who collaborating centers in iran meeting with who colleagues june 4,2014

1

WHO Collaborating Centers In Iranmeeting with WHO Colleagues

June 4,2014

Reza Malekzadeh M.DProfessor of Medicine

Deputy for Research and TechnologyMOHE IR Iran

WHO Collaborating Centres1. Digestive Disease Research Institute, TUMS2. Endocrinology & Metabolism Research Institute, TUMS3. Research Centre for Diseases of Ear, Nose Throat, IUMS4. Mental Health Research Centre, IUMS5. Centre for Nursing Care Research, IUMS6. National Research Institute of Tuberculosis and Lung Disease, SBMU7. Community Oral Health Department, School of Dentistry, SBMU8. Ophthalmic Research Centre, SBMU9. Tobacco Prevention and Control Research Centre, SBMU10. Educational Development Centre, SBMU11. Isfahan Cardiovascular Research Centre, MUI12. Regional Knowledge Hub for HIV/AIDS Surveillance, KMU13. National Public Health Management Centre, TBZMED14. Rabies Research Department, Pasteur Institute of Iran, MOHME15. Reference Health Laboratories, MOHME16. Iranian Blood Transfusion Organization (IBTO)

WHO Collaborating CentresPending Status

1. National Nutrition and Food Technology Research Institute, SBMU

2. Research Institute for Endocrine Sciences, SBMU

3. Scientific Publication and Information Development Center, MOHME

Proposal for designation as WHOCC

1. National Institute of Health Research, TUMS

2. Institute for Environmental Research, TUMS

3. Safety Promotion and Injury Prevention Research Centre, SBMU

4. Toxicological research Centre, SBMU

5. Health Policy Research Centre, SUMS

6. Occupational Health Research Centre, IUMS

7. Institute for Futures Studies in Health, KMU

8. Malarial and Vector Research Group, Biotechnology Research Centre, Pasteur Institute of Iran

9. Reference Food and Drug Laboratories, FDO

10. Noor Ophthalmology Research Centre

WHO Collaborating CentresPotential Centres Candidates

1. Centre for Research and Training in Skin Disease and Leprosy, TUMS

2. Sina Trauma and Surgery Research Centre, TUMS

3. Growth and Development Research Centre, TUMS

4. Psychiatry and Psychology Research Centre, TUMS

5. Food Security Research Center, MUI

6. Zahedan Health Promotion Research Centre, ZAUMS

7. Liver and Gastrointestinal Diseases Research Centre, TBZMED

6

Health in the Islamic Republic of Iran

May 2014

Global Burden of Disease (GBD) Study Iran, 2010

7

Archives of Iranian Medicine May 2014 special ISSUE

History of GBD• GBD is the largest study on health at global, regional, and

national levels• GBD has been started since 1990 with collaboration of

486 researchers from 302 research center in 50 countries• Methodologically, GBD is a systematic review of all

published and unpublished data at national levels in 188 countries from 1990 to 2010

• In GBD, novel statistical methods have been used to estimate prevalence of diseases and risk factors in places and times where no data is available

Main Features of GBD

• Innovation of indicators that make possible the comparison of burden of

diseases between different countries, in different regions, and different

time frames

• Innovation of indicators that measure not only diseases (289 diseases) and

risk factors (67 risk factors), but also health, quality of life, and disability

10

Epidemiological Transition

• In developing countries, a trend from communicable diseases to non-communicable chronic diseases has been observed

• The epidemiological transition is an evident sign of development in a developing country

11

GBD 2010 Iran• Burden of 67 risk factors and 291 diseases for

three time points (1990, 2005, and 2010) during the last 20 years in Iran*

• The obvious finding is a shift away from premature death to years lived with disability and from infectious and communicable etiologies to chronic non-communicable diseases (NCDs)

*AIM 2014 May

12

Two Decades increase in Life expectancy

• Despite post revolution conflicts, an 8-year war, tight economic sanctions by Western countries, and multiple earthquakes over the last three decades:

