Health in Iran
The health system, sometimes referred to as the healthcare system or health and treatment system, is the organization of individuals, institutions, and resources that provide health services to meet the health needs of the target population. Health in Iran is an important topic that we will address further.
A wide range of health systems exists worldwide, each with different histories and organizational structures, much like the various countries themselves. Inherently, countries must design and develop health systems according to their needs and resources, although common elements in almost all health systems include primary healthcare and public health measures. In some countries, health system planning is distributed among market participants. In others, there is a coordinated effort among governments, labor unions, charitable institutions, religious organizations, or other coordinated entities to provide targeted healthcare services to the populations they serve. However, healthcare planning is often described as evolutionary rather than revolutionary.
Iran, as the third largest and most populous country in the Middle East, with a population of over 82 million, is classified among countries with “upper-middle” income globally. The fertility rate in this country has decreased from 6.5 births per woman in 1985 to 1.8 in 2016. Despite achieving a 95% coverage of free public education in urban and rural areas of Iran, the country still faces some shortcomings in this regard, particularly in certain limited rural regions.
A noteworthy point is the increase in general literacy rates in Iran, which has risen from 10% and 30% for women and men, respectively, to over 84% and 91%! Additionally, the number of students in Iran has seen significant growth, increasing from 312,000 in 1990 to four million in 2016. The unemployment rate in Iran is 10.9% for men and 18.6% for women, with the highest unemployment rate among university graduates. One of the main reasons for this is the increased presence of women in higher education and their lower participation in the labor market for various reasons.
World Health Organization (WHO)
The World Health Organization (WHO) is responsible for leading and coordinating health within the United Nations system and promotes the goal of global health care to ensure that all people can access health services without incurring financial costs. According to the World Health Organization, the goals of healthcare systems include ensuring the well-being of citizens, responding to the expectations of the population, and providing fair means for financing.
Progress toward these goals depends on how systems perform four essential functions: delivering health services, generating resources, financing, and monitoring. Other dimensions for evaluating health systems include quality, efficiency, acceptability, and competency. In the United States, these are also referred to as the “five C’s”: cost, coverage, consistency, complexity, and continuity of care, which is one of the main objectives.
Health care in Iran
Health care in current Iran is provided by both private and public sectors.
After World War II, with the efforts of the Pahlavi government, international agencies, and philanthropists, the health conditions in Iran significantly improved. By around 1963, Iran was able to eradicate smallpox, eliminate plague, and nearly eradicate malaria from its territory. Cholera also became prevalent around 1970 but was controlled shortly thereafter; this disease re-emerged in the early 1980s and was promptly addressed. However, Iran’s health facilities remain inadequate, and there is a noticeable shortage of doctors, nurses, and medical equipment in the country.
Public hospitals alongside private institutions, provide health and medical services to the people, but are still insufficient. The Ministry of Health, Treatment, and Medical Education oversees the country’s medical services. Welfare services are also implemented by the Iranian Welfare Organization, the Martyrs and Veterans Affairs Foundation, and the Foundation of the Oppressed and Disabled. According to 2017 statistics, the maternal mortality rate in the country was 16 per 100,000 live births (ranking 50th out of 185 countries). This rate has decreased to one-third compared to seventeen years earlier (2000), making Iran the 13th in terms of reducing maternal mortality during this period.
The infant mortality rate, based on estimates from 2019 is 12 per 1,000 live births, placing Iran 82nd among the 193 countries surveyed. The life expectancy in Iran is 76.5 years (75 years for men and 78 years for women).) In this regard, Iran ranks 73rd in the world (out of 199 countries). This figure has seen an increase of more than twenty-two years. The per capita number of hospital beds in the country in 2018 was 1.6 beds per 1,000 people, and their distribution across the provinces is uneven. According to 2017 statistics, nearly 75% of the available beds in Iran were in the public sector.
A significant number of beds in private hospitals often remain unoccupied, attributed to the financial inability of many Iranians. The most common water and foodborne illness in the country is bacterial diarrhea. The coronavirus pandemic in Iran (2019) also occurred and left significant casualties due to its sustained spread within the Iranian community.
The pharmaceutical and medical equipment sectors are consistently addressed together in budgets and five-year development plans at a ratio of 60% to 40%, together with occasional support from the Planning and Budget Organization. The total healthcare expenditures in Iran in 2005 were 20.4% of the gross domestic product. 73% of Iranians are covered by health insurance. In its latest report, the World Health Organization (WHO) ranked the level of health system performance in Iran as 58th and the overall health system performance among governments worldwide as 93rd.
According to the statistical yearbook published in 2017, there are 125,566 hospital beds in 31 provinces of the country, including 8,212 ICU beds.
Performance of Health Systems
Since 2000, increasing initiatives at both international and national levels have been undertaken to strengthen national health systems as essential components of the global health system. Keeping this context in mind, it is essential to have a clear and unrestricted vision of national health systems, which can encourage further advancements in global health. The development and selection of performance indicators are heavily dependent on the conceptual framework established for evaluating health system performance.
Like most social systems, health systems are complex adaptive systems where change does not need to follow rigid management models. In complex systems, path dependence, emergent properties, and other nonlinear patterns can be observed, which can lead to the development of inappropriate guidelines for creating responsive health systems.
