مجله فرهنگ و ارتقای سلامت (فرهنگستان علوم پزشکی جمهوری اسلامی ایران)
سال سوم شماره 3 (پیاپی 7، پاییز 1398)

Health Resistance Economy is based on general health policies. Comprehensive health and healthy human is its main purpose and in this approach human and Islamic principles and values are observed. This policy brief presents principles and values and practical strategies of resistance health economy.

Increase of healthcare costs has become a major challenge worldwide. In order to ensure the security of treatment for all people, resiliency is necessary for the country’s health economy and must promote in the country. The aim of this article is to introduce the macro-axes and specific issues of each axis.

In this study, concurrent-nested mixed method was used. After discussing in focus group meeting and qualitative content analysis, the macro- axes priority of the resistance economy and specific issues were extracted. Studies in the field of health and resistance economics were identified as the complementary role by searching the databases of sid, magiran and Google scholar and with the keywords health, resistance economy, health system and Iran and the final list was obtained.

Twelve macro-priority areas and specific issues of each axis were identified. The macro-axes are: "Conceptualism", "Basis, Principles, Values, Goals", "Policies and Strategies”, “Pathologic barriers and Challenges of the Health Economics", "Indices", " Intersectoral dimensions of the Health Economics and the Resistance Economics", "Requirements", Examples/Objective Examples in Contemporary History”, “Culture and Culture-Building”, “Dimensions of Health Economics Management”,  and “Implementation Strategies" in each macro-axis, a number of specific issues were introduced.

Strengthening the countrychr('39')s health system in normal conditions, crisis and disaster, war and bioterrorism, and economic sanctions, requires the implementation of health resistance economy. An excellent, efficient and responsive health system is possible with comprehensive implementation of the general health policies, related clauses of the resistance economy general policies, and other upstream documents in the field of health. Monitoring, evaluating and macro observation of health are also necessary for dynamism and prosperity of health economy and the achievement of affect and defense capabilities.

Resistance economics in health is an economy based on human and Islamic principles, to achieve a comprehensive approach for health and a healthy person based on "valid references of Islamic economics", "Principles of the Constitution of the Islamic Republic of Iran", "Comprehensive Scientific Map of the Country", "Documents of General Policies of Health, Science and Technology, principle 44 of the Constitution and the Resistance Economy, notified by the Supreme Leader” and "Other Related Documents of the Policy related to Islamic Republic of Iran". The strategies identified in this study present the realization of a resistance economy for achieving the health system to the following macro goals:Identify and apply the scientific, technical and economic capacities of health to access the capability.Monitoring the programs of the sanctions, managing the risks against economy, preparing active, fast and timely response plans against internal and external risks and achieving defense capability.

This article has been prepared by reviewing library references in political documents and national sources and selected from international sources after a focused group discussion in resistance economics group of the Academy of Medical Sciences.

The major and main strategies identified in this study are: "approach of health equity", "adherence to other human and Islamic values in health", "scientific authority with the approach of promoting human capital of health", "generalization the integration of education and research in services and care”, "comprehensive implementation of the principle of prevention", "realization of insurance system with a comprehensive approach for public health insurance”, "Developing of the countrychr('39')s health care network", "self-sufficiency and cutting dependence on health services and goods", "reforming the consumption pattern in the health system", "creating, maintaining and increasing of strategic and essential reserves", "increasing peoplechr('39')s participation with promoting in culture and health literacy" and" achieving health system and defense capabilities. “In each macro strategy, a number of specific strategies were considered. In theoretical study, principles, goals, policies and basics have been presented from valid and credible references.

The definite and permanent resilience and resistance of the health system in all circumstances can be possible with "Islamic economic system" based on knowledge and technology, "justice", "endogenous and exodenous", "dynamic and progressive", "Islamic approaches" "cultural", "ethical and spiritual", "transparency and accountability", "fight against corruption and abuse", "flexibility", "Production", "Productivity and cost-effectiveness", "Entrepreneurship", "Saving".