• Life expectancy increased by 22 years for women and 21 years for men

Results 2010 GBD

• Total number of deaths in 2010 in Iran: 351,814

• Deaths in men in 2010: 223,768

• Deaths in women in 2010: 128,045

• Transport accidents have been the main causes of YLL

14

NCDs in global scale

57.1%

34.1%

8.8% Non_communicable Diseases

Communicable Diseaes

Injuries

Causes of death, 2010


65.5%

24.9%

9.6%

GBD 2010

15

NCDs in Iran

76.4%

14.4%9.2%

57.2%

26.8%

22.0%

Non_communicable Diseases

Communicable Diseaes

Injuries



GBD 2010

16

Main NCDs in Iran

Fatal Diseases

1) Ischemic Heart Disease2) Stroke3) Hypertension4) Diabetes5) Transport accidents6) Cancers

Non-fatal disabling Diseases

1) Mental Diseases2) Musculoskeletal Diseases3) Diabetes4) Transport accidents5) Chronic Respiratory

Diseases6) Unintentional Injuries

GBD 2010

17

Main causes of death in men in Iran, 2010

Ischemic heart disease

26%

Hypertensive heart disease

3%Diabetes

2%

Other33%

Road injury10%

Stomach cancer3%

COPD2%

Stroke10%

Lower respiratory in-fections

2%

Lung cancer2%

Other cardio & circulatory5%

Congenital anomalies2%

Preterm birth complications2%

GBD 2010

18

Main causes of death in women in Iran, 2010

Ischemic heart disease

25%

Hypertensive heart disease

4%

Diabetes3%

Other32%

Road injury4%

Stomach cancer2%

Other endocrine2%

Stroke12%

Lower respiratory in-fections

3%

Urinary diseases2%

Other cardio & circu-latory

6%

Congenital anomalies3%

Preterm birth complications2%

GBD 2010

19

Mental Diseases:

28%

Musculoskeletal Diseases: 25%

Diabetes: 7%

Nutritional Disorders:

5%

Neurological Diseases: 5%

Chronic Res-piratory Dis-

eases: 6%

Uninten-tional

Events: 4%

Transport Accidents:

3%Other: 17%

Main causes of disability in men in Iran, 2010

GBD 2010

20

Mental Diseases:

30%

Musculoskeletal Diseases: 26%

Diabetes: 8%

Nutritional Disorders:

7%

Neurological Diseases: 5%

Chronic Respiratory

Diseases: 5%

Uninten-tional Events:

2%

Transport accidents:

1%

Others: 15%

Main causes of disability in women in Iran, 2010

GBD 2010

21

Factors Influencing the Epidemiological Transition

• Increased Literacy Rate• Modernization• Increased Urbanization• Increased Socio-Economical Status• Change in life style towards Western Style

AND

• The efficiency of the health system in prevention and control of communicable, maternal, and neonatal diseases and nutritional disorders

22

Achievements of Health System in Iran

• Increased life expectancy at birth by 22 years despite war,

earthquakes, and economical sacntions

• Decrease in mortality rates in all ages

• Decrease in mortality rates among children under 5 years old

• Decrease in maternal mortality rates

• Decrease in fertility rates

Ministry of Health and Medical Education

23

Achievements of Health System in Iran

• The percentage of iodinated salt surpasses 95%

• The vaccination coverage of BCG, DPT, Polio, MMR, and

hepatitis B surpassed 99%

• Polio is eradicated

• The prevalence and incidence of main communicable

diseases including malaria, typhoid, and tuberculosis has

decreasedMinistry of Health and Medical Education

24

Decreased Inequality in Under 5 Mortality Rate from

1981 to 2011

1980.51981.5

1982.51983.5

1984.51985.5

1986.51987.5

1988.51989.5

1990.51991.5

1992.51993.5

1994.51995.5

1996.51997.5

1998.51999.5

2000.52001.5

2002.52003.5

2004.52005.5

2006.52007.5

2008.52009.5

2010.50

20

40

60

80

100

120

140

160

180

Deat

hs p

er 1

000

live

birt

hs

Farzadfar et al unpublished

25

The Trend in Control of Malaria from 1994 to 2012

19941995

19961997

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20120

10000

20000

30000

40000

50000

60000

70000

80000

Num

ber o

f rep

orte

d ca

ses (

thou

sand

s)


Trend in Control of Typhoid from 1962 to 2010


27

The Trend in Incidence of Tuberculosis


28

Trend in Detection and Control of HIV

• Prevalence of HIV/AIDS in patients suffering from tuberculosis:

in 2010: 3.8%in 2012: 2.5%


29

Improvement of Infrastructure

• The achievement of campaigns for construction and literacy, increased GDP per capita, and the establishment of primary health care system in Iran:

