Health inequality in Iran ( IPhSA, Iran

BRIEF INTRODUCTION ABOUT THE MEDICAL AND PHARMACEUTICAL FIELD IN IRAN MODERN MEDICINE AND PHARMACY IN IRAN: A BRIEF HISTORY AMBASSADORS: MINA JABBARI, FATEME AKHAVAN, YOUNES VAEZPOUR IPHSA,IRAN

The pharmaceutical industry in Iran began in its modern form in 1920 when the Pasteur Institute of Iran was founded (1). In the field of drug production, Iran follows both USA guidelines and its own guidelines, which leads to the production of high quality and safe products. Iran has boosted scientific production in nanotechnology, biotechnology, biomedical engineering, bioengineering, biomaterials, and biophysics. For instance, the rankings of Iran were fourth in nanotech, 12th in biomedical engineering, ninth in bioengineering, and eighth in biomaterials in 2017 (2).

Iran is the first country in the East Mediterranean region that has the technical and scientific capability to export vaccines to various world countries (3).

In addition to the above, health, medical and pharmaceutical services in Iran are relatively well developed, and training doctors, pharmacists, and medical staffs who can serve the people of the country has always been one of the priorities. According to the ministry, 100% of urban and 98% of rural areas in Iran now have access to at least primary medical services (2).

Health inequality as an important Pharmacy Profession issue

Health care is recognized as a fundamental right in most countries (4). Pharmacists are an essential part of the healthcare system. The primary task of pharmacists is to monitor and ensure the medicine dispensing accuracy to patients as well as to provide pharmaceutical consultations to other clinical professions. Pharmacist collaboration and alignment with other healthcare professionals are expected to increase the productivity and optimal utilisation of health care services (5).

inflation rate and medical tariffs resulted in the majority of people not considering their health at the top of their priority list. So, the equal distribution of pharmacists in the country can help reduce drug-related morbidity and mortality, decrease the cost of services, and increase patient satisfaction (6).

The role of the pharmaceutical industries is providing the needs of the community by drugs with high quality, and suitable price (7). Some medicines are not currently manufactured domestically in Iran as their production is not economically justifiable because of low consumption. Financial and banking sanctions have limited the life-saving medicine trade, which harshly targeted the patients suffering from rare diseases (8).

Which Group of the population is most affected by health inequality?

Because economic problems and people's incomes directly affect health inequality, patients are one of the main victims of this issue. In fact, income inequality leads to inefficiency and the spread of injustice in the health sector. Population concentration in large cities can affect this issue both directly and indirectly. Economic sanctions have also had a significant impact in recent years. With the shortage of some drugs and medical equipment in Iran, physicians and pharmacists are faced with more restrictions on treatments.

On the other hand, the increase in the price of drugs has made the situation more difficult for patients and promotes health inequality on a global scale. Another issue is the small number of pharmacists and pharmacies in some provinces of the country. This issue affects both pharmacists and patients because it causes patients not to receive proper services, and also it makes pharmacists not be well used as an effective member of the health system. This inequality also exists in medical institutions, beds, and rehabilitation centers among the country's provinces, making things harder, especially for patients living in villages and small towns. (9,10,11,12)

What steps have been taken to solve this challenge?

Over the past years, various measures have been taken to address health inequalities, and because deprived areas and villages have fewer facilities and are considered more vulnerable, there has been a focus on equipping these areas. Among the measures taken, we can mention these items: Establishing medical centres, creating health insurance, Increasing hospital beds, the Presence of specialised doctors in these areas, etc. However, it is clear that these measures have not yet been able to address health inequalities across the country fully. There is a need for a comprehensive plan that can compensate for the shortage of health workers regularly and simultaneously and expand the quality of health care. The issue of economic sanctions also remains (13,14).

Who are the key stakeholders and have positive influences in this process?

1-MoHME (Ministry of Health and Medical Education), IMC (Iranian Medical Council) and basic health insurance organisations, 2- MCLSW (Ministry of Cooperatives, Labour and Social Welfare), Parliament Health Commission, and the Vice-Presidency for Strategic Planning and Supervision of the MoHME, 3special councils and public/private hospitals, 4- 17 supplementary insurance funds and smaller stakeholders. (15)

The Iranian government has made significant efforts to reduce health inequities through the establishment of a primary health care network (PHC). However, there is still a concern about fair access to health care (16). These deficiencies led the policymakers to adopt a reform known as the Health Transformation Plan (HTP). The most important goals of this program were reducing the Out of Pocket (OOP) and preventing referral of patients to centres outside the hospitals affiliated with the Ministry of Health for the purchase of medicines, laboratory and radiological equipment and services, strengthening special clinics, and promotion of outpatient care services, supporting the retention of physicians in deprived areas, etc. (17,18)

Most of the pharmaceutical companies in Iran are owned by the government. The Iranian government can help the pharmaceutical industry develop by putting some limitations on importing drugs, exempting some companies from paying customs toll and duties, providing tax exemptions and low-interest-rate loans for those research-centred companies.

Government can differentiate essential and strategic drugs from other products, modify insurance policies (such as leaving OTC drugs out of insurance list and putting national products on that list), adjust drug prices along with putting some incentive prices, and alter prescribing behaviours of doctors and encourage them to prescribe generic drugs (19).

References

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