Iranian Journal of Public Health
Year:2009 | Volume:38 | Issue:1 (SUPPLEMENTARY ISSUE)|Papers Count:47

In Iran, the policy making process still has room for improvement. These include the opportunities for better co-ordination of policies on medical education, health research and service provision; improvement of decision making mechanisms; a more evidence-based policy making process, and more involvement of stakeholders; reducing fragmentation of policy making foci; and establishing a qualified institution for system analyses and progress monitoring. The Health Policy Council of Ministry of Health and Medical Education (MOHME) has to act as a consultant, and help develop evidence- based policy making and use of expert opinions. Every attempt has been made to define specific procedures for this matter. To achieve these, a project was designed to review the policy-making mechanisms within MOHME. The project resulted in a) a policy paper on how to make policies in MOHME; b) a particular framework (guideline) on how to develop a policy note (policy document); and c) a protocol on how to manage the Health Policy Council . As a result, some of the important national health policies and programs are reviewed in this council. In addition, evidence-based policies are defined with a consensus on stakeholders.

Prior to the Islamic Revolution, there was hardly a health care “system” in Iran. Preventive health care was very limited, and a fairly decent curative care could only be found in Tehran and, to a lesser extent, in a few large cities where a great majority of the 12-14 thousand Iranian physicians were practicing. In 1985, according to the law, all health-related schools and institutions were taken away from the Ministry of Higher Education and were integrated into the Ministry of Health, forming the Ministry of Health and Medical Education. In 1994 provincial health organizations and the universities of medical sciences were integrated, and universities of medical sciences and health services were established. Since then, the chancellors of these universities are not only responsible for education and research, but also for the health care of their entire province. As a result of the integration, research has become more public health oriented and medical education more community oriented. The integration has also led to an improvement in the health situation of the country; particularly in the villages, remote areas and less developed provinces.

Background: Iran has made significant development in health and its scientific productivity, but a cohesive approach through a long-term plan is required to utilize knowledge for the country’s health and development of health science and technology. As a part of a national agenda for development of “Comprehensive Scientific Map of the Country”, the draft of the plan in the health-sector has been prepared.Methods: A combination of two normative and exploratory approaches has been adopted to prepare the plan. For each part of the plan, a project defined. The group-projects developed their parts and consequently the draft of the plan developed. In the normative approach, the Islamic-Iranian values besides the country’s vision for the year 2025 were assumed. National Innovation System concept used to analyze the related environment. Expert panels, using foresight methods, mainly prepared the information required for developing the plan. To finalize the plan, the draft was disseminated and receiving feedbacks, the document was polished appropriately.Results: The long-term plan in the health sector has been prepared with the participation of around three-hundred experts. This plan includes vision, goals, monitoring and evaluation indicators, priorities, scenarios, policies, strategies, and requisites. Conclusion: The main challenges were as follows: considering equity in health, balance in choosing priorities (primordial and primary prevention against advanced technologies), and the role of the government in knowledge management.

It is a well-known fact that in an ideal world; the most effective health intervention for every condition would be known, every health manager would know the most effective intervention for each condition, and every health manager would practice the most effective interventions that he/ she knows. On the other hand, in the real world; much of what should be known is not known, much that is known, is not known by most health managers, and health managers often fail to practice what they know to be the most effective form of health intervention….

Medical education has undergone vast reform following the Islamic Revolution in the last three decades, with remarkable qualitative and quantitative progress having been achieved following the establishment of the Ministry of Health and Medical Education in 1985. There have been rises in the number of medical, dentistry and pharmacy schools from 7 to 36, 3 to 15 and 3 to 11, respectively, and in the numbers of student admissions in all programmers of medical sciences from 3630 to 6177 and teaching staff from 1573 to 13108, in the decades mentioned. The numbers of students in clinical subspecialty and PhD degrees have increased from zero to 268 and 350, respectively. The quality of medical education has improved with increasing field and ambulatory care training, with more emphasis on teaching preventive medicine and a significant rise in the research activities. In conclusion, Islamic Republic of Iran has been successful in upgrading medical education and research by the unification of health services and medical education into one ministry.

Four values of social accountability are, relevance, quality, cost effectiveness and equity, as they pertain to the activities of medical schools, namely education, research and service. Integration of medical education into health service provision is the best strategy for health system responsiveness and social accountability of medical education.

The Ministry of Health and Medical Education in Iran is responsible for public health, medical treatment and the management and planning of medical education, that is, training under supervision, of which expertise at all levels, from first degree to doctorate, is organized. The plan to create a health and treatment network and integrate medical education into healthcare system was designed to revolutionize the health machine in the country.

