Some Policies & Strategies for Some Policies & Strategies for Maximizing Positive Synergies Maximizing Positive Synergies

between Global Health Initiatives between Global Health Initiatives and Health Systems:and Health Systems:

The I.R. IRAN’s perspectiveThe I.R. IRAN’s perspective

By:By:

Payman Hemmati, MDPayman Hemmati, MD

Ministry of Health & Medical Ministry of Health & Medical EducationEducation

I.R. IRANI.R. IRAN

Venice, Italy - June 22Venice, Italy - June 22ndnd, 2009, 2009hemmatipayman@yahoo.com

The objectives of the High The objectives of the High Level Dialogue:Level Dialogue:

• To To improve Health outcomesimprove Health outcomes through through strengthening synergies between GHI & strengthening synergies between GHI & Health systemsHealth systems

• To To setset national, regional, and global national, regional, and global policiespolicies to to strengthen strengthen the the synergysynergy

• To To seek strategiesseek strategies to address those to address those policies policies

Map of collaboration between the Map of collaboration between the GHIs & MOHME in IRANGHIs & MOHME in IRAN

Global Global Health Health

InitiativesInitiatives(Global Fund, WB,)(Global Fund, WB,)

Other GHIs?Other GHIs?

Ministry of Ministry of Health & Health & Medical Medical

EducationEducation

Improve Health OutcomesImprove Health Outcomes(In the area of (In the area of Major Health Issues Major Health Issues of the of the GlobeGlobe))

Two main factors, which influence the health Two main factors, which influence the health Outcome in Iran Outcome in Iran ((An Integrated Medical An Integrated Medical

Education & Health Care SystemEducation & Health Care System

Educational Educational Program Program

(Curricular (Curricular model) at model) at

Medical SchoolMedical School

Health Health Programs Programs

especially PHC especially PHC programsprograms

Health Care SystemHealth Care SystemM

anpower

Manpow

er

Processes

Processes

Problems arisen by backward-reasoning-based models Problems arisen by backward-reasoning-based models (Bolded items share in decreasing quality of health care)(Bolded items share in decreasing quality of health care)

HDR-basedHDR-based CurriculaCurricula

11

continuing continuing cyclical process)cyclical process)

55 Time consuming so Time consuming so inconsistent with inconsistent with

magnitude of clinical magnitude of clinical professors’ non-professors’ non-

educational educational responsibilitiesresponsibilities

22Burden of education on residents and Burden of education on residents and

FFCC by students FFCC by students (Residents see (Residents see interns as extra pairs of hands)interns as extra pairs of hands)

Long-lasting Long-lasting (slow) clinical (slow) clinical

inferenceinference

66Shortage of beginner Shortage of beginner

physicians’ physicians’ knowledge & skills knowledge & skills for clinical practicefor clinical practice

33

Diagnostic & Diagnostic & therapeutic errors therapeutic errors

by junior by junior physiciansphysicians

88

44

Long list of Long list of investigations, investigations,

procedures procedures and questionsand questions

99

Elongation of Elongation of clinical practice clinical practice

time for time for ambulatory ambulatory (rotation (rotation between between

different officesdifferent offices)) & inward patients & inward patients (Bed occupancy (Bed occupancy

time)time)

1010

Rising the Rising the country’s country’s

health care health care system system

expensesexpenses

1111

771212

1616

Medical students’ Medical students’ dissatisfaction dissatisfaction

(Attitude toward (Attitude toward curriculum)curriculum)

1717

Self-esteem Self-esteem loss loss

(avoiding to (avoiding to involve with involve with

patient)patient)

Medical Medical students’ students’

depression then depression then attrition or attrition or

changing field changing field of studyof study

1818

1818

Patients feel Patients feel junior junior

physicians’ physicians’ incompetence incompetence

and and dissatisfies dissatisfies then resist then resist

against them against them to acquire to acquire

skillsskills

1919

Increased Increased Morbidity & Morbidity &

Mortality Mortality rate rate

(decreased (decreased community community

health)health)

1313

1515

1414

UncoopUncooperative erative patientpatient

20202121

2121

Possible roles of GHIs in Possible roles of GHIs in strengthening the strengthening the programs in Health programs in Health

Systems Systems

Modern Modern Curricular Curricular model model at at

Medical SchoolsMedical Schools

Health Health Programs Programs

especially PHC especially PHC programsprograms

Health care systemHealth care system

More Competent Manpower

More Competent Manpower

Fostered programs

Fostered programs

IntegrationIntegration

Mate

rial (V

accin

es, m

edicin

es, e

tcM

ate

rial (V

accin

es, m

edicin

es, e

tc

GHIsGHIs

To To setset global global policies policies at the at the following domains:following domains:

• To To improve Health outcomesimprove Health outcomes , it is , it is necessary that GHIs:necessary that GHIs:

1.1.Have policies to restrict bans’ on Have policies to restrict bans’ on supplying the vaccines, medicines and supplying the vaccines, medicines and health products to all countries health products to all countries

Otherwise the health systems may be weakened and Otherwise the health systems may be weakened and communicable diseases expand in some countries, which is communicable diseases expand in some countries, which is

against IHR 2005against IHR 2005

To To setset global global policies policies at the at the following domains:following domains:

• To To improve Health outcomesimprove Health outcomes , it is , it is necessary that necessary that allall GHIs: GHIs:

2.2.Foster investments in the Public Health Foster investments in the Public Health ProgramsProgramsIt is necessary that all GHIs participate, e.g. recently WB It is necessary that all GHIs participate, e.g. recently WB has decided to disconnect collaborations with I.R. IRAN has decided to disconnect collaborations with I.R. IRAN

(IS Removing some GHIs is helpful in maximizing synergies (IS Removing some GHIs is helpful in maximizing synergies between GHIs & the Health System of the country ??!!)between GHIs & the Health System of the country ??!!)

