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Highs and Lows in Iran’s Healthcare
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Highs and Lows in Iran’s Healthcare

The World Health Organization (WHO) regularly releases reports on the progress of the 194 member states in achieving health goals determined by the world body in line with reaching the UN Sustainable Development Goals (SDG) by 2030.
The nine indexes which are monitored regularly by WHO include life expectancy, mortality due to certain diseases, infectious diseases (including 17 selected infectious illnesses), healthcare services coverage, risk factors (such as high blood pressure, tobacco and alcohol consumption, and unsafe water, sanitation and hygiene), health systems, healthcare expenditure, inequalities in distribution of healthcare services, and figures on social, economic, and demographic changes.
But in many developing countries, as the national statistics and data information systems are not up to standard, the statistics and figures provided by them may be substandard or lack accuracy and reliability, the Persian language weekly ‘Tejarat-e-Farda’ reported.
According to the latest figures by the WHO, between 1990 and 2013, the global maternal mortality rate (MMR) decreased by 45%; however there is still a long way to go to achieve the 75% goal set by the WHO. During the same period, 13 countries had not achieved any progress.
In this regard, Iran with a 96% decrease in the MMR has been ranked as the third most successful country in the Middle East after Oman and Lebanon.
Also, in terms of access to sexual and reproductive health services, Iran has achieved 97% coverage and therefore has got closer to the WHO’s 100% access goal.  Reproductive health implies basic rights for all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to the highest attainable standard of sexual and reproductive health.
During the same period, 50% more Iranians had access to improved drinking-water, in keeping with the WHO target.    
While worldwide, approximately 50% of all rural and urban households utilize solid fuels for cooking or heating, the figure is 5% in Iran. Solid fuel use is likely to be a major cause of disease burden in communities where it is prevalent. Globally, 2.6% of all ill-health is attributed to indoor smoke from solid fuels, nearly all in poor regions.

  AIDS, Malaria and Other Diseases
While Iran’s progress in improving access to reproductive health, reducing maternal and under-five mortality, increasing access to healthy water have been satisfactory and closer to reaching the global health watchdog’s goals, the country has not seen much success in reducing HIV and malaria infections as per the WHO targets.
Between 1990 and 2013, AIDS prevalence in Iran increased by 21% and, therefore, there is still a long way to go to prevent and control the spread of the disease.
Further, while the goal set by the WHO was 75% in bringing down the number of malaria cases, the country achieved only 36% decrease by the year 2013. In the same year, 520 malaria cases were reported in medical centers across the country. The disease is most common in three southeast provinces including Sistan-Baluchestan, Hormozgan, and Kerman. Much more needs to be done in this regard particularly in vector control.
The health status of Iranians in several vital indices has no doubt improved over the last two decades and life expectancy has increased to 73 years.
In 2013, Bloomberg News ranked Iran 45th as having the most efficient healthcare system ahead of the United States and Brazil.

  Health Reforms
The Health Plan, launched in 2014, is the latest reform in healthcare in Iran.  Since taking office in 2013, President Hassan Rouhani has made investment in the health sector a priority. With more than 10 million Iranians now registered with the Iran Health Insurance Organization, they have to pay less than 10% of their bills at state-run hospitals. The cost of some outpatient treatment and medicines are also covered.
“Under Rouhani, there has been greater investment in state-run hospitals and physicians have been encouraged to practice in deprived areas. Spending on healthcare has reached 68,000 billion rials ($2.3 billion), in part funded by a reduction in energy subsidies,” said an article published in ft.com last September.
The total expenditure on health in Iran was 6.69% of the GDP in 2013 (as against the global average of 10.10%), according to the World Bank. The health expenditure per capita was $432 in the same year.
Nevertheless, in January this year, a report published in thelancet.com said, “The presence of some challenges could have a negative effect on the (health) reform in future— heavy financial burden on government, neglect of primary healthcare, inefficient payment methods, scarce financial sources, unequal distribution of specialists, and disregard of outpatients in public sectors and patients in private hospitals.”
A disparity between public and private service, separated health insurance, and absence of universal protocols and guidelines is hampering this system. Moreover, an ineffective health information system prevents efficient assessment of the key health sector. Public health expenditure as a percentage of gross domestic product is still low and needs to be amplified, the report added.

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