The main aim of the Master of Public Health (MPH) program is to equip the participants with the knowledge and skills essential for better service management and applied (including health system) research. The content of the program is revised and expanded in the last three decades and currently there are different MPH programs included the general MPH, Modular MPH, Medical Ethics MPH and MD-MPH programs. General evaluation and feedback show that the MPH program has been reasonably successful. MPH program enables participants to perform their duties and functions more successfully.  

Exceptional Talents Development Center (ETDC) in Tehran University of Medical Sciences (TUMS), has started to work since 2005 and was established to coordinate all activities for designing and implementing strategy and programs for identification and training of gifted and talented students in TUMS. ETDC has designed a three axes differentiated program to ensure that these students are provided with opportunities to develop their abilities and to meet their potential for outstanding achievement….

Medical education in Iran has witnessed important reforms within the last three decades. Among them was the formation of the Ministry of Health and Medical Education and a sudden rise in medical student admissions. This reform took place in a specific time period and was aimed to meet the country’s requirement of training more physicians. Other reforms have aimed to improve the quality and outcomes of physician training. This is possible through two measures: a change in medical education procedures, or a change in the ‘input’ of medical education (i.e. students) or both. Graduate admission to medical schools is a step toward changing the ‘input’. In 2008, twenty one bachelor students were admitted in Tehran University of Medical Sciences through a series of prerequisites, tough scientific exams and structured interviews. This move had three objectives: strengthening the links between basic and clinical sciences, selecting the students on the basis of a wider range of criteria (instead of strictly academic ones), and providing a chance for applicants to make a more informed choice of medicine (considering that the graduate applicants are older and have previous academic experience). Further areas of education reform are also being followed: a change in medical students’ educational content and procedures, and considerations and development of joint degrees such as MD-MPH and MD-PhD.

The growing developments in science and technology have raised ethical challenges which should practically be addressed by scientists, regulatory bodies and policy makers. Likewise, challenging issues of medical ethics have also drawn a great deal of academic attention in Iran. In other words, recent decades have been an occasion of considerable development for contemporary bioethics in Iran. At first, the ongoing initiatives to arrange the national and regional research ethics committees and to compile the national strategic plan for medical ethics is worth mentioning. Currently, research ethics committees are actively established in the universities and research centers across the country. Furthermore, the subject of ethics in different fields of science, which was followed in a traditional approach previously, is an important object of discussion currently. Much research is now being undertaken in various areas of bioethics nationwide. Consequently, during the period under review, considerable articles and books have been published in the emerging subjects of bioethics. Several educational workshops and courses have been frequently taken place in the universities and research centers. Foundation of academic courses and fellowship in bioethics are also among the recent activities in the realm of medical ethics education in Iran. Likewise, considering several areas of bioethics that need legislation or reconsideration of previous regulations; the authorities, policy-makers, and scientists have carried out some endeavors to prepare appropriate law, codes, and guidelines. This report summarizes the bioethical activities and achievements in different fields of policy-making, organizing, teaching, and putting ethics into practice in our country during two recent decades.

International ranking of universities by bibliometric assays has received a great attention in recent years. The developing countries have commenced to build their own infrastructure of research and post graduate training during the past couple of years. In 2000, the Ministry of Health and Medical Education of Iran began an annual national survey for assessing research activities in medical universities and their affiliated institutions by applying a customized ranking method. Research indicators were scored in three topics; Stewardship, Capacity Building, and Knowledge Production. In 2000, there were about 300 published medical articles in ISI/Thomson and PUBMED from the whole country. This number increased up to 3376 in 2007. The score of indexed papers in international databases per academic member rose from 0.1 in 2000 to 0.63 in 2007. The share of global articles (in the field of Medicine) grew from 0.06% in 2000 to 0.55% in 2007. This rising in article output led to a change from grade 57th in 2000 to 27th in 2007 in the ranking system of Scopus database. The number of local medical journals, which were 53 in 2000, increased to 141 at the end of 2008. This rising scores was ongoing while the growth of the total staff of the academic members was about 25% (from 9086 in 2000 to 11324 in 2007). The number of the short training courses rose from 458 in 2000 to 1097 in 2007. The registered research projects in health topic rose from less than 3878 in 2000 to 6816 in 2007.

