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

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

Cesarian Section in Iran is 4 times world's standard

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

5 cancers get free treatment

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

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