• Increased access to healthy drinking water• Increased access to healthy waste• Increased access to electricity and gas• Improved roads between cities

30

The age structure in Iran 2013

Statistical Center of Iran

31

Population of Iran from 1956 to 2011

1335 1345 1355 1365 1375 1385 1390*0

10000000

20000000

30000000

40000000

50000000

60000000

70000000

80000000

BothUrbanRural


32

Urbanization in Iran from 1956 to 2011

1335 1345 1355 1365 1370 1375 1385 13900

10

20

30

40

50

60

70

80


33

The literacy rate among people older than 5 from 1956 to 2011

1335 1345 1355 1365 1370 1375 1385 13900

10

20

30

40

50

60

70

80

90

100

BothMenWomen


34

Access to Drinking Water and Healthy Waste in Rural Areas from 2006 to 2010

1385 1386 1387 1388 13890

10

20

30

40

50

60

70

80

90

100

Drinking WaterHealthy Waste


35

The Number of HIV/AIDS Deaths

1385 1386 1387 1388 13890

50

100

150

200

250

300

132

172196

242 248


36

The Necessity of Change in the Health System

• The necessity of changing policies based on new needs

and priorities of the health system

• The necessity of integrating service packages into the

current health system to control NCDs and accidents

• The necessity of inter-sectoral collaboration

• The necessity of cost effective planning for optimal

allocation of limited financial resources

37

Non-Communicable Diseases

NCDs are main threats to economy

NCDs lead to inequality in income, decrease in household wealth, increase

in health care cost, and decease in productivity

Prevention is crucial

38

The Trend of the fraction of YLLs caused by main NCDs, 1990 to 2010

1990 1995 2000 2005 20100%

5%

10%

15%

20%

25%

30%

35%

CardiovascularTransport AccidentsCancersDiabetes

GBD 2010

39

Mental Diseases

• Prevalence in different regions in Iran: 29%• Prevalence in Tehran:

– In 1998: 21.5%– In 2007: 34.2%

• Lifetime risk of incidence: 14.3%• Prevalence in women: 14.3%• Prevalence in men: 7.3%

40

The Trend in Prevalence and Burden of Main NCDs

• Necessity of national surveys to measure and monitor those diseases that impose most burden on Iranians

• Necessity of improving the quality of routine data

• The Golestan Cohort Study is the largest prospective study in Middle East has released comprehensive results

*Gastro-Esophageal Malignancies In Northern Iran

Arch Iran Med. 2013 Jan;16(1):46-53. doi: 013161/AIM.0014.T

*

41

Golestan Cohort Study

(GCS)• This is a prospective study

on 50,045 subjects 40 to 75 years old

• Recruitment of subjects in 326 villages and Gonbad city, from 2004 to 2008

• Subjects consisted of 57% women, 8% rural dwellers, and 74% Turkmens

• Data collected:• Demographic• Life style• Anthropometric• Biochemical samples• 10 year follow up

Area Hypertension Prevalence Urban 43.9% Rural 42.3%Sex Male 36.4% Female 47.2%Age35-39 23.9%40-44 27.1%45-49 36.5%50-54 45.9%55-59 52.4%60-64 57.3%65-69 62.9%70-74 65.0%75-79 64.8%80-84 33.3%

Prevalence of Hypertension

GCS 2007

Area Hypertension Treatment Coverage

Urban 47.4%

Rural 39.4%

Sex

Male 29.2%

Female 47.7%

Education

Illiterate 42.6%

<=5 years 34.6%

6-8 years 38.0%

High school 36.9%

University 41.0%

Treatment Coverage of Hypertension

GCS 2007

Area Diabetes Prevalence Urban 10.0% Rural 6.4%Sex Male 5.3% Female 8.4%Age35-39 2.5%40-44 4.2%45-49 6.1%50-54 7.9%55-59 9.8%60-64 10.3%65-69 9.5%70-74 8.5%75-79 10.6%80-84 0%