In Iran, Population Research Centers, which were established in medical universities in 2001, were working for the aim of health promotion in particular and human development in general. These centers were based on community participation in their activities to develop the necessary capacity to allow people "more control over their own health and development". Iran's experience reveals that Community-Based Participatory Research is an approach that uses community knowledge and local resources. Its objective is to empower all stakeholders of development. The priority in local communities and the grass-root of health problems were mainly social determinants of health. On the other hand, both approaches of top-down and bottom-up approaches must be simultaneously considered for dealing with these determinants. Establishment of such centers can create good opportunities for developing original solutions for dealing with social determinants of health. The success of Population Research Centers depends on policy makers’ concepts and attitude toward social determinants of health and the role of community participation in this regard. It seems that a more extensive engagement of different sectors including universities, governmental and non-governmental organizations is also vital for such movements.

Community-based participatory research (CBPR) is believed to be a potent means for the promotion of health in the community. To that end, Iran has conducted several CBPR projects in various community research centers (CRCs). We aimed to assess the quality of some of these CBPR projects in Iran from the perspective of Iranian academicians. In this cross-sectional study, carried out during 2005, five CBPR projects implemented in Iranian CRCs (Tehran, n=3; Qazvin, n=1; and Bandar Abbas, n=1) were selected. Three academic members involved in each project were interviewed using a structured questionnaire that appraised the extent to which the research project was aligned with the principles of participatory research. Results show that the CRCs and the academic members in our CBPR projects should receive further training and consultation. Quality assessment of CBPR projects seems essential from the view point of other participants of such projects, namely community and stakeholders.

Knowledge translation was created in response to the knowledge-do gap. With the growing number of research projects, utilization of research knowledge roused interest. One of its defects, which are seen more in developing countries, is the scarcity of recognized practical knowledge translation applications. The actions taken to strengthen knowledge translation can be classified into three categories of ‘push, pull and exchange’. In Iran, some of the interventions effective in knowledge translation, may not have primarily taken place with this aim, but can however be effective in it. Some of the measures taken specifically in Iran’s research system are: capacity building of human resources for knowledge translation, better utilization of research by the Ministry of Health and Medical Education, creating necessary incentives among medical universities, identification of barriers and proposing interventions. Pilots of knowledge translation interventions are concerned with ‘push’ activities whose main focus is to support knowledge translation activities and promote active strategies (or increase interaction between researchers and decision makers during research and utilization of results). Long-plan programs such as ‘Iran’s Health Innovation and Science Development plan have also been designed for the future. These include formation of centers for reducing the knowledge-do gap in the form of knowledge and health technology translation centers.

The Millennium Development Goal's (MDG's) represent a global partnership that has grown from the comments and targets established at the world summits of the 1990's. Responding to the world's main development challenges and to the calls of civil society, the MDG's promote poverty reduction, education, maternal health, gender equality , and aims at combating child mortality, AIDs and other diseases, environmental sustainability and global partnership. Set for the year 2015, the MDG's are an agreed set of goals that can be achieved if all actors work together and do their part. Poor countries have pledged to govern better, and to invest in their people through health care and education. Rich countries have pledged to support poor countries through aid, debt relief and fairer trade. MDG's at the Ministry of Health and Medical Education in Iran aims to, reduce the under- five mortality rate to two thirds between 1990 and 2015, improve maternal health by reducing to three quarters the mortality ratio and achieve universal access to reproductive health, to combat HIV/AIDS, Malaria, and TB, and to have them halted by 2015, to reverse the spread of HIV/AIDS and to achieve by 2010 a universal access to treatment to all those who need it and by 2015 begin to reverse the incidence of malaria and TB.

During the last decade, nanotechnology has gained remarkable attention by international scientific and industrial societies. In this respect, various countries have launched their short and long-term programs to benefit from the huge market expected by utilization and implementation of this technology in their industrial/technological infrastructures. Islamic republic of Iran, also by considering the undeniable impact of this technology on her nation's wealth and economy, initiated her national nanotechnology development plan referred to as "Future Strategy" in 2005. The strategic plan outlines countries major action plans for ten-year period up to 2015 with the target to be amongst the top 15 countries active in this very important area. This paper, while reviewing briefly the objects, targets of the plan will also consider the status and achievements obtained by implementation of this strategic plan. Further, the impact of various developed infrastructures on the success of the program will be also discussed.

Primary health care in the Islamic Republic of Iran was conceived and nurtured on the strength of scientific research, political commitment, and well thought out planning. Due to expansion of PHC network in rural areas of Iran health Indicators have significantly improved. The health care and network in this country is, however, in need of serious repair if all this endeavors hither to be wasted.

