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

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

Priorities of the Ministry of Health for the next four years

Seyed Hassan Hashemi , MD, and the new minster of health explained the priorities of the Ministry of Health (MOH) for the next five years. Meeting the needs for [essential] pharmaceuticals is the first and the foremost first task of the MOH he stated. He acknowledged the unmet needs of patients with hard-to-treat conditions. Establishing a single payer system is what MOH will accomplish as its most important mission in the coming four-year term according to him. Improving and expanding the family physician network was what Dr. Hashemi described as a parallel important plan for the MOH.

My comment: It seems that essential drug supply is the right immediate mission for the MOH. Single payer system helps integrate the medical care in Iran. This is doable because less than 2% of the health insurance coverage is provided by private medical insurances. Family physician network is essential as well but is a rather difficult task to accomplish. With more than 90% of outpatient care being in private sector enforcing the referral guidelines and managing the provider payment system is quite challenging.

Source: It's an interview in Farsi posted on youtube :

http://www.youtube.com/watch?feature=c4-overview&v=5AEgpDjaoOw&list=UUI01l6WXUWeKEpaNJD3x6fQ&desktop_uri=/watch?v=5AEgpDjaoOw&feature=c4-overview&list=UUI01l6WXUWeKEpaNJD3x6fQ&nomobile=1

150 pulmonologist (lung diseases subspecialist) for 77 million Iranians

Dr. Katayoun Najafi Zadeh MD, the chair of Organ Donation Center of Shahid Beheshti Medical University in Tehran-Iran,  says we should increase this number to 1500 in order to meet the needs of our population. Najafi Zadeh believes that if number of pulmonologists in Sweden was the right benchmark we would already train around 4000 of these specialists.

My comment: There are two problems here: 1) the distribution , and 2) the absolute low number. Medical specialists in developing countries tend to provide services in big cities. This is very true about Iran as well. The low number of pulmonologists regardless of where they practice seems to be a serious issue. However, it seems like Iran has to have its own health service provision map rather than looking at western benchmarks. Training more sub-specialist physicians cannot be an optimal solution in a system with disintegrated care for chronic conditions. In fact, more sub-specialist does not guarantee more efficient ( high quality at lower cost) medical care.

Source: Tasnim News, Tasnim News ID: 112574 ; URL: http://www.tasnimnews.com/Home/Single/112574 accessed August 7, 2013

Health insurances do not afford coverage for prescribed medicines anymore

With the recent sanctions against the country and skyrocketing  market inflation health insurance companies have problems with reimbursing  prescribed medicines. 

Reported by Tasnim News Agency Ahmad Ariayei Nezhad , a member of the Health Commission of the   Parliament of the Islamic Consultative Assembly, announced that insurance companies pay pharmacies according to old contracts in which the price of drugs is about one third of the current rates.

He seriously warned that if insurance firms do not receive enough premiums/governmental source of money they will soon go bankrupt.  

Source: http://www.tabnak.ir/fa/news 
News code: 334650 (In Farsi) 
Accessed: July 27, 2013 

My comment:  Health insurance companies in Iran for the most part receive their monetary input from the government. Only a fraction of the money come from premiums. Pharmacies have two main sources  of monetary input for prescribed drugs : Purchaser's out of pocket money (either co-payment or  entire payment), and reimbursements mae by the insurance companies. Recently, many people have to pay hundreds of dollars out of their pocket to buy expensive medicines they need to treat specialized conditions such as various cancers and multiple sclerosis. Lately, US government removed the ban from exporting  life-saving drugs to Iran. The sanctions have created an alarming  problem for Iranians seeking for a variety kinds of medical treatments.

(see http://www.guardian.co.uk/world/2013/jan/13/iran-lifesaving-drugs-international-sanctions) 

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

Inadequate insurance and shortage in providers to support patients with burn

"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

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

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!

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

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

"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

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

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

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

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

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

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

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

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!

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

"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

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%

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

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

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

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

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

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

"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

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