Volume 21, Issue 81 (8-2021)
refahj 2021, 21(81): 87-127 |
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Abdolahtabar H, Sajjadi H, Sam Aram E, Tajmazinani A. (2021). The institutional context of the health system and its developments in Iran. refahj. 21(81), 87-127.
URL: http://refahj.uswr.ac.ir/article-1-3792-en.html
URL: http://refahj.uswr.ac.ir/article-1-3792-en.html
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Introduction: Health policy as a part of social policy is a function of the economic and social development of countries, therefore, the study of health policy or institution needs to be addressed from a historical, economic and political perspective, and this with “interdisciplinary studies” that can be It is possible to adopt hybrid (interdisciplinary) approaches to explain its change. The aim of this study was to investigate the effect of historical events and political, economic, social and cultural characteristics on how the health system is formed in Iran and the process of developments and its ups and downs and consequences.
Method: The selective approach in this research is institutionalism which has a political, cultural, social and economic context in economic performance and development. Because to examine the trend of health policy in the last century in Iran, we must focus on data that indicate evidence from the past, the present study is of a historical type and according to the subject under discussion, books and writings related to the health system, Laws and programs related to health, regulations and instructions, upstream documents (government documents), etc. are examined to identify and analyze the factors affecting the developments of the health system in Iran.
Findings: There are five main institutional sets of agents in the field of social policy that play a role in the development of the health system: a(Government: After the formation of the Pahlavi government in Iran (1304 AD), the central government is primarily responsible for providing basic social services, including health After the revolution, the government took over the provision of social services and explicitly emphasized it in the principles of the constitution. Therefore, the main role in these developments is the responsibility of the government. B) Civil society: In the field of health, apart from hospitals and endowed clinics and charities, social movements have occurred from time to time and have also influenced social policy. Among these movements we can mention the establishment of the Tudeh Party, the oil nationalization movement, the uprising of June 6, 1963 and the Islamic Revolution in 1996. C) Private sector: Attention to this issue was raised in Iran’s development programs and health policy before and after the revolution. Entrusting part of the medical treatment and education to the private sector and implementing the hospital self-government plan is part of this process. However, by 2015, less than one-third of health activities have been privatized. D) Family: is one of the agents of family social policy, whose role, of course, has become less important than in the past; And somehow the government has taken on the role of sponsor and provider of health services, but the provision of health services is still determined by the job situation and the economic situation of the families. Plans such as rural insurance and public insurance have been proposed in this regard. E) International institutions: multilateral institutions such as the World Bank and the International Monetary Fund; International donors; United Nations agencies such as the World Health Organization, the United Nations Development Program, the United Nations Children’s Fund, and the United Nations Institute for Social Development Research are among the institutions whose actions have influenced health policies.
In addition to these agents, four categories of underlying factors play a role in the evolution of the health system: situational, structural, cultural, and international or external factors. Establishment of Dar el-Fonun; Plague and cholera epidemics in the Persian Gulf region in the 1280s; Devastating earthquake in Bojnourd; Prevalence of sexually transmitted diseases and infectious diseases in the early 1320s; Accident of collapse of the roof of the waiting hall of Mehrabad airport; Occurrence of the Islamic Revolution of Iran; And Iraq’s eight-year imposed war on Iran has been one of the factors influencing Iran’s health system.
The structural weakness of the Qajar government and its incompatibility with the ideals of the Constitutional Revolution; Economic and political turmoil and very weak social indicators at the beginning of the twentieth century; The focus of the first Pahlavi government on the modernization of the country in various fields, including the health system; Weak infrastructure required by the health system in most parts of the country; A non-industrial economic system based on traditional agriculture, which later became dependent on oil revenues and became a rentier government; Numerous changes at different organizational levels of the health system; The low share of health in government revenues and the lack of sufficient financial resources to implement health plans and programs and the concentration of health plans and measures in the capital and provincial centers have been among the structural factors affecting the Iranian health system.
Existence of traditional physicians in Iranian society and the impossibility of supervising their work; Low level of literacy and public awareness as one of the obstacles to the proper implementation of health policies and programs; Desire to have many children; Religious beliefs about some of the rules of medicine and treatment and changes in people’s lifestyles have been among the cultural factors affecting the Iranian health system.
Teaching medicine in the Academy of Arts and forming health councils in Iran by European doctors; Allied occupation of Iran; The entry of the World Health Organization as an international institution and its role in the development of health programs in Iran; Establishment of the International Health Cooperation Organization in Iran; Implementation of the Truman Four principle; Iraq invaded Iran in 1980 and the eight-year imposed war; Unilateral US sanctions and then other international sanctions after the Islamic Revolution were among the external factors affecting Iran’s health system.
Discussion: The main features of the political institution in Iran, such as dependence on oil revenues, its extensive dominance over the economy and its decisive role in macro-planning indicate the prominent role of the political institution in the Iranian health system. After the political system, the economic factor has had a greater impact on changes in the health system. The government’s dependence on revenues from oil sales and oil price fluctuations at various times has had a direct impact on the development of health system infrastructure and the implementation of health programs. Social characteristics such as literacy rate, population growth rate, migration, employment, etc. in turn have influenced the adoption of health policies, which ultimately the policy institution has decided to take into account economic factors. Cultural factors also influence health policies and regulations, which may be quite the opposite in another country or at another time. The role-playing of other health actors and agents also depends on government decisions and orientations. For this reason, in order to formulate better policies and pave the way for the establishment of social justice, this institution needs to pay more serious attention to the elements of civil society, family change and entrusting matters to the private sector. It will be very effective.
Ethical considerations
Contribution of authors
All authors have contributed to the design, execution, and writing of all sections of this article.
Funds
This article is part of Dr. Hadi Abdollahtabar’s dissertation entitled “Health Policy Evolution in Iran (1925-2015)” in the Department of Social Welfare at the Faculty of Social Sciences of Allameh Tabataba’i University under the guidance of Dr. Homeira Sajjadi, Dr. Ezatollah Sam Aram and Dr. AliAkbar TajMazinani.
Conflict of interest
According to the authors, there is no conflict of interest in this article.
Adherence to the principles of research ethics
In this article, all rights relating to references are cited and resources are carefully listed.
Introduction: Health policy as a part of social policy is a function of the economic and social development of countries, therefore, the study of health policy or institution needs to be addressed from a historical, economic and political perspective, and this with “interdisciplinary studies” that can be It is possible to adopt hybrid (interdisciplinary) approaches to explain its change. The aim of this study was to investigate the effect of historical events and political, economic, social and cultural characteristics on how the health system is formed in Iran and the process of developments and its ups and downs and consequences.
Method: The selective approach in this research is institutionalism which has a political, cultural, social and economic context in economic performance and development. Because to examine the trend of health policy in the last century in Iran, we must focus on data that indicate evidence from the past, the present study is of a historical type and according to the subject under discussion, books and writings related to the health system, Laws and programs related to health, regulations and instructions, upstream documents (government documents), etc. are examined to identify and analyze the factors affecting the developments of the health system in Iran.
Findings: There are five main institutional sets of agents in the field of social policy that play a role in the development of the health system: a(Government: After the formation of the Pahlavi government in Iran (1304 AD), the central government is primarily responsible for providing basic social services, including health After the revolution, the government took over the provision of social services and explicitly emphasized it in the principles of the constitution. Therefore, the main role in these developments is the responsibility of the government. B) Civil society: In the field of health, apart from hospitals and endowed clinics and charities, social movements have occurred from time to time and have also influenced social policy. Among these movements we can mention the establishment of the Tudeh Party, the oil nationalization movement, the uprising of June 6, 1963 and the Islamic Revolution in 1996. C) Private sector: Attention to this issue was raised in Iran’s development programs and health policy before and after the revolution. Entrusting part of the medical treatment and education to the private sector and implementing the hospital self-government plan is part of this process. However, by 2015, less than one-third of health activities have been privatized. D) Family: is one of the agents of family social policy, whose role, of course, has become less important than in the past; And somehow the government has taken on the role of sponsor and provider of health services, but the provision of health services is still determined by the job situation and the economic situation of the families. Plans such as rural insurance and public insurance have been proposed in this regard. E) International institutions: multilateral institutions such as the World Bank and the International Monetary Fund; International donors; United Nations agencies such as the World Health Organization, the United Nations Development Program, the United Nations Children’s Fund, and the United Nations Institute for Social Development Research are among the institutions whose actions have influenced health policies.
In addition to these agents, four categories of underlying factors play a role in the evolution of the health system: situational, structural, cultural, and international or external factors. Establishment of Dar el-Fonun; Plague and cholera epidemics in the Persian Gulf region in the 1280s; Devastating earthquake in Bojnourd; Prevalence of sexually transmitted diseases and infectious diseases in the early 1320s; Accident of collapse of the roof of the waiting hall of Mehrabad airport; Occurrence of the Islamic Revolution of Iran; And Iraq’s eight-year imposed war on Iran has been one of the factors influencing Iran’s health system.
The structural weakness of the Qajar government and its incompatibility with the ideals of the Constitutional Revolution; Economic and political turmoil and very weak social indicators at the beginning of the twentieth century; The focus of the first Pahlavi government on the modernization of the country in various fields, including the health system; Weak infrastructure required by the health system in most parts of the country; A non-industrial economic system based on traditional agriculture, which later became dependent on oil revenues and became a rentier government; Numerous changes at different organizational levels of the health system; The low share of health in government revenues and the lack of sufficient financial resources to implement health plans and programs and the concentration of health plans and measures in the capital and provincial centers have been among the structural factors affecting the Iranian health system.
Existence of traditional physicians in Iranian society and the impossibility of supervising their work; Low level of literacy and public awareness as one of the obstacles to the proper implementation of health policies and programs; Desire to have many children; Religious beliefs about some of the rules of medicine and treatment and changes in people’s lifestyles have been among the cultural factors affecting the Iranian health system.
Teaching medicine in the Academy of Arts and forming health councils in Iran by European doctors; Allied occupation of Iran; The entry of the World Health Organization as an international institution and its role in the development of health programs in Iran; Establishment of the International Health Cooperation Organization in Iran; Implementation of the Truman Four principle; Iraq invaded Iran in 1980 and the eight-year imposed war; Unilateral US sanctions and then other international sanctions after the Islamic Revolution were among the external factors affecting Iran’s health system.
Discussion: The main features of the political institution in Iran, such as dependence on oil revenues, its extensive dominance over the economy and its decisive role in macro-planning indicate the prominent role of the political institution in the Iranian health system. After the political system, the economic factor has had a greater impact on changes in the health system. The government’s dependence on revenues from oil sales and oil price fluctuations at various times has had a direct impact on the development of health system infrastructure and the implementation of health programs. Social characteristics such as literacy rate, population growth rate, migration, employment, etc. in turn have influenced the adoption of health policies, which ultimately the policy institution has decided to take into account economic factors. Cultural factors also influence health policies and regulations, which may be quite the opposite in another country or at another time. The role-playing of other health actors and agents also depends on government decisions and orientations. For this reason, in order to formulate better policies and pave the way for the establishment of social justice, this institution needs to pay more serious attention to the elements of civil society, family change and entrusting matters to the private sector. It will be very effective.
Ethical considerations
Contribution of authors
All authors have contributed to the design, execution, and writing of all sections of this article.
Funds
This article is part of Dr. Hadi Abdollahtabar’s dissertation entitled “Health Policy Evolution in Iran (1925-2015)” in the Department of Social Welfare at the Faculty of Social Sciences of Allameh Tabataba’i University under the guidance of Dr. Homeira Sajjadi, Dr. Ezatollah Sam Aram and Dr. AliAkbar TajMazinani.
Conflict of interest
According to the authors, there is no conflict of interest in this article.
Adherence to the principles of research ethics
In this article, all rights relating to references are cited and resources are carefully listed.
Type of Study: orginal |
Received: 2020/11/24 | Accepted: 2021/06/2 | Published: 2021/09/14
Received: 2020/11/24 | Accepted: 2021/06/2 | Published: 2021/09/14
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