A "resilient economy “is one that can sustain the growth and development of a country in times of trouble ie sanctions, war etc. Conditions requiring surgery places a considerable cost burden on the impoverished in a society; Surgery is not always a cost-effective treatment modal. Cost-effective strategies when feasible can help the Impoverished. A resilient economy based on Islamic values and economics seeks scientific prosperity and equity in rendering advanced national health services, and expenditure. This study assesses economic strategies for poverty elimination and equity in healthcare and surgery.

This article is a review of the authorchr('39')s views and experiences.

A resilient economy may be applied in the following sectors: "Prioritizing of health and prevention instead of treatment", "preventing inequity in surgery", "seeking cost -effectiveness of diagnostic-therapeutic methods and surgical techniques" "promoting Healthy lifestyle such as adequate sleep , physical activity and nutrition", "preventing Obesity and excdess weight in surgical patients", "Prevention and control of surgical complications", pursuing "Indication and priorities in treatment ", preventing unnecessary and undue procedures.

Attention to scientific and safety principles and surgical indications is necessary in reducing expenditure and preventing undue procedures on under- privileged people can help remove poverty from Islamic societies.

The Iranian Health House is a peripheral unit of the Iranian Primary Health care (PHC); it is the most comprehensive health service unit in rural areas of the country. These Healthcare units, were formed with the intention of increasing of social and health equity in health to benefit those in need of healthcare services. In this study, the cost of health services delivered in 1995 to prevent child mortality and disability in children under 5 years of age were assessed.

Data were obtained by literature review of studies conducted on the costs of Healthcare clinics as well as information from websites of the Statistics Center of Iran, National Organization for Civil Registration, Central Bank, Ministry of Health and Medical Education and interviews with key informant involved in the development of healthcare centers and then the cost of preventing death and disability of children under 5 years of age were estimated.

The healthcare cost of a villager was US$ 10 per year in 1995. Health expenditure of a child was US$ 3 per year. The number of deaths and disabilities of children prevented were reduced was 2400 in 1995. Taking into account the population under 5 years, primary health care costed about US$ 3,000 a year for each child under 5 saved from death or disability. The cost of treatment such as open heart surgery or a kidney or liver transplant that year costed at least $ 10,000.

Based on the results of this study and review of the available literature, it was shown that in 1995 the cost effectiveness of primary health care compared to major operations such as open heart surgery or kidney transplantation was 18 times more than the cost of prevention in children under 5 years of age.

Fasting is one of the most important duties recommended in Islam. It is ordered to be performed on adults and healthy people and forbidden on people who cause or aggravate disease. Replacement of this duty can be performed in another appropriate time, after the holy month of Ramadan. Diabetes is a prevalent disease and some of the diabetic patients do not have conditions to perform this duty. In this article, some of the most important aspects of fasting in diabetes are reviewed.

This study is a summary of several meetings on fasting and diabetes was held in the Academy of Medical Sciences of Iran, which has been prepared and presented in focus group discussion and literature review in national references.

Many diabetic patients can do this duty during Ramadan or in other months if they follow the principles of nutrition and dietary guidelines and prescribe medication. It is recommended that patients with the following conditions do not being fast: "patients with uncontrolled diabetes", "Diabetes mellitus type 1 Brittle", "Pregnant diabetic women ", "Patients with a history of ketoacidosis or hyperosmolar coma","Diabetes with major risk factors or diseases such as coronary artery disease, liver cirrhosis, chronic renal failure, the elderly with mental disorders" "history of high or low blood sugar before or during Ramadan," and  "diabetic patients who do not follow dietary and medication orders or it is not possible for them to obey these orders carefully and correctly."

Fasting is one of the main duties recommended in Islam and can be useful in prevention and treatment of some of the diseases. Necessary conditions for fasting are health and not traveling. As a result, if fasting is harmful for a patient, it is not only obligatory, but also incorrect. Fasting is not acceptable in patients who are not allowed to fast, because as self-harm is forbidden, eating too much or too little food is considered self-harm and is forbidden.