Background: The objective of this study was to estimate the burden of disease and injury in Iran for the year 2003, using Disability-Adjusted Life Years (DALYs) at the national level.Methods: Methods developed by the World Health Organization for National Burden of Disease (NBD) studies were applied to estimate disease and injury incidence for the calculation of Years of Life Lost due to premature mortality (YLL), Years Lived with Disability (YLD), and DALYs. The following adjustments of the NBD methodology were made in this study: a revised list with 214 disease and injury causes, development of new and more specific disease modeling templates for cancers and injuries, and adjustment for dependent co morbidity.Results: We estimated that in the year 2003, there were 21,572 DALYs due to all diseases and injuries per 100,000 Iranian people of all ages and both sexes, 62% were due to disability premature deaths (YLD) and 38% were due to premature deaths (YLL); 58% were due to non communicable diseases, 28% - to injuries, and 14% - to communicable, maternal, perinatal, and nutritional conditions. Fifty-three percent of the total number of 14.349 million DALYs in Iran were in males and 47% of DALYs were in females. The disease and injury causes leading to the highest number of DALYs in males were road traffic accidents, and in females were ischemic heart disease. Conclusions: The health and disease profile in Iran has made the transition from the dominance of communicable diseases to that of noncommunicable diseases and road traffic injuries. NBD results are to be used in health program planning, research, and resource allocation generation policies and practices.

This paper aims to describe the Iranian Vital Horoscope System. This system has been designed to collect and display vital events within the community. Baseline population data are collected by health workers (Behvarz), and are entered onto the Vital Horoscope Chart. The objective of this data collection system is to compile relevant data to quantitatively assess the performance of the health unites at the different levels each year, according to conventional health indicators. Assessing indices reported based on this data sources confirmed the consistency of the Vital Horoscope as a data collection mechanism and provided face validity of the data source. However, further study is needed to evaluate content validity and reliability of data from this system.

Expanded Programme on Immunization (EPI) in I.R.Iran began in 1984 after establishing of health network for PHC all over the country and reached to high & accepted coverage rates for active immunization of infants against vaccine preventable diseases including Diphteria, Tetanus, Pertussis, Measles, Poliomyelitis and Tuberculosis.

Currently, in Iran blood transfusion is an integral part of the national health system and blood donation is voluntary and nonremunerated and blood and its components may not be a source of profit. In 1974 and following establishment of Iranian Blood Transfusion Organization (IBTO) all blood transfusion activities from donor recruitment to production of blood components and delivery of blood and blood products were centralized. The activities of IBTO are followed the laws and regulations of Ministry of Health and criteria of Iran National Regulatory Authority. In order to meet the country's demand in 2007 IBTO collected about 1.7 millions units of blood from the population of 70 millions. In 1979 coincided with the Islamic revolution the number of blood units collected throughout the country were 124,000 units or 3.4 unit per 1000 population whereas after about 30 years this increased to about 25 unit per 1000 population. With improving the pool of voluntary donors, IBTO has been successful in excluding "family replacement" donation since 2007 and reached to 100% voluntary and nonremunerated blood donation. Currently more than 92% of blood donors in Iran are male and contribution of female in blood donation is less than 8%. Although all donated blood in Iran screened for HBsAg since 1974, screening of blood units for HIV and HCV started since 1989 and 1996, respectively. The frequency of HBV infection in blood donors showed a significant decline from 1.79% in 1998 to 0.4% in 2007. The overall frequency of HCV and HIV infection are 0.13% and 0.004% respectively.

Background: Screening program in schools are designed to identify children who have early signs of health problems. This study provides information about the findings of national screening program in Iran.Methods: This national program is conducted by the Ministry of Health & Medical Education (MOHME) with collaboration of the Ministry of Education & Training. This program had two major parts including 1) screening of behavioral, hearing and visual disorders, pediculosis and calculating body mass index and 2) physical examination of students, conducted by primary care physicians. All services are offered free of charge. The students’ parents are informed about the health status of their children.Results: The screening program conducted in 2007-2008 included 3,124,021 students from 33 cities who were studying in the first- and third- grade- students in elementary schools, first- grade- students in middle and high schools. Of total students studied, 12.48% had weight disorders, i.e. body mass index <3rd percentile or ³ 95th percentile. 4.77% had visual disorders, 3.95 % had head lice, 2.24% had behavioral disorders, and 0.6% had hearing disorders.Conclusion: In addition to its benefits to the students’ health status, the results of this screening program help health policy makers to design interventions for prevention and or early detection and treatment of the most common disorders documented among school students.

