Health Legislation and Legal Health Legislation and Legal Structure in IranStructure in Iran

Nouradin Pirmoazen ,MD,FACS, Clinical Research Fellow,Harvard Medical School

Turning Point : Turning Point : MotivationMotivation

History of Ronak!History of Ronak! 12 Y/F12 Y/F Fever, Anorexia, Abdominal PainFever, Anorexia, Abdominal Pain Perforated AppendecitisPerforated Appendecitis Complications!Complications! Life-long infertilityLife-long infertility

``Declare the Past,``Declare the Past,

Diagnose the Diagnose the Present,Present,

Foretell the Foretell the Future.``Future.``

Hippocrates (c.470-277 BC)Hippocrates (c.470-277 BC)

Declarations History:Declarations History:Revolution in Thinking and Revolution in Thinking and

PracticePractice 19781978 : :Declaration of Alma-Ata: Declaration of Alma-Ata: Health for AllHealth for All -Health For All (HFA) by 2000-Health For All (HFA) by 2000 -Primary Health Care (PHC)-Primary Health Care (PHC) -Protect and Promote the Health-Protect and Promote the Health -Health is Fundamental Human Rights-Health is Fundamental Human Rights -National Health System (NHS)-National Health System (NHS) 20002000: : Millennium Declaration: Millennium Declaration: All for HealthAll for Health -Comprehensive Development Framework-Comprehensive Development Framework -MDG s Place a Central Focus on Public Health-MDG s Place a Central Focus on Public Health -Public Health Improvement Break `Poverty Vicious -Public Health Improvement Break `Poverty Vicious

Cycle`Cycle` -MDG s Depend Critically on Scaling up Public Health -MDG s Depend Critically on Scaling up Public Health Investments in Developing Country (Sachs, Bulletin Investments in Developing Country (Sachs, Bulletin

WHOWHO

GenderEqualityGenderEquality

ChildMortalityChild

Mortality

EnvironmentalSustainability

EnvironmentalSustainability

HIV/AIDSMalaria….

HIV/AIDSMalaria….

MaternalHealth

MaternalHealth

PrimaryEducationPrimary

Education

Poverty&

Hunger

Poverty&

Hunger

GlobalPartnership

Forum!

GlobalPartnership

Forum!

MDG s : Focused on MDG s : Focused on HealthHealth

1.1. Eradicate Extreme Poverty and HungerEradicate Extreme Poverty and Hunger2.2. Achieve Universal Primary EducationAchieve Universal Primary Education3.3. Promote Gender Equality and Empower Promote Gender Equality and Empower

WW4.4. Reduce Child MortalityReduce Child Mortality5.5. Improve Maternal HealthImprove Maternal Health6.6. Combat HIV/AIDS, Malaria…Combat HIV/AIDS, Malaria…7.7. Ensure Environmental SustainabilityEnsure Environmental Sustainability8.8. Develop Global Partnership for Develop Global Partnership for

DevelopmentDevelopment

Bridging the `Know-Do Bridging the `Know-Do Gap`Gap`Policies:

MDG s Achievement

Premises:Better World

Promises:Better Health

Translating Knowledge into Translating Knowledge into ActionAction

Policy

Plan

Politics

WHO PRSP: Poverty- Health WHO PRSP: Poverty- Health LinksLinks

Poverty/Wealth

Inequality

Health

Soviet Medicine Before Soviet Medicine Before the Fallthe Fall

The Financing of the Health Services came The Financing of the Health Services came last, after all expenditures had been met, last, after all expenditures had been met, and it had to take whatever was left, which and it had to take whatever was left, which was very little!was very little!

`Residual Service``Residual Service`

Chazov ,Chazov ,

Health MinisterHealth Minister

Harvard Medical Alumni Bulletin Harvard Medical Alumni Bulletin

Principles of Health Principles of Health ReformReform

Fair Access:Fair Access: to Essential Health Care to Essential Health Care Services, Equity, Universal Coverage Services, Equity, Universal Coverage

Efficiency:Efficiency: to Deliver with Maximum to Deliver with Maximum OutcomeOutcome

Responsiveness to Society: Responsiveness to Society: Accountability,Accountability, Quality ,Performance, Quality ,Performance, Expectations, Protections Expectations, Protections

Innovations:Innovations: on a Day to Day Basis, on a Day to Day Basis, Products, Diagnostic, Therapeutic….Products, Diagnostic, Therapeutic….

Legislative PyramidLegislative Pyramid

Cabinet

Assembly of Expert

Guardian Council

Parliament

Parliament ,Majlis,Parliament ,Majlis,National Assembly,290 MPs, 10% MD

Council of GuardiansCouncil of Guardians

Six Faqih ,Cleric Islamic Canonists

Six Jurists

Legislations Comply Legislations Comply with Islamic Laws with Islamic Laws and Constitutionand Constitution

Laws PathwayLaws Pathway

Government Bills: Presented to Parliament after approval in the Cabinet

Representatives Plans: Proposed by MPs if Sponsored by 15 MPs

Public Health Law in the Public Health Law in the ConstitutionConstitution•Article 3/12:Creating Welfare,Removing Poverty

Eliminating any form of Deprivation in the field of Nutrition, Housing, Employment, Health Care

Generalized Social Insurance

Public Health Law in the Public Health Law in the ConstitutionConstitution• Article 29:Universal Right of All in-Social Security covering Retirement, Unemployment, Old age, Disability,

Destitution, Accidents, Calamities,

-National Medical Insurance,

Health Care Services and Treatments

Public Health Law in thePublic Health Law in theConstitutionConstitution

• Article 43/1:-Satisfaction of Basic Needs:

Housing,Nutrition, Clothing,Preventative Health,Medical Treatments,

ServicesEducationFamily for All Setting

Health For All:Health For All:Health Care Network SystemHealth Care Network System• Health Houses (HH)• Health Centers (HC)• `Behvarz` Training• Geographic Locations • Whole Country Distribution• Care Delivery Levels • Specialized Clinics, Hospital• Teaching Modern Hospitals• PHC System! Access!PHC System! Access!

National Health Policy:National Health Policy:PrinciplesPrinciples

AccessibilityEquityQualityInsurance Coverage

Investing in Health means Investing in Health means Investing in People and Investing in People and

DevelopmentDevelopment

Health Allocation fromHealth Allocation from GDP GDP::

2001-2004 5.7% 2001-2004 5.7%

2005-2010 7.2%2005-2010 7.2% Out-Of-Pocket Out-Of-Pocket 2001-2004 50-60% 2001-2004 50-60%

2005-2010 30%2005-2010 30%

Public Health Public Health ImprovementImprovement

AssessmentFiguring Out what health problems are

Policy DevelopmentDeciding What to do

AssuranceDoing it well

To Strive,To Seek,To Find,And not to Yield!

Thank You All!Thank You All!

Thank Thank YouYou All!All!