development of the national health policy with emphasis on phc dr. gholamreza heidari july/ 9/ 2012...
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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
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– 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
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Primary Health CarePrimary Health Care Experience in IranExperience in Iran
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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
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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 istr ictH ea lth C en ter
D istr ictG en era l H o sp ita l
D irecto r o f D is trictH 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
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Major Health AchievementsMajor Health Achievements
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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
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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%
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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
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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
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SOSOOur PlansOur Plans
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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-
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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
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High Council for Health Chair by the High Council for Health Chair by the
PresidentPresident
And secretary of Health MinisterAnd secretary of Health Minister
Other 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
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Thank You
for Your
Kind Attention