Finding the root causes of maternal mortality plays a significant role in identifying the status of development in the society and in expressing the current situation of maternal health and the adoption of appropriate measures towards its improvement. With the above in mind and for the purpose of fulfillment of objectives and national and international commitments, the National Maternal Mortality Surveillance System was designed in 2000 and implemented from 2001 throughout the country in Iran. Implementation of this program aimed at identifying the factors contributing to maternal mortality during prenatal, delivery and postnatal periods through discovering the process that each mother has followed until her death, identifying avoidable causes of death and designing interventions in order to solve problems and prevent occurring of similar deaths.

I.R.Iran is exposed to a wide variety of natural and man-made hazards. Human-related consequences of disasters and its impact on health service delivery bring the health to the top agenda of disaster management. This article presents the DHM’s progress in Iran and the related challenges. Iran has achieved considerable academic and administrative success in terms of emergency management and risk reduction in health sector, but many rooms for improvement are left. Earthquakes of Bam (2003), Zarand (2005) and Lorestan (2006), Golestan floods (2001 and 2005), Cyclone Gonu (2007) and re-current droughts were the largest disasters during last 10 years, which health system could learn from and apply the lessons learned. The challenges have been changed during last decade, as disaster health management upgraded from a unit under Center for Environmental Health to Emergency Management Center under deputy of minister directing national Emergency Operations Center (EOC). Heath system needs strengthening intra and inter-sectoral collaboration and coordination, information management system, community-based initiatives and integration of disaster health management in Primary Health Care (PHC) network. It also needs to focus on disaster risk reduction, while enhancing response capacity. Investing on research would lead to quality decision-making in disaster health management.

Road traffic injury (RTI) was the leading cause of premature death and disability in I.R.Iran, measured by disability-adjusted life-year (DALY) in 2003. In this paper, we describe the progress and challenges of health system dealing with RTI. MOH&ME has initiated or contributed in national efforts with collaboration of Police, Ministry of Road & Transportation (MoRT), media and Iranian Red Crescent Society (IRCS). As for the pre-crash and crash phases, EMC works on Safe Community (SC) project and public awareness. To minimize the risk of post-crash phase, MOH&ME has enhanced the EMS capacity in terms of technical, equipmental and operational, which has led to coverage of 95% of mass casualty incidents and decreasing the “to scene” and “transport” times. Despite the 16.9% decreasing number of RT-related death in 2007, Iran is in the highest rank in the world. RTI prevention needs a national concerted campaign with collaboration of health system and all other concerned partners. The most costly interventions are those deals with road design and safety during pre-crash and crash phases. But, focusing on people through awareness of safe traffic behavior with combination of low enforcement, would lead decreasing the RTI in shorter time. Health system needs to focus on groups at the highest risk, including urban accidents and young men drivers. Increasing the quality and coverage of EMS, road risk assessment and close intersect oral collaboration would assist health system on the prevention programs. Injury research and surveillance are the basis for effective injury prevention.

Background: The health status of children in the Iran has improved in many areas such as lower rates of infectious diseases and declines in malnutrition. However rapid lifestyle changes might make them prone to chronic diseases in adulthood. Because of the importance of collecting national information about related risk behaviors and risk factors, this national project was conducted for the first time in the Eastern Mediterranean region.Methods: The baseline survey was conducted among 21111 school students aged 6-18 years, and their parents living in 23 provinces; biochemical tests were obtained from 4811 students.Results: Underweight and overweight had similar prevalence (13.9% underweight, 13.4% overweight).The most prevalent type of dyslipidemia was low HDL-C and hypertriglyceridemia. In addition to providing national percentiles and reference curves for weight, height and body mass index, this study provided the first reference curves for waist circumference and blood pressure of children, as well as the first national prevalence of pediatric metabolic syndrome in Asia. Unhealthy nutrition and low physical activity were associated with most risk factors. Conclusion: Close monitoring of children and adolescents for risk factors and risk behaviors should be considered as a public health priority, thus a national school-based surveillance program is being established in this regard in Iran.

To control hypertension in Iran, one of the most preventable diseases, a program was established in rural areas of the country, employing the main strategy of people screening aged 30 years old and above, confirmation of suspected cases, offering cares and follows up. This program is integrated in the primary health care system at rural areas. An evaluation system embedded in the program, helps collecting data on main variable defined, including new cases and care taken. According to the results, the defects of the program are mainly categorized as education and referral system accessibility.