Prevalence of Diabetes

GCS 2007

Area Diabetes Treatment Coverage

Urban 72.7%

Rural 67.3%

Sex

Male 68.5%

Female 68.9%

Education

Illiterate 67.9%

<=5 years 72.5%

6-8 years 72.7%

High school 67.2%

University 69.5%

Treatment Coverage of Diabetes

GCS 2007

Prevalence of Overweight and Obesity

• Prevalence of overweight: 62.2%• Prevalence of obesity: 28%

• Comparing to United States:– Iranian women are more obese than American women– Iranian men or thinner than American men

47GCS 2007

Baharmi h,Malekzadeh R BMC public health 2006

The Prevalence of Overweight and Obesity in Iranian and American men and women in GCS

GCS 2007

49

Epidemic of Overweight, Obesity, and Lack of Physical Activity

• Prevalence of Overweight: 38%

• Prevalence of Obesity: 22%

• Significant decrease in physical activity especially

among women

• Prevalence of Diabetes: 10%

• Prevalence of fatty liver: 30%GCS 2007

50

Diet

• Prevalence of excess consumption: 40%

• Iranian diet: 40% excess carbohydrate, 30% excess oil

• High consumption of white rice: Iran is the 13th

country in the world in terms of excess consumption

of rice (46 kg per person per year)

Non-Communicable Diseases Surveillance Survey 2009

51

The Main Risk Factors of NCDs


Low fruits and vegetables

low activity Overweight or Obesity

Hypertension Smoking0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MenWomen

52

The Most Prevalent of NCDs Risk Factors among Adolescents and Youth

0% 10% 20% 30% 40% 50% 60%

Second Hand Smoking

Low Physical Activity

Overweight

Smoking

Hookah Con-sumption

CASPIAN Kelishadi et al 2008, 2007

53

Risk Factors in Adolescents and Youth

• 10 to 18 years– Second hand smoking: 50.6%– Low physical activity: 36%– Smoking: 12%

• 15 to 24 years- Low physical Activity: 34.5%- Overweight: 28%- Smoking cigarettes and Hookah: 8%


Drug Abuse

• Iranians consumes 42% of all opium in the world (?)

• Transit from Afghanistan to Iran

• Drug abuse as a leisure or due to beliefs on its

therapeutic effects

Drug Abuse• Prevalence of drug abuse in subjects 40 years old and older

in GCS: 17%

• The mean proportion of adolescents who abuse drugs (Kerman, Zanjan, Shiraz, Tabriz):– Boys: 12.7% - 26.5%– Girls: 7.7% - 11.5%

Sequelae of Drug Abuse

• Increased all-cause mortality rate

• Increased mortality rate due to cardiovascular diseases and cancers

• Increased mortality rate due to asthma, tuberculosis, and chronic

respiratory diseases

GCS 2012

Alcohol Consumption

• High School Adolescents:

– Boys: 18%

– Girls: 8%


58

Environmental Risk Factors

• Expansion of slum areas without access to health care and low sanitation

• Air and noise pollution in cities• Exposure to poisons in work places• Limited water sources and the risk of drought• Use of fossil fuels• Inequity in access to fuels• Destruction of jungles and green spaces

Female Male

25-34 35-44 45-54 55-640

0.2

0.4

0.6

0.8

1

Undiagnosed diagnosed but not treatedTreated

Num

ber

25-34 35-44 45-54 55-640

0.2

0.4

0.6

0.8

1

Undiagnosed diagnosed but not treatedTreated

Prop

ortio

n

Management and Quality of Health Care for NCDs at National Level

Non-Communicable Diseases Surveillance Survey, 2005

60

Management of NCDs

• Necessity of research on prevalence of Diseases, communicable and non-communicable at provincial level for cost-efficient policy making

• Necessity of detecting risk factors for prevention

61

The Coverage of Diabetes and Hypertension Diagnosis and Treatment in Urban and Rural Areas of Iran, 2005

Diabetes Diagnosis Diabetes Treatment Hypertension Diagnosis Hypertension Treatment0%

10%

20%

30%

40%

50%

60%

70%

Urban RuralBoth


62

The Association of Risk Factors with NCDs

63GBD 2010

64GBD 2010

65

The Pathway from Risk Factors to NCDS

NCDs

Direct Health Care Costs NCDs

Social Determinants of Health

Globalization, Urbanization, Population Ageing

Raised Blood Pressure, Obesity, High Blood Glucose, High Lipids

Unhealthy Diet, Smoking, Physical Inactivity, Substance abuse

Indirect Costs due to Income and Productivity Losses

66

Impact on Socio-Economic Development: A Vicious Circle (2)

