Health System Developments in the Framework of Development Programs in Iran

Since one of the main areas of understanding of social policy, and that of health policy, is the attention to how the government focuses on the economic, social, political, and cultural development of the country; therefore, it can be traced to its development through the evolution of countries. This research was carried out with the aim of investigating the changes in the health system of Iran during development and development programs before and after the 1979 revolution. The present study was conducted using a comparative method with qualitative content analysis technique based on data collection from valid sources related to the health system in Iran (including medicine, health, etc.) ,the text of development programs ,evaluations , andrelated reports. In this way, the success or failure of development and development programs before and after the Islamic Revolution was compared to achieve social policy objectives, including health policy, and the impact of previous programs on future policies and programs. The research data were extracted from first-hand sources, second-hand sources,  previous evaluation, and research reports, and they were analyzed using the basic concepts of institutionalization approach. In addition to analyzing the impact of developmental plans and development on the changes in the health system, and showing the trend of these changes, the differences and similarities between developmental plans and their impact on health system orientation were counted. The main difference in the planning of the two study periods is the orientation of the established governments; in the government of Pahlavi and modernization of the country happened based on the nation-state andlarge-scale decisions and policies, but in the government of the Islamic Republic, establishing social justice is the basis of large-scale policy making and the welfare of the people. It is also part of the realization of these goals. Another difference is that there was not a long history of programming in Pahlavi era and strategies for achieving goals, and development plans were often conducted with the guidance and involvement of European and American experts and planners. Moreover,hardware infrastructures, such as asphalt roads and railways, appropriate communication facilities, and software infrastructures, such as the level of education and desire to participate in the advancement of programs are very insignificant, and this impediment has been an obstacle to many of the development goals, especially in the field of health.. However, in the post-revolutionary period  due to the particular circumstances of the revolution, the thinking of the mid-term planning was abandoned (the sixth development plan was generally ignored), and attempts to approve the development plan had not survived until 1988, but development plans one after the other was developed internally by experts and, in some cases, by modeling afterother countries. Besides, the required hardware and software infrastructure was provided to a large extent, and implementation of health and medical programs was facilitated more easily.  the planning differences in the two pre and post-revolutionary phases is related to foreign relations and international conditions. In the second half of the year, with the exception of the short period after the nationalization of the oil industry, there was little international pressure on Iran’s economy. After 1332 the American influence onIran’s politics and economy, and financial advisers hasalways been advocating for a dependence on the United States after implementing the policies of the White Revolution. After the 1357 revolution, consideringthe anti-capitalist ideology of the revolutionary architect from the very first days of opposition to the United States and other influential countries, such as the Soviet ::::::::::::::union:::::::::::::: and the United Kingdom beganas a result. After the revolution,the country has always been subject to international tensions and pressures. The imposition of eight years of war, the confiscation of the properties of the state and the Iranian people in the United States, the adoption of a variety of economic, scientific, and military sanctions, and ultimately, the boycott of Iranian oil purchases over the past decade have been examples of the measures that have always been an obstacle to the implementation of development and justice promotion programs. The most important similarity of development planning and social policy before and after the revolution is the dependence of the program resources on the proceeds from the sale of oil, which is the main component of the development and development costs of oil money, and ithas two major consequences for the health system: The formation of the rentier government, the reduction of government accountability to the public ,the creation of uncertainty in the provision of resources for development programs, and the failure to implement many social policies, including health policies. The other similarity of the administrative system before and after the revolution is thatthe scope of the government’s involvement in the administration of state affairs and recruitment has had its roots in both corruption and ineffective administration. Finally, as it is the case in many developing countries, the share of health financing has been very low, and the efforts made to transfer part of health care to the private sector have not been so successful; hence, allocating more funding to the health sector can help improve the health of the people. After seven decades of development planning in Iran, despite the advances and changesmade in the health sector, equity in health, especially in the treatment sector, has not yet been achieved, and inequalities in access to health servicesstill exists, and its cost is high and has increased over the past decade, partly due to rising health care costs and the other part because of lower income levels and an increase in the gap between income groups, which is not reflected in the objectives of development plans in other headings, especially the economic headline. Therefore, the success of the implementation of health policy and the realization of social justice depends on developingprograms based on data and rational and realistic estimates, moving towards mixed plans (guiding grammar), and implementing fundamental structural reforms in social and economic planning.