To To setset global global policies policies at the at the following domains:following domains:

e.g. the fruitful collaboration of I.R. Iran & e.g. the fruitful collaboration of I.R. Iran & WB to prepare the NPP of Avian/Pandemic WB to prepare the NPP of Avian/Pandemic

Flu which is a global concern and not a Flu which is a global concern and not a national concernnational concern

To To setset global global policies policies at the at the following domains:following domains:

• To To improve Health outcomesimprove Health outcomes , it is , it is necessary that necessary that allall GHIs: GHIs:

3.3.Start investments in Development of modern Start investments in Development of modern Curricular Programs at Medical Schools Curricular Programs at Medical Schools

Thus, by benefiting the capacities of the medical schools Thus, by benefiting the capacities of the medical schools graduates in Public Health Programs, a huge & more competent graduates in Public Health Programs, a huge & more competent

Human resources will be added to PHC system and programsHuman resources will be added to PHC system and programs

To To setset global global policies policies at the at the following domains:following domains:

• To To improve Health outcomesimprove Health outcomes , it is , it is necessary that necessary that allall GHIs: GHIs:

3.3.Invest in integration of the modern Invest in integration of the modern Curricular Programs with PHC programsCurricular Programs with PHC programs

Thus, It will provide unique opportunities for medical Thus, It will provide unique opportunities for medical schools graduates to be trained in Public Health Setting and schools graduates to be trained in Public Health Setting and

PHC programs will be incorporated in medical schools PHC programs will be incorporated in medical schools curriculumcurriculum

StrategiesStrategies of I.R. IRAN to of I.R. IRAN to address those policiesaddress those policies

• PHC programs :PHC programs :

– To prepare a National Preparedness Plan to fight To prepare a National Preparedness Plan to fight Avian/Pandemic Influenza through collaboration with the Avian/Pandemic Influenza through collaboration with the World BankWorld Bank

– To run programs to fight Malaria, TB, HIV/AIDS through To run programs to fight Malaria, TB, HIV/AIDS through collaboration with “Global Fund”collaboration with “Global Fund”

– To run programs by national funds in the following To run programs by national funds in the following areas, which can be used by other regional countries areas, which can be used by other regional countries due to similar cultures :due to similar cultures :

• Women’s Health, HIV and STI prevention & care, Harm reduction in Women’s Health, HIV and STI prevention & care, Harm reduction in prisonsprisons

• Elimination program for MalariaElimination program for Malaria

• Safe Community : Safe Community : A selected strategy to prevent civil injuriesA selected strategy to prevent civil injuries

Other Suggested programsOther Suggested programs of I.R. of I.R. IRAN to address those policiesIRAN to address those policies

(based on Iran’s experiences in recent years)(based on Iran’s experiences in recent years)

• To To foster synergies foster synergies between Health between Health System of the countries and GHIs by the System of the countries and GHIs by the following actions:following actions:

– Develop modern Curricula for medical schools Develop modern Curricula for medical schools especially the fifth generation of curricular especially the fifth generation of curricular models (Clinical Presentation Curriculum, CPC)models (Clinical Presentation Curriculum, CPC)

– Integration of Health System with Medical Integration of Health System with Medical curriculumcurriculum

AcknowledgementAcknowledgement

• Prof. Peter H. Harasym (WHO Consultant)Prof. Peter H. Harasym (WHO Consultant)Dept. of Community Health Sciences, University of Calgary, CanadaDept. of Community Health Sciences, University of Calgary, Canada

• Dr. Mubasher SheikhDr. Mubasher SheikhWHO Representative in Iran, MOHMEWHO Representative in Iran, MOHME

• Dr. Bahram EinollahiDr. Bahram EinollahiDeputy Minister for Educational & Student Affairs, MOHMEDeputy Minister for Educational & Student Affairs, MOHME

• Dr Nader Momtazmanesh, MDDr Nader Momtazmanesh, MDDirector General, Medical Education Development Center, Undersecretary of Director General, Medical Education Development Center, Undersecretary of Educational & Student Affairs, MOHMEEducational & Student Affairs, MOHME

• Dr. Mohammed M. GooyaDr. Mohammed M. GooyaThe head of Center for Disease Control, Deputy Ministry of Health The head of Center for Disease Control, Deputy Ministry of Health Affairs, Ministry of Health and Medical EducationAffairs, Ministry of Health and Medical Education

• Dr. Mohammed H. NicknamDr. Mohammed H. NicknamDirector General, Dept. of International Affairs, MOHMEDirector General, Dept. of International Affairs, MOHME

Thank Thank you you

Questions ?Questions ?