High costs due to chronic nature of diseases

Needs to access drugs and health services

Probable needs to seek services and drugs in private sector

Treatments not part of core services

Increased Out-of-Pocket Catastrophic Expenditure

Financial Turnover in Health System in Iran

• Total Health Expenditure• The proportion of health expenditure out of GDP• Out of Pocket• The share of public and private insurance

organizations• Insurance coverage• Catastrophic expenditure• Payment Mechanism

67

GDP (Billion Dollars) from 1999 to 2013

68

1378 1379 1380 1381 1382 1383 1384 1385 1386 1387 1388 1389 1390 1391 13920

100

200

300

400

500

600

700


Trend of Health Expenditure by Financial Sources (Billion Rials)

69

1381 1382 1383 1384 1385 1386 13870

20000

40000

60000

80000

100000

120000

140000

Total Household ExpenditureHousehold out of pocketGovernmental ResourcesEmployers' Resources

Ministry of Health and Medical Education, National Health Accounts

Trend of Health Expenditure by Health Care Functions (Billion Rials)

70

1381 1382 1383 1384 1385 1386 13870

20000

40000

60000

80000

100000

120000

140000

Treatment CareOutpatient CareTrainingInvestmentResearch and Development


Trend of Health Expenditure by Providers (Billion Rials)

71

1381 1382 1383 1384 1385 1386 13870

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

Hospitals

Outpatient Providers

Drug Stores and Medical Equip-ment

Related Organi-zations


The Proportion of Total Health Expenditure out of GDP in Iran

Data: WHO (Global Health Expenditure Database)

Total Health Expenditure Per Capita


Out of Pocket Expenditure as % of Total Health Expenditure


Percentage of Catastrophic Expenditure

Data: Household Expenditure Survey

Challenges in Health System (1)

• Limited Financial Resources• Lack of accordance between the capacity of health

system and the need for prevention, control, and treatment of NCDs

• Incomplete insurance coverage and high percentage of out of pocket and catastrophic expenditure

• Increase in induced demands• No implementation of referral system in urban areas

76

Challenges in Health System (2)

• No insurance coverage in slums areas• Inequity in access to health care• Low quality of health care• Low satisfaction of health care• Lack of an appropriate approach towards Health

Technology Assessment• Focus on treatment instead of prevention• Lack of evidence-based policy making• Low quality of health data infrastructure

77

78

What should we do?• Reconfigure the current primary care system

to be responsive to the new burden estimates.• Fast and cost-effective move toward a system

that focuses on preventing NCDs and road injuries

79

The alternative no-actionscenario :

• Is secondary and tertiary prevention of these conditions that will impose enormous financial costs on the system and, indirectly, on the population.

80

IR PHC is not well prepared for NCD challenges

• The PHC in Iran, similar to several other health systems in LMIC, is not well prepared for confronting the challenges caused by the epidemics of NCDs because of its typical policy direction toward preventing maternal-child conditions and infectious diseases

81

The policy message

• Nationwide, low-cost, early, and sustainable interventions are needed to mitigate NCDs’ increasing burden

82

NCD Challenge

• Prevention, early diagnosis and care of NCDs need a different and well prepared health infrastructure to avert huge co-morbidities which contribute greatly to rising health care costs and compromise of economic productivity

Ministry of Health and Medical Education (MoHME)Undersecretary of Research and Technology

Strategic Plan (2014-2019)

June 2014

Strategic Aim One: Strengthening Health Research Infrastructure

1-1- Reestablish of the National Research Center for Medical Sciences

1-2- Disease Registries Program

1-3- Cohort Studies

in adult (min. 100,000 population per study)

in neonates and children (min. 2,000 population per study)

Strategic Plan (2014-2019)Strategic Aim One

UK Medical Research Council (MRC) has a 50-year history of supporting population cohort studies, including:

British 1946 Birth Cohort: the world’s longest continuously

running birth cohort

UK Biobank: which tracks half a million participants.

Million Women Study: the largest longitudinal study of

women’s health 2·2 million people in the UK are currently taking part in these

large population cohort studies—one in 30 of the general population

Why Cohort Studies?