Cancer is the third main cause of death in Iran. This report was provided for explaining most common cancers in Iranian Women. The National Cancer Registry reports from 2003 to 2006, pathologic based cancer registry reports from all of provinces of Iran. The age-standardized incidence rate of cancers was 56.80, 75.15, 6.18, 102.43 per 100 000 among females in 2003, 2004, 2005, 2006, respectively. The male to female standard ratio was 1.12. The most common cancer among women was breast cancer. The cancer registration system, is the main tool of management and control of cancers and such important information source is not only necessary for epidemiologic studies of the illness, but also for planning and forecasting the events, measuring the accuracy of the studies, and the effects of medical interventions. Without a cancer registry with defined standards, we may not be able to formulate, execute, and observe any cancer control plan. According to the results, breast cancer is the most common cancer in Iranian females. Therefore, breast cancer screening should be start in Iran.

In Iran, Primary Health care (PHC) has been a main approach to control of communicable diseases over past thirty years. This approach drastically improved main health indices including Infant Mortality Rate (IMR) in Iran. The experience has had two main impacts on the health situation of the country. Firstly community control of health burden of communicable diseases and secondly, bringing about opportunities to non-communicable diseases including genetic disorders to emerge. Past three decades have been also a determining era for profound progress in basic genetic knowledge and development of community tools for prevention and control of genetic and congenital disorders in the world. These advances will widen the gaps between developing countries that are already lacking of basic genetic knowledge and technologies and developed countries that own these capacities, unless there are clever designing to employ the opportunities to bridge the gaps. Iran has enjoyed its first experience of using community tools for control of one of its prevalent genetic health problem, thalassemia major, adopting primary health care approach. This article explains the expansion of the concept and the approach to community control of genetic and congenital disorders and that, how this concept is leading the country to fill the gap of genetic knowledge.

The present paper is a review of progress and major activities in education, research, services and ethics in the field of medical genetics in some centers in Iran. National projects of population genetics, genetic epidemiology, like national human genome projects, Connexin 26 and Pejvakin, distribution of thalassemia, hemophilia, etc in different ethnic groups, and religious minorities of Iran, are mentioned.

Background: Non-communicable diseases cause more than 60% of disease burden and 70% death by 2020. NCD risk factors surveillance system is a global strategy to combat with this problem in the world. It has been established since 2004 in Iran.Methods: The first national surveillance risk factors of Non-communicable disease (SURFNCD) run as a cross sectional study on 89000 populations by applying who stepwise approach in January and February 2005. Result: The prevalence of common risk factors were 14.2 current smokers, 32.5% did exercise at least 10 minutes in their free time in ages 15-64 yr, 7.7 diabetics and 25.2 hypertensive in ages 25-64 yr. Obesity, overweight and hypercholesterolemia were 14.8, 28.6 and 15.1, respectively in ages 15-64 yr.Conclusion: Implementation of this system is one of the main concerns of Iranian prototype surveillance system and international concerned bodies such as World Health Organization. Multi-pronged policy and programmatic interventions promoting for maximum effectiveness are needed to conduct.

Introduction: During recent 30 years and particularly after establishment of primary health care network in 1984, a noticeable reduction in burden of communicable diseases has been shown which was mainly resulted by conducting EPI activities for vaccine preventable diseases, establishment and improvement of surveillance systems and environmental health and water and food sanitation. By conducting surveillance and treatment activities and proper follow-up of patient and also improvement of preventive measures via health education, immunization and water and food sanitation activities, there have been fundamental reduction in prevalence of many communicable diseases…..

Poliomyelitis is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. After initiation of polio eradication programme in 1988 by WHO, number of polio cases abruptly decreased. In 1988, polio paralyzed nearly 350000 children annually worldwide while in 2007 just 1360 cases reported. The programme has been started in Iran since 1991 and based on high routine immunization coverage, robust Acute Flaccid Paralysis surveillance system and very qualified supplementary immunization activities which has been established and implemented in all the country, number of reported cases decreased from 50 to zero in 2001 and Iran has been polio free since 2001. However due to endemicity of poliomyelitis in Afghanistan and Pakistan (two neighboring countries of Iran) and high level of international traveling between these countries, risk of polio importation and re-emergence of wild polio virus is very high.

Death and disease information are key information in priority setting. Because importance of valid and reliable mortality data, death registration system in I.R.Iran as a multi source registration system was established and improved from 1998. In this system mortality data are collected from hospitals, health houses and health centers, forensic medicine bureau, authorized cemeteries, civil registration bureau and other probable sources in district and within a defined process data are collected in provincial health centers and then in ministry of health. For improvement of registered data some important activities have to done in different level such as continuous education and strengthening intersectoral collaboration.