Cancer prevention is an important action in the period of resistive economy. Breast cancer (BC) is the most common women cancer worldwide. BC is preventable cancer. Cancer screening aims to find cancer in the early stage when a patient is in the asymptomatic phase. Early diagnosis causes patient management easier in the shorter period, more effective with less cost, ultimately screening leads to increase survival rate and improve patient’s quality of life.
The aim of this study was to investigate the role of charities in the screening and early detection of breast cancer in the period of resistive economy.

First, we received a list of non-governmental charities along with their areas of activity from the National Network of Charities (NNC) in the area of cancer and then we analyzed the reports of four non-governmental charities that have been active in the prevention and screening of BC.

There are more than 60 non-governmental organizations in the field of cancer in the country. NNC covers 34 of them. Most of their activities were financial and non-financial supports (85%), the second activity was in the field of education and information (80%). We received the reports of four charities that have been involved in the primary and secondary prevention of BC.

Cancer charities in Iran are active in the area of information and public education for BC prevention. They have limited experience on early detection and they didn’t document their activities. It is necessary to work together and developed their activities based on scientific documents. We suggest to collaborate with research centers and other scientific organization and documented their activities with precise. NNCs in cancer play a key role in this regard.

An economic crisis is any decrease in economic activity in the whole economy of a country that lasts more than a few months and is visible in GDP, income, employment, industrial production and major and minor sales. The poorare more susceptible to irreparable damage to health due to economic crises. Inability to finance health services may force them to neglect essential services. The purpose of this study was to identify the effects of economic crises on health spending, and utilization of services among thepoor.

In this qualitative study first, the major financial crises of the health system, budget shortages and financial protection policies in crises with focus on the poor over the past fourteen years were sought and identified through semi-systematic searches of valid databases. Then, a questionnaire based on the findings of a review of studies including the main topics of health system financial crises, the effects of crises on the health system and the health system response to them, designed by experts and Health system specialists selected by convenience and purposeful sampling were completed.

A clear policy response to protect the poor has not been formulated in the health system to deal with financial crises, and laws and documents relate to conditions of economic stability. A review of the financial crises of the last four decades has shown that in crises with a foreign origin (war and sanctions), often reduce access to services and diminish the services having the most important effects on the health system and the austerity policies were the main policy response. Costs shifting has also been the most important policy response in domestic financial crises (caused by rising costs and lack of budget due to economic policies).

Governments that place greater focus on social safety net programs, justice and health financing, are more resilient to financial crises. Efficacy, cost reduction, and income support mechanisms can help governments maintain critical services for the poor and vulnerable. The countrychr('39')s health system must focus on ensuring the access of the poor to health services in times of crises.

According to economics classic assumptions, entrance of technology in health, can transit curve of a countrychr('39')s production facilities by reducing costs and increasing productivity, but from one time, development of technology which is used in the field of health, despite its increase share of health in GDP, will not have a significant effect on promoting social welfare and cheap and easy access to health services. So, the permanent question is where is the limit and border for technology entrance in the health sector for improving indicators? The answer of this question has made an issue named health technology assessment as a main point in health policy, which has an important role for promoting of countrychr('39')s health systemchr('39')s resilience and its level. Health technology assessment in Iran always related to policies of Ministry of Health and Medical Education. Evaluation the approach of countrychr('39')s health policy structure for technology issue needs to assess performance of this ministry.

This study performed by using scientific published references and semi-structured interviews.

Evaluation of health technology in Iran was performed in 5 areas including definition of technology, criteria for evaluating of technology, training of human resources, role of insurances in technology assessment and the role of new technologies.

Revising of the countrychr('39')s technology assessment model and decision-making structure regarding the entry of technology in the health sector is needed, especially considering the new types of technology in the health sector.

The purpose of this study is to analyze clause 7 and other health related clauses of the general policies of resistance economy.

In this review and comparative study, qualitative methods were used for data collection and analysis.