34 largest UK population cohort studies:

Almost £30 million is spent per year on the 34 largest UK

population cohort studies

50% of these cohort have been followed for more than 20

years

92% of cohort participants are aged 45 years or older

62% are female

Why Cohort Studies?

What are the strength of Cohort study?

• Ability to identify multiple risk factors over time

• Assessment of exposures that cannot be randomized (smoking, alcohol,…)

• Collection of serial measurements and samples that enables measurement of

changes in exposure and their effect on health outcomes over time

• Identifying the effect of one risk factor on multiple outcomes

• Cohorts are generally more inclusive than RCTs which are usually highly selective

• Findings from cohort studies can, therefore, be more generalizable to the

population as a whole

• Feasibility of further research through linkage to routine data and further

laboratory and genetic study

Why Cohort Studies?

Cross-cohort collaborations• An effective way to increase statistical power

• The Healthy Ageing Across the Life Course (HALCyon) collaboration merged data from nine cohorts to undertake studies of ageing that would not have been feasible using any single cohort

• Cohort and Longitudinal Studies Enhancement Resources (CLOSER) initiative, funded by the MRC and Economic and Social Research Council, brings together nine cohorts with the aim of combining variables across these studies

• Cohorts should use standardized and validated approaches, where possible, to facilitate cross-cohort comparisons

Why Cohort Studies?

1-4- To Build Core Laboratories in 10 Medical Universities

1-5- Development of Cutting-Edge Science

Iran National Brain Mapping Center Regenerative Medicine Centre Iranian Genomes Project

1-6- Application of Electronic Health Records in Clinical, Epidemiologic and Health Management Research

Strategic Plan (2014-2019)Strategic Aim One

Strategic Aim Two: Capacity building for academic and research staff

2-1- Clinician Scientist Training Program

2-2- Postdoctoral Research Program

2-3- Improving the Quality of PhD by Research Program

2-4- Research Grant for Top Scientists (with high ranked h-index)

2-5- International Collaboration with Health and Biomedical Research Centers

Strategic Plan (2014-2019)Strategic Aim Two

International Collaboration of Medicine Documents in Iran

SCImago Journal & Country Rank

Strategic Aim Three: Health Technology Development

3-1- Clinician Scientist Training Program

3-2- Development of Incubators in Medical Universities

3-3- Supporting Knowledge-Based Companies in Health and Biomedical Field

Strategic Plan (2014-2019)Strategic Aim Three

Strategic Aim Four: Development of Sources of Health Research Funding

4-1- Allocation of at least one percent of a medical university’s budgets for research

4-2- Supporting establishment of non-governmental health and biomedical research centers

4-3- Development of health and biomedical research charities

4-4- Absorption of funds for health research from other governmental sources

Strategic Plan (2014-2019)Strategic Aim Four

“Development of Research and Technology” Budget Chapterin Ministry of Health Compared to Ministry of Science (1393)

Million Rial Chapter proportion

8,767,638 38% Ministry of Science, Research and Technology

3,047,645 13% Ministry of Health, and Medical Education

11,265,293 49% Other governmental organizations

23,080,576 100% Development of Research and Technology Budget Chapter

Research Budget in Iranian Medical Universities, Research Centers and Ministry (1393 compared to 1392)

Change Research Budget (Year)

Title1393 1392

4.15% 645,523 559,562 Medical Universities

6.3% 1,540,745 1,487,360Research centers and Pasteur Inst.

0.8% 861,377 797,377Ministry of Health and Medical Education

1.7% 3,047,645 2,844,299 Total

Charitable spending on research in the UK 2008-2012

Medical research charities have consistently spent more than £1bn on research in each of the past five years

See more at: http://www.amrc.org.uk/our-members/sector-data/research-spend#sthash.U2ZGARpv.dpuf

Strategic Aim Five: Enhancing the Quality of Health Research

5-1- Improving assessment of health research and researchers

5-2- Quantitative and Qualitative Development of “Health System Research”

5-3- Supporting Iranian Medical Journals for Indexing in MEDLINE, ISI Web of Science and Scopus as well as Enhancing Their Quality

5-4- Improving Peer-Review System in Health Research and Technology Assessment

5-5- Shifting Authority of Medical Journals from Public Universities to Scientific Medical Associations and NGOs

Strategic Plan (2014-2019)Strategic Aim Five