient deficieny is commonplace while average weight of the population is on the increase.

10- Tuberculosis, malaria, brucellosis, and other infectious diseases have a patchy pattern and are endemic in parts of the country.

11-Health insurance policies are not efficient. More than 90 percent (and according to self-reported estimates at least 75%) of the population are covered by at least one type of health insurance plan. Less than one percent of the health insurance policies are private. Supplementory health insurance plans are only for a limited number of people working in high class formal sector.

code:1A