TEHRAN - Mohammad Shariati, associate professor at the Tehran University of Medical Sciences and former director of the national health network, believes that thanks to the expanded and efficient national healthcare system, not even one person is deprived of primary healt care (PHC) services.

In an exclusive interview with the Tehran Times, Shariati referred to the country’s public health coverage, saying that there is not a single person in Iran even in the most remote areas that do not have access to medical care services. 

“We provide all the population with primary health care and health services.

“In this regard, we established mobile team, through which customized vehicles travel to the heart of communities, especially remote areas, and provide prevention and healthcare services; They overcome barriers of time, money, and trust, and provide community-tailored care to the whole populations.

The villagers whose population is less than 500 and there is not a health center in the village, receive prevention and primary health care services from mobile teams, and can receive emergency services through 115, depending on the location or by ambulance or helicopter,” he explained.

“The other way to offer these services to the deprived populations is health clinics affiliated to universities of medical sciences that dispatch helicopters in case of any reports from rural areas, he added.

All universities of medical sciences are responsible to provide services to the whole remote areas or villages with few residents in their province,” Shariati noted.

Even during coronavirus pandemic, no one was left behind and we have provided millions of people with insurance coverage, even the deprived or the refugees, while in many developed countries there have been many patients who lost their lives on the streets being left untreated, he lamented.

He further said that but in comparison to other countries with full potential, income, technology advances, and numerous medical staff, Iran better handled the crises and provided treatment to all, despite U.S. sanctions and all restrictions.

All COVID-19 tests is free for those who need to be tested by a health care professional, he added.

Development of PHC network 

Referring to the network’s development, Shariati said that we always assess the need of society and improve the network procedures in line with the new standards and strategies.

The key point is that the network has made extensive changes in terms of urban areas coverage, although villages have always been the network’s priority.

With the implementation of the Health Transformation Program, the primary health care network in the suburbs was expanded and primary health care is provided to suburban residents free of charge.

Another important change in the network in recent years has been the addition of nutritionists and clinical psychologists to the health team, especially in the cities.

But the most significant of all was the national electronic health record (EHR) system in which every citizen is registered with the national ID number, which provides us with comprehensive health data on different fields.

However, the network must grow in different fields, including, achieving quantitative and qualitative standards, compliance with upstream laws and regulations, solving problems, and respond to current health needs, redesigning based on future conditions.

 EHR a unique experience

"Each person who refers to the health houses or health posts is registered in the system, in urban areas, over 95 percent of the population are registered and in rural areas, the number reaches up to 99 percent, because in villages all the residents refer to the health houses while it is less in metropolitan areas.

Although, almost it was believed that setting up an e-health record in PHC system is more difficult than building and equipping a hospital and developing treatment process because we wanted to set up an online system in villages where there was not even internet, and sometimes we had to first build a road.

However, we succeeded, and now only 2 percent of the population residing in remote areas may have not accessed the