Background: After the Islamic Revolution, the Iranian government aimed to improve the health status and reduce the inequality simultaneously. This study was conducted to explore the impact of the implemented programs.Methods: we extensively reviewed published papers in Persian and English journals and explored grey literature, mainly the formal reports of relevant organizations to find appropriate and valid statistics, which show the health status of Iranian population classified by sex, living in rural and urban areas and different provinces.Results: We found that safe delivery index had been improved in the past 3 decades (delivery with unskilled birth attendance was decreased from 30.1 % to 10.4%) and its standard deviation decreased from 15.3 to 10.9. Prenatal care visits in rural and urban inhabitants are comparable and their difference is around 5% now. The standard deviation of Infant Mortality Rate between provinces has decreased from 6.2 to 4.9 in recent decades as well. The adult literacy rate as one of the main social determinants of health has been raised from 54% to more than 80%, such a progress was observed in rural and urban areas, in nearly all provinces and in males, females, and more importantly the gaps have decreased. The positive trend of Human Development Index was also significant in recent years.Conclusion: Constant improvement of main health indicators and fewer gaps between subgroups are promising. In addition, improvement in the literacy rate may imply sustainable improvement in following decade since it is one of the main health determinants. Nonetheless, more attention to remote areas is a sensible recommendation.

Clinical pharmacy is delineated as that area of pharmacy involved with the science and practice of rational medication use. Clinical pharmacy is a health science discipline in which pharmacists provide patient care that optimizes medication therapy and boosts health, wellness, and disease prevention.

Organ and tissue transplantation have a long history in Iran. Some researchers believe that Avicenna was the first to suture nerves together. However, organ transplantation using modern methods and technologies goes back to 1930s. Registered data from Iran shows an acceptable progressing trend in the quantity and quality of various types of organ and tissue transplantation in Iran over recent decades. For instance, Iran has one of the most successful kidney transplantation programs in the region, along with various attempts of policy-makers in order to provide preventive approaches for end-stage renal diseases, distribute dialysis equipment, and enhance cadaveric organ donation. Referring to some published and unpublished data, the current article provides an overview of transplant activities in Iran over the past three decades. Furthermore, the background and characteristics of the Iranian Model of kidney donation will be also reviewed.

Background: Upon the implementation of the plans of the selected hospitals in Paragraph (C) Article [88] of the Law of the Fourth Development Plan, the amount of assessment relative to the execution of each of the Paragraphs related to the directives or guidelines of the mode of managing these hospitals is compulsory. The present article has made efforts to assess the implementation basis of Paragraph [9] of the above-mentioned directives and a survey of conditions as to the performance of the support services in these hospitals.Methods: This study rested on the performance of 14 supporting activities of 18 selected decentralized hospitals that took place in 2007. Data were collected from questionnaire that had 6 parts about support services and how they were done in each hospital. Then the data were analyzed with Excel software.Results: In hospitals 35. 60 % of the activities are performed by the contractor. The materials utilized in activities are 10. 34 percent, equipping is 26. 48% and equipment repair is 31. 47% of the cases are secured by the contractor. Results pertaining to the survey of manpower engaged in activities show that 62. 71% of the manpower engaged has an intermediate level of education and the relative average of manpower active in such work as of functional beds can be stated as 0.64, likewise, the average satisfaction rate of the services rendered was 71%.Conclusion: A strategy leading to a decrease of incumbency and an elevation in the support service quality can bring about an increment in the quality of support services being presently rendered in hospitals which could prove effective.

Reference health Laboratory of Iran (RHL) has been established under the Secretary of Health in 2007. This organization has been developed from integration of Reference laboratories of Iran, Directorate of General Affairs and Laboratory department of CDC. In accordance with policies of Ministry of Health and Medical Education, also Millennium Development Goals and requirements of IHR the RHL has highlighted his main goal as “Quality Improvement of Medical Laboratory Network”. In order to achieve this goal as soon and efficient as possible, RHL has tried to launch Quality Management system in medical laboratories. After studying and analyzing the situation in the country RHL has tried by using ISO 15189 which is an successful international standard to draw national standards and write necessary manuals, guidelines and checklists. For a successful implementation and detailed managerial observance, three phases were designed: Training, Stepwise implementation of standard requirements in the laboratories, accreditation of laboratories. After one year of training and sending out national standards and guidelines, the RHL is in the middle of the second phase “implementation”.

Imam Khomeini Relief Foundation (IKRF) was officially established on March 5th 1979, to aid the underprivileged, alleviate poverty and improve the self sufficiency of the needy people. The Foundation, funded mainly by people’s contributions, has implemented several plans to preserve human benevolence, assist the needy people, meet their essential needs and solve their cultural and economic problems. Its services for the improvement of the lives of the needy people including providing food, clothes, housing, health care, insurance, education and employment are not limited to borders and have been extended to other countries.