In this study, clause 7 of general policies of resistance economy especially in health system and other related general clauses were reviewed. Food security and treatment in normal condition, defensive, crisis and disaster have been analyzed and the worthy position of health resistance economy in Islamic Revolution, background for the realization of authority and modern Islamic civilization has been designed.

Most of general policies of resistance economy clauses are related to different parts of health. Policy of resistance economics and achieve it in health is not a cross-sectional tactic for confronting sanctions and economic pressures. It is a long-term strategy and should be extended to all of the conditions (normal-critical and disaster, and defensive). It’s ideal and worthy position is a basis for achieving scientific authority and new Islamic civilization.

Following the Islamic revolution in 1979, great advances have been made in Clinical Postgraduate Medical Education. Despite the significant achievements, there has been no comprehensive documentation of the growth trends. This study aimed to describe and analyze the quantitative development in Postgraduate Medical Education in I.R.IRAN over the last 4 decades.

A comprehensive growth trend analysis was conducted, via the Academy of Medical Sciences of IR Iran. First-hand data were obtained from the Council on Medical Education& Specialty training of the Ministry of Health and Medical Education, and the Medical Council of Iran. Specialty and subspecialty training growth rates within the different disciplines and physician-to-population growth trends were calculated.

Clinical postgraduate training disciplines have increased from 18 specialties in 1979 to 27 specialty disciplines in 2016, and from 1 subspecialty discipline in 1985 (the establishment of first subspecialty training programs ) to 25 subspecialties and 55 fellowship disciplines in 2016. The total number of residents admitted to specialties subspecialties and fellowships increased from 600 in 1986 to 3500 in 2015. ( 485 %. percentage increase). Women constituted about 55 % of admitted residents to specialty programs and 35 % of admitted specialists to subspecialty programs in 2016. Between 1979 and 2016, the number of specialists has increased by 333%., the number of sub-specialists has increased by 589% and the percentage increase per 100,000 populations was 112.61 %.

The results revealed that, over the last 4 decades, Iran has had significant quantitative progress in postgraduate medical education. Iran’s postgraduate medical-education system is successful and self-sufficient in providing medical manpower to serve Iranian people in different specialties and subspecialty medical fields. Along with this development, the number of Iranian female specialists and sub-specialists significantly increased to fulfil the female patient’s request for same gender physicians.

In the past decades, health has been a significant concern in all countries. Health criteria varies in different countries; disagreements on health ratings are common. The Islamic Republic of Iran, with its strong support for Islam is able to define the criteria of health according to all aspects of human existence. In this study, the criteria of health were extracted based on the 23rd prayer written in the Sahifah Sajjadiyah book of Imam Sajad (PBUH).

This study was performed based on the  Sahifa Sajjadiyyah, the Holy Quran, the hadith of the Imams and a variety of library studies.

Imam Sajjadchr('39')s (PBUH) request from God for the highest level of health is not only an accepted criterion for the basis of the health system in our country but also allows for postulation  in this regard Imam Ali ibn al-Hussein (PBUH) said: The maximum health a person can ask for is that where  all physical aspects and organs be in the best possible health and function. If injury occurs, they will have a speedy recovery back to normal.

Health starts with the physical aspect and culminates in spiritual aspects. According to this theory, theories about worldly life and the phenomenon of death should both be considered.

Culture plays an important role in improving health. Cultural determinants are effective in health service providers. Therefore, the presentation of a health system model via a cultural approach using the conceptual framework of cultural determinants affecting this system is important.

This study was conducted in a methodological manner inspired by "cultural determinants of the health system". A qualitative study  based on applied results, was carried out in two stages using a qualitative content analysis approach. In the first stage, the required data was obtained by qualitative analysis of documents and texts and semi-structured interviews. In the second stage, designing the cultural model of the health system based on cultural determinants, was done; the factors required to identify and encode in the form of models using the conceptual model was  arranged.

Improvement of cultural determinants through attention and development to underlying, structural and cultural factors from the macro level of health policy to health providers and, health care recipients can promote health and reduce health inequalities.

The results of this research can provide insight for planning and implementation of optimal interventions to create a culture of health in accord with demand in health care recipients.