Road Map of Health Area in Iran Health System

The achievements of the healthcare network in the country have changed over the past three decades, and in some cases the healthcare network has achieved success at international level as well; for example, the decline in infant mortality, children and pregnant women mortality rates, and the control of infectious diseases. These successes have been due to the development of health services in rural and deprived communities. The main reasons of these successes has been the development of human resources in the health sector as well as the promotion of social factors, such as increasing people’s literacy and the development of health, welfare, and infrastructures facilities in rural communities by other sections collaboration. Due to several reasons, it seems that the quality and quantity of health services in the healthcare networks of the country need to be changed and improved. Some main causes are as follows: 1- The reversal of urban and rural populations over the past three decades, population density in cities and its margins (or informal settlements). 2- Changing the causes of the diseases and early deaths from infectious to non-communicable (which is dependent on the lifestyle of people and economic, social, political, technological, international, and environmental factors). 3- Low coverage of primary health care in cities and towns. The major aim of this study is situation analysis and defining health transformation plan. This study was conducted using a qualitative approach at three stages: conceptual framework designing and stakeholder’s analysis, health indicators status analysis, and direction determination. Data were collected in three ways: literature review, written opinion polls, stakeholders’ focused group discussions. According to the health challenges which was achieved by analyzing the people health indicators in addition to stakeholders’ views, in the beginning, 19 strategic health goals were agreed upon in order to improve the physical, psychological, and social health indices. Due to the lack of a similar program and subsequent evaluations, determining the success rate for each goal in the coming years was defined on the basis of a set of documents and stakeholders’ views, including the Global Prevention Program,Control of Non-Communicable Diseases, and the Millennium Development Goals. These 19 strategic goals are as follows: 1- Promoting awareness, attitude and self-care group skills by 30% compared to base year. 2-Increasing community participation in equitable health promotion by 30% compared to base year. 3-Increasing coverage and benefiting from early diagnosis services. Issuing health cards and increasing care coverage up to 60% of the country population. 4-Five percent reduction in deaths from cardiovascular infarctions, cancer, and respiratory diseases. 5-Organizing inter-sectoral cooperation in reducing health risk factors 6- Ten percent reduction in salt intake and rate of smoking, high blood pressure, and low physical activity. 7- Reducing the slope of the diagram of changing overweight people in to obese ones. 8- Reducing the prevalence of prevalent psychiatric disorders (depression and anxiety disorder) by 5% compared to baseline (based on the results of the National Mental Health Survey). 9- Reducing the prevalence of drug abuse by 5% compared to the base year. 10-Reducing the prevalence of alcohol consumption by 5% compared to the base year. 11-Improvement of social health indicators by 5% compared to the base year (based on the results of the indicators of the Iranian social health scale in the National Survey of 2014) 12-Improving the quality of care for chronic non communicable diseases by 30% compared to base year. 13- Increasing the number of health protection places (place of residence, study, work, recreation, worship, and provision of services and neighborhoods) to 15% of the base year until the end of the program. 14- Decreasing of sugar, fat, and salt of food to standard levels declared by the Ministry of Health. 15- Increasing the safety of health units in terms of functional readiness, structural and non-structural safety status up to 50% of the status quo. 16- Improving preparedness of the population covered by health care centers for disasters to the extent of 50% of the existing situation. 17-Reducing the deaths of target groups including infants, children, and pregnant mothers. 18- Improvement of the evolutionary level of children up to 20% (in the fields of talking, counting as well as physical, social, emotional, and educational situations). 19-Promoting total fertility rates up to alternative rate. Based on stakeholders’ perspectives, three major strategies were proposed: 1) Promoting health literacy and empowering people; 2) Inter-sectoral collaboration for safe environments and health policies; and 3) Developing primary health care network services (PHC). In order to establish and ensure the implementation of the above-mentioned aims, redesigning of the principles in the health services network of the country is necessary. Accordingly, 18 principles have been designed, for example: 1) Establishing the rights and duties of citizens’ health (self-care and participation. 2) Being responsible for the burden of diseases, especially non-communicable diseases and social injuries. 3) Assisting the process of equitable improving of citizens’ quality of life. 4) Making strategic purchases by hiring well-educated staff capable of updating themselves. 5) Providing services actively, social marketing for utilization of the services, and the other 13 principles. Totally six national programs were proposed based on the three major strategies and 18 principles in the provision of comprehensive health services to gradually develop throughout the country by the end of the eleventh government. In developing these programs, three axes of political support, operational capacity building, and culture promotion were taken into account. In a study conducted in the eighties, it was determined that the Ministry of Health and Medical Education, based on the analysis of the role and share of devices at that time, had the range between 14% to 17% of the share in improving the health of the population, so as long as other devices would not do their defined share and role, it is not expected to improve the situation of the health indicators. The implementation of the proposed plan requires the provision of contextual factors, such as redesigning the organizational structure of health system (from staff to line level), determining the expectations of other deputies of the Ministry of Health and medical universities, as well as defining the role and sharing of non-health sectors.