Research Center for Science and Technology in Medicine (RCSTIM), affiliated with Tehran University of Medical Science (TUMS), was established in Imam Khomeini Hospital, the largest hospital complex of this kind in Iran in 1994. A major strategy of RCSTIM has been providing a common research environment for close cooperation between specialists involved in science, medicine, engineering and industry. This collaboration in one hand highlights RCSTIM research policy direction and on the other hand assure high quality standards required for design and development of novel medical devices. Since 1998, in line with the Third Development Plan of I.R. of Iran, the work has been focused on applied research activities to promote technical knowledge of the medical device industry, advance the health technology and establish joint research programs between universities and industry. There are seven research groups within RCSTIM conducting advanced researches in their specialties. In these many advanced research have been performed leading to design of hi-tech devices and systems. Some of case reports of these technologies are being presented in this paper.

Pharmaceutical market in Iran has been expanding since 2001 when the new development act was approved in the parliament of the Islamic republic of Iran. The pharma market size has annually increased 6.8% in terms of volume and 18.5% in terms of value. However, the growth rate of imported items has been greater than locally produced items both in terms of value and volume. This may be mainly due to the introduction of free market regulations at macroeconomic point of view that has influenced the pharmaceutical market as well. The expansion of pharmaceutical market is welcomed by the industry which is investing heavily in the manufacturing and research and development capacity of pharma sector in Iran. However it does also mean greater access of the public to essential and vital medicines. In the same situation the presence of extra choices in the market may be a challenge for the local industry as the demand for higher quality medicines grows. Market forces are always a challenge for the advocacy of rational prescription and use of medicines.

The Adverse Drug Reaction Monitoring Center (ADRMC) in Iran started its activities as a full member of WHO International Drug Monitoring Program in 1998. The Center has followed pharmacovigilance activities in the country with the main goal of increasing drug safety and preventing drug-related morbidity and mortality. To achieve its main goals, ADRMC has developed and implemented spontaneous ADR reporting system by health care professionals. In this article we have tried to elaborate on the achievement of the ADRMC in Iran. A total number of 17967 adverse drug events has been collected and evaluated by the Center. Evaluation of registered reports has led to 86 drug safety alerts to health care professionals, recall of 23 pharmaceutical products and labeling changes of 30 others, suspension on distribution for 8 medicines and withdrawal from national drug list of 4 different products.

Rational use of drugs is one of the major issues in health systems. Analyzing the prescriptions would be of help in recognition of physicians' behavior and population beliefs. The prescriptions were analyzed with "Noskhe Pardaz" software and the major indications in 10 years period between 1998 and 2007 were extracted. The mean item of drugs per prescription, percent of prescriptions including antimicrobials and injectable drugs decreased during study period. Prescriptions including corticosteroids increased. The National Committee of Rational Use of Drugs (NCRUD) activities to educate physicians, general population and children in rational use of drugs were efficient. The results show reduction of irrational use of drugs.

Traditional Iranian Medicine (TIM) or Persian Medicine consists of the sum total of all the knowledge and practices used in diagnosis, prevention and elimination of diseases in Persia from ancient times to present. It is based entirely on practical experience and observations passed down from generation to generation.Traditional medicine has the advantage of being considered as part of the culture therefore, bypassing cultural issues that may affect the practice of medicine. On the other hand, it can be used in conjunction with and as an aid to the conventional medicine. Development and promotion of traditional medicine could be considered as respect and honor to the culture and heritage of the people all around the world.

Background: In health system of any country, securing financial resources and management of the same is one of the most vital apprehensions in regards policy makers. This article expresses a part of the obstacles and threats present in the management of the government financial resources of health sector and in assimilating this, the requirement for amendments in the financial system and designing new financial management system of health sector in Iran. Methods: The authors conducted a case study based on interviews with government, and academic participants. Two methods of data collection were used: retrospective analysis of official documents and in-depth interview. Results: The root of the obstacles relevant to the management of financial resources in health sector in four intricate and fundamental modes of executing cash accounts in contrary to accrual accounts, where there is an intense weakness in the internal controls due to the lack of periodic reports, so as to define the source of deviations, the lack of a mechanized system and ultimately, the absence of a comprehensive monetary plan in the Country. Based on these obstacles, the new financial management system of health sector in Iran was designed including mission, objectives, structure, human resources and duties, processes and procedures, external environment.Conclusion: Designing new financial system in health sector of country is a way to effective and efficient management of financial resources and aid health system to achieve ultimate goals.