Development of the National Health Development of the National Health policy with emphasis on policy with emphasis on PHCPHC

• Dr. Gholamreza Heidari• July/ 9/ 2012 PHA3

– Area:• 1’648’000 km2

– Population:• 7496172

• Rural %21• Uraban%79

– Province:• 30

– District:• 300

– Village:• 65000

I.R. IRAN

Tehran

Turkmenistan

Afghanistan

PakistanSaudi Arabia

Kuwait

Iraq

Azerbaijan

Armenia

Persian Gulf

Oman Sea

CaspianSea

Primary Health CarePrimary Health Care Experience in IranExperience in Iran

Background:Background:

1972: West Azerbaijan research project on PHC

1977: Government accepted the concept of PHC network

1979: Broad programming for Health System Development based on PHC

1981: Preparation of master plans for countrywide expansion of PHC network

1985: Establishment of prototype district PHC networks approved by the parliament

The Structure of the Health System in IranThe Structure of the Health System in Iran

S ch o o lo f .............

B eh v a rzT ra in in g C en ter

M a tern ityF a cility

H ea lthH o u se

H ea lthH o u se

H ea lthH o u se

H ea lthH o u se

R u ra lH ea lth C en ter

H ea lthP o st

H ea lthP o st

H ea lthP o st

H ea lthP o st

U rb a nH ea lth C en ter

D is tr ictH ea lth C en ter

D istr ictG en era l H o sp ita l

D irecto r o f D istr ictH ea lth N etw o rk

T ea ch in gH o sp ita l

U n iv ers ity o f th ep ro v in ce

M in is try o f H ea ltha n d

M ed ica l E d u ca tio n

Major Health AchievementsMajor Health Achievements

Trend of Demographic and Health Indicators Trend of Demographic and Health Indicators in I.R.Iranin I.R.Iran

1986 1991 1996 2012

Population (million) 49.4 55.8 60 7496172

Urban population 54.3% 57% 61% %71

Under 15 45.3% 44.3% 39.5% 24.3%

64 and over 3% 3.4% 4.4% 6.5

Male life expectancy 58.5 62.4 68 71

Female life expectancy 59.2 63.2 70 73.17

NMR 21 19 16 12

IMR 51 33 26 18

U5MR 70 42 33 22

MMR 140 54 37.4 22

Annual PGR 3.2 2.7 1.56 1.3

The causes of all deaths and YLL in provinces in I.R.Iran

MI 15%CVA and other

cerebral dis. 5.5%

Related to length gestation & fetal growth 4.2% Respiratory & Cardiovascular disorders to the perinatal period 2%

pneomonia 1.1%

Percentage the Cause of death in provinces of YLL

Cardiovascular disease 28%%

Non intententional accidents 26.5%

Antenatal disease . 4.8% 11% cancers

4.8% intentional accidents

Respiratory disorder 4.5%

Transport accidents 17.3%

3.3% burn

cancer of Stomach 2% leukemia 1.7%

Pulmonary cancer 1%

suicide 3.2%violence 1.6%

ConsequencesConsequences

• Increase frequency of non communicable diseases– Injuries– traffic accidents– cardiovascular daisies– …

• Challenges in Equity and equality in health due to– Increase the needed health expenditures– Decrease the ability of pubic funds to support people – Increase the risk of induced demands and out of

packet payments

What are the Challenges for the health What are the Challenges for the health care systems in the last decades?care systems in the last decades?

• Demographic transition• Epidemiologic transition• New expectations of the clients• Entering new expensive diagnostic and

intervention technologies• Changing socioeconomic environment

SOSOOur PlansOur Plans

Health market regulationFamily physician and referral system

Human resource policy for healthMore integrated medical education to health

systemConstruct out come-based education on the

basis of new health needsAccessibilities

Expand insurance plans for the basic needs

The policies implemented- The policies implemented-

Regulation of health technology on the basis of the available resources

Priority of prevention in resource allocation Priority of ambulatory care to hospitalization Control of entering expensive health technologies

Health finance strategy Using public funds like as insurance plans Benefit packages More performance based payment mechanism Taxation on tobacco products, 10% for domestic

products & 20% for imported 10% energy subsidies saving goes to Health

program .

The policies implementedThe policies implemented

High Council for Health Chair by the High Council for Health Chair by the PresidentPresident

And secretary of Health MinisterAnd secretary of Health MinisterOther Departments in High Health CouncilOther Departments in High Health Council Ministry of AgricultureMinistry of Agriculture Ministry of InteriorMinistry of Interior Ministry of Culture and GuidanceMinistry of Culture and Guidance Ministry of Public Highway and TransportMinistry of Public Highway and Transport Ministry of EducationMinistry of Education Management and Planning (Vice President)Management and Planning (Vice President) Ministry of Welfare and social security Ministry of Welfare and social security Ministry of EconomyMinistry of Economy

Leadership for Leadership for Healthy People 2010 Healthy People 2010 through the 5-year Development Planthrough the 5-year Development Plan

Thank You

for Your

Kind Attention