Status of Iran’s Primary Health Care System in Terms of Health Systems Control Knobs: A Review Article
Abstract
Background: After the establishment of Primary Health Care (PHC) program in Iran, health indicators have improved every year. This progress was so rapid that a number of shortcomings and weaknesses of the PHC program remained silent behind its successes. This study aimed to assess the status of Iran’s PHC system (strengths, weaknesses, opportunities and threats) in terms of health system’s control knobs.
Methods: The search was conducted through two English `databases of Web of Knowledge and PubMed, two English publications of Science Direct and Springer and two Persian databases of Magiran and SID. Keywords were selected from MeSH and included primary health care, PHC and Iran in both Persian and English. No time limit was considered.
Results: Iran's PHC system has numerous successes in dealing with health system’s control knobs; which largely part of that related to the health network implementation, the role of Behvarz, improvement of health indicators in rural areas and the elimination of urban-rural inequality, but there are some weaknesses, opportunities and threats in the Iranian PHC system as well.
Conclusion: By considering socio-economic changes the current structure of PHC system needs to be reformed to coordinate with phenomenon of chronic diseases, accidents and aging. The current information system in PHC does not provide the required information for decision makers and policy makers so it needs to be transformed to the electronic system with unique electronic health file for individuals.
Park JE, Park AK (2004). Park's textbook of preventive and social medicine. ed. Samat, Tehran.
Bagyani-Mogadam H, Ehraampoosh MH (2003). Principles of Health Services. ed. Cherag-E Danesh, Tehran.
Shodjai-Tehrani H, Ebaadi-Fard-Azar F (2003). Principles of Health Services. ed. Samat, Tehran.
Davoodi S (2007). Health and Its Determinants. ed. Asar-E Moaser, Tehran.
Neale F (2005).Western Australian Clinical Governance Guidelines. Health Reform Implementation Taskforce. Australia.
Mehrdad R (2009). Health system in Iran. JMAJ, 52:69-73.
World Bank (2015). Annual population growth rate for year. The World Bank Group, Based on data from the Central Bank of Iran.
Naeli J, Mogimi D (2007). Primary care health promotion policy document. Ministry of Health, Tehran, Iran.
Asadi-Lari M, Sayyari AA, Akbari ME, Gray D (2004). Public health improvement in Iran--lessons from the last 20 years. Public Health, 118:395-402.
Roberts MJ, Hsiao W, Berman P, Reich MR (2003). Getting health reform right: A guide to improving perfrmance and eqity. ed. Oxford University Press.
Lea P (2016). Iran: promises and prospects for health. Lancet, 387:918.
Heshmati B, Joulaei H (2016). Iran's health-care system in transition. Lancet, 387:29-30.
Sadoughi F, Shahi M, Ahmadi M, Davaridolatabadi N (2016). Health information management system for elderly health sector: a qualitative study in Iran. Iran Red Crescent Med J, 18: e21520.
Anonymous (2013). Critical Appraisal Skills Programme (CASP). Oxford, UK.
Anonymous (2014). Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. National Heart,Lung and Blood Institute, USA. https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort
Maghsoudloo M, Abolhassani F, Lotfibakhshaiesh N (2016). Connecting Primary Health Care: A Comprehensive Pilot Study. Acta Med Iran, 54:441-7.
Zanganeh Baygi M, Seyadin SH, Rajabi Fard Mazrae No F, Kouhsari Khameneh A (2016). Adaptation Of Goals And Organizational Structure In Iran’s Primary Healthcare System, A Systematic Review. Payavard, 9:446-458.
Mohammad-Alizadeh CS, Wahlstrom R, Vahidi R, et al (2009). Barriers to high-quality primary reproductive health services in an urban area of Iran: views of public health providers. Midwifery, 25:721-30.
Sheikhattari P, Kamangar F (2010). How can primary health care system and community-based participatory research be complementary? Int J Prev Med, 1:1-10.
Tavassoli M (2008). Iranian health houses open the door to primary care. Bull World Health Organ, 86:585-6.
Eslami M, d’Arcangues C (2016). Aiming for quality in Iran’s national family planning program—two decades of sustained efforts. Contraception, 93:209-215.
Vosoogh Moghaddam A, Damari B, Alikhani S, et al (2013). Health in the 5th 5-years Development Plan of Iran: Main Challenges, General Policies and Strategies. Iran J Public Health, 42(Supple1): 42–49.
Khayati F, Saberi M (2009). Primary Health Care (PHC) an Ever Strategy for Health Equity Extension. J Health Adm, 12:33-40.
Mostafavi Darani F, Ali Abedi H, Riji HM (2009). Conditions Affecting the Elderly Primary Health Care in Urban Health Care Centers of Iran. Res J Med Sci, 3:202-213.
Moshiri E, Rashidian A, Arab M, Khosravi A (2016). Using an Analytical Framework to Explain the Formation of Primary Health Care in Rural Iran in the 1980s. Arch Iran Med, 19:16-22.
Lebaron SW, Schultz SH (2005). Family medicine in Iran: the birth of a new specialty. Fam Med, 37:502-5.
Parkash J, Younis M, Ward W (2015). Healthcare for the Ageing Populations of Countries of Middle East and North Africa. Ageing Int, 40:3-12.
Bagheri Lankarani K, Alavian SM, Peymani P (2013). Health in the Islamic Republic of Iran, challenges and progresses. Med J Islam Repub Iran, 27:42-49.
Moghadam MN, Sadeghi V, Parva S (2012). Weaknesses and challenges of primary healthcare system in Iran: a review. Int J Health Plann Manage, 27:e121-31.
Baygi MZ, Seyedin H (2013). Imbalance between Goals and Organizational Structure in Primary Health Care in Iran- a Systematic Review. Iran J Public Health, 42:665-672.
Mehrolhassani M, Jafari Sirizi M, Poorhoseini S, Yazdi Feyzabadi V (2012). The Challenges of Implementing Family Physician and Rural Insurance Policies in Kerman Province, Iran: A Qualitative Study. J Health Develop, 1:193-206.
Khayatzadeh-Mahani A, Takian A (2014). Family physician program in Iran: considerations for adapting the policy in urban settings. Arch Iran Med, 17:776-8.
Nasseri K, Sadrizadeh B, Malek-Afzali H, et al (1991). Primary health care and immunisation in Iran. Public Health, 105:229-238.
Mohammad-Alizadeh S, Wahlström R, Vahidi R, Johansson A (2009). Women's perceptions of quality of family planning services in Tabriz, Iran. Reprod Health Matters, 17:171-80.
Aghajanian A, Mehryar AH, Ahmadnia S, Kazemipour S (2007). Impact of rural health development programme in the Islamic Republic of Iran on rural-urban disparities in health indicators. East Mediterr Health J, 13:1466-75.
Rafiei M, Ezzatian R, Farshad A, et al (2015). Occupational Health Services Integrated in Primary Health Care in Iran. Ann Glob Health, 81:561-7.
Singh D, Negin J, Otim M, Orach CG, Cumming R (2015). The effect of payment and incentives on motivation and focus of community health workers: five case studies from low-and middle-income countries. Hum Resour Health, 13:58.
Simbar M (2012). Achievements of the Iranian family planning programmes 1956-2006. East Mediterr Health J, 18:279-86.
Mansouri N, Gharaee B, Shariat SV, et al (2009). The change in attitude and knowledge of health care personnel and general population following trainings provided during integration of mental health in Primary Health Care in Iran: a systematic review. Int J Ment Health Syst, 3:15.
Shadpour K (2000). Primary health care networks in the Islamic Republic of Iran. East Mediterr Health J, 6:822-5.
Sohrabi MR, Albalushi RM (2011). Clients' satisfaction with primary health care in Tehran: A cross-sectional study on Iranian Health Centers. J Res Med Sci, 16:756-62.
Benyoussef A, Christian B (1977). Health care in developing countries. Soc Sci Med, 11:399-408.
Mehryar A (2004). Primary Health Care and the Rural Poor in the Islamic Republic of Iran. http://web.worldbank.org/archive/website00819C/WEB/PDF/IRAN_PRI.PDF
Malekafzali H (2014). Primary Health case in Islamic Republic of Iran. http://journals.tums.ac.ir/sjsph/article-1-5150-en.pdf (In Persian).
Malekafzali H (2009). Primary Health Care in the Rural Area of the Islamic Republic of Iran. Iran J Public Health, 38(Suppl.1):69-70.
Abou Basha LM, Fadali GA, Nour BM, Abdalla MS (1989). Uncommon complications of human fascioliasis in Alexandria. J Egypt Soc Parasitol, 19(2):743-9.
Farzadfar F, Murray CJL, Gakidou E, et al (2012). Effectiveness of diabetes and hypertension management by rural primary health-care workers (Behvarz workers) in Iran: a nationally representative observational study. Lancet, 379:47-54.
Tehrani FR, Simbar M, Abedini M (2011). Reproductive morbidity among Iranian women; issues often inappropriately addressed in health seeking behaviors. BMC Public Health, 11:863.
Javanparast S, Coveney J, Saikia U (2009). Exploring health stakeholders' perceptions on moving towards comprehensive primary health care to address childhood malnutrition in Iran: a qualitative study. BMC Health Serv Res, 9:36.
Baygi MZ, Seyedin H, Salehi M, Sirizi MJ (2015). Structural and contextual dimensions of Iranian primary health care system at local level. Iran Red Crescent Med J, 17: e17222.
Jafari F, Eftekhar H, Pourreza A, Mousavi J (2010). Socio-economic and medical determinants of low birth weight in Iran: 20 years after establishment of a primary healthcare network. Public Health, 124:153-158.
Forouzan AS, Ghazinour M, Dejman M, Rafeiey H, San Sebastian M (2011). Testing the WHO responsiveness concept in the Iranian mental healthcare system: a qualitative study of service users. BMC Health Serv Res, 11:325.
Farahbakhsh M, Nikniyaz AR, Zakeri A (2006). Survey of data management in health care delivery system in the East Azarbaijan province. Health System, 2:51-58.
Schieber G, Klingen N (1999). Islamic Republic of Iran Health Financing Reform in Iran :Principles and Possible Next Steps. Health Economic Congress, World Bank, Washington, DC.
Habibzadeh F (2012). The control of non-communicable diseases in rural Iran. Lancet, 379:6-7.
Rahmanian K, Shojaie M (2012). The prevalence of pre-hypertension and its association to established cardiovascular risk factors in south of Iran. BMC Res Notes, 5:386.
Sadeghi Poor Roodsari HR, Heidari AB, Ghazy Sherbaf P (2005). Study of The Ratea nd Causes of Islamshahr Urban Residents’ voiding to refer to The Health Centers For Receiving Health Services (2003). Tehran Univ Med J, 63:141-150.
Yazdizadeh B, Nedjat S, Mohammad K, et al (2011). Cesarean section rate in Iran, multidimensional approaches for behavioral change of providers: a qualitative study. BMC Health Serv Res, 11:159.
Ekman B, Pathmanathan I, Liljestrand J (2008). Integrating health interventions for women, newborn babies, and children: a framework for action. Lancet, 372:990-1000.
Jafari Sirizi M, Yazdi Fiezabadi V, Aleksanyan AS (2010). Major Policies in Health Area in Islamic Republic of Iran During Past 30 Years: Results, Challenges and Strategies. Res J Biol Sci, 5:683-691.
Asadi F, Hosseini A, Moghaddasi H, Nasr Haydarabadi N (2012). Primary Health Care Information Systems in Health Centers of Tehran, Iran. Health Inform Manage, 9:1-10.
Javanparast S, Baum F, Labonte R, et al (2012). The experience of community health workers training in Iran: a qualitative study. BMC Health Serv Res, 12:291.
Zohour A, Paryani A (2001). Client satisfaction with the performance of home health and rural health centers in 1378 Qorveh city. ZUMS Journal, 9:74-77.
Vahidnia F (2007). Case study: fertility decline in Iran. Popul Environ, 28:259-266.
Ziaoddini H, Kelishadi R, Kamsari F, et al (2010). First nationwide survey of prevalence of weight disorders in Iranian children at school entry. World J Pediatr, 6:223-7.
Yasamy MT, Shahmohammadi D, Bagheri Yazdi SA, et al (2001). Mental health in the Islamic Republic of Iran: achievements and areas of need. East Mediterr Health J, 7:381-91.
Mojtahedzadeh V, Razani N, Malekinejad M, et al (2008). Injection drug use in Rural Iran: integrating HIV prevention into iran's rural primary health care system. AIDS Behav, 12:S7-12.
Shirpak K, Chinichian M, Maticka-Tyndale E, et al (2008). A Qualitative Assessment of the Sex Education Needs of Married Iranian Women. Sex Cult, 12:133-150.
Joulaei H, Motazedian N (2013). Primary Health Care Strategic Key to Control HIV/AIDS in Iran. Iran J Public Health, 42:540-541.
Mandel JS, Brickley DB (2008). AIDS prevention research in low and middle-income countries: generating the evidence upon which local decisions are made. AIDS Behav, 12:S1-6.
Rezayie A (2004). The necessity of activating healthcare centers and proposes several operational approaches. Teb va Tazkiyeh, 13:9-0.(In Persian)
Esteghamati A, Khalilzadeh O, Anvari M, et al (2009). The economic costs of diabetes: a population-based study in Tehran, Iran. Diabetologia, 52:1520-7.
Adib-Hajbaghery M, Aghahoseini S (2007). The evaluation of disability and its related factors among the elderly population in Kashan, Iran. BMC Public Health, 7:261.
Delbari A, Roghani RS, Tabatabaei SS, Lökk J (2010). A Stroke Study of an Urban Area of Iran: Risk Factors, Length of Stay, Case Fatality, and Discharge Destination. J Stroke Cerebrovasc Dis, 19:104-9.
Barzegar MA, Djazayery A (1981). Evaluation of rural primary health care services in Iran: report on vital statistics in West Azarbaijan. Am J Public Health, 71:739-42.
Ahmad Kiadaliri A, Najafi B, Haghparast-Bidgoli H (2011). Geographic distribution of need and access to health care in rural population: an ecological study in Iran. Int J Equity Health, 10:39.
Akbari N, Ramezankhani A, Pazargadi M (2013). Accelerators/decelerators of achieving universal access to sexual and reproductive health services: a case study of Iranian health system. BMC Health Serv Res, 13:241.
Bristol N (2010). US region to model health service on Iranian system. Lancet, 375:625.
Javanparast S, Baum F, Labonte R, Sanders D (2011). Community health workers' perspectives on their contribution to rural health and well-being in Iran. Am J Public Health, 101:2287-2292.
Farzadfar F, Danaei G, Namdaritabar H, et al (2011). National and subnational mortality effects of metabolic risk factors and smoking in Iran: a comparative risk assessment. Popul Health Metr, 9:55.
Rezapur-Shahkolai F, Naghavi M, Shokouhi M, Laflamme L (2008). Unintentional injuries in the rural population of Twiserkan, Iran: a cross-sectional study on their incidence, characteristics and preventability. BMC Public Health, 8:269.
Nabilou B, Rasouli J (2013). Quality of family health services in selected cities of west azerbaijan province health posts from reality to expectations of service consumers. J Urmia Univ Med Sci, 24:277-285.
Joulaei H, Motazedian N (2013). On the Effectiveness of Primary Health Care System in Controlling HIV/AIDS in Iran. Iran J Public Health, 42:783-784.
Nabilou B, Farokh Eslamlou H (2013). Assessing quality of family health services in view points of service users in urmia health posts. J Urmia Nurs Midwifery Fac, 11:343-349.
Shahidzadeh-Mahani A, Omidvari S, Baradaran HR, Azin SA (2008). Factors affecting quality of care in family planning clinics: a study from Iran. Int J Qual Health Care, 20:284-90.
Bhatti JA, Salmi L-R (2008). Injury in the Developing World—From Prevention to Care. Int J Emerg Med, 1:235-250.
| Files | ||
| Issue | Vol 46 No 9 (2017) | |
| Section | Review Article(s) | |
| Keywords | ||
| Primary health care Health system Control knob Iran | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
