Iran Health Profile 2012

Health status has improved over four decades. The Ministry of Health and Medical Education (MOHME) finances and delivers primary health care (PHC). Recent remarkable developments in the health sector, such as establishing health networks to ensure provision of PHC services, resulted in improvement in various health indicators. However, considerable disparities remain; over 8-10% of the population is not covered by any insurance scheme and has to pay directly.
Restricted access and low service availability in the less developed provinces (Sistan and Baluchistan) result in poor health indices compared to the rest of the country. Communicable disease morbidity and mortality have decreased, accounting for only 1.9% of all deaths in 1999b. Hepatitis C is a common cause of chronic liver disease and there are high rates of mother-to-child transmission of hepatitis B with high fatality rates. The estimated number of HIV-positives is greater than 30 000 with 700 AIDS cases; intra-venous drug use and needle sharing account for 62% of transmissions; 8-9% is infected through sexual contact; for 30% the mode of transmission is unknown.
Maternal and child health have improved but malnutrition and low-weight births are higher than average in rural areas. Non Communicable diseases and accidents are increasing, accounting for 24% and 18% of all deaths respectively. Cardiovascular disease, hypertension, degenerative and stress-related disorders contribute to more than 45.7% of adult deaths. Accidents account for 14.8% of adult deaths, 8.9% due to traffic accidents.
Mental health disorders and substance abuse are highly prevalent (21.9%), particularly in females (25.9% versus 14.9% in males); this is reflected in the numbers seeking professional assistance and the amount of psychotropic drugs used. Major depression and generalized anxiety are common morbidity causes. Drug-related deaths increased by 70% in 2003 compared to 2002. Suicides represent 1.61% of deaths and homicide and violent deaths 0.98%.
Emergency preparedness and response are vital in a country prone to natural disasters which claim lives, cause damage to infrastructure and threaten socioeconomic development. The earthquake in Bam (December 2003) caused 29 000 deaths. Economic challenges. The increased birth rate in 1979-1991 affected the economy and reduced per capita gross domestic product (GDP). Current challenges include high unemployment, due to entry of this birth cohort into the job market. In 2001, unemployment was particularly high in those aged 15-24, 35% in men and 40.6% in women; a recent labour survey found that the rate has decreased to 11.2% in men and 22.5%d in women. The entry into marriage and family formation of the cohort will cause increased demand for housing and generate a second wave of increased fertility rates.

OPPORTUNITIES

• The right to health care for all citizens guaranteed by the Constitution
• Health sector reform perceived as a priority for the MOHME
• Government control on pharmaceutical pricing and quality assurance; most basic drugs produced
locally
• Integrated National Disaster Management Plan.
• Lack of institutionalization of evidence-based policy-making within the MOHME and poor governance capacity

CHALLENGES

• Inadequate financing of the health system; reduction of regional inequalities
• Poor human resource planning and management; excess production of health professionals and unemployment
• Disjointed health information system; poor use of data for stewardship, policy and decision making
• Strengthening intersectoral collaboration
• Improving economic performance
• Exploring the role of the private sector for extending health services at primary, secondary and tertiary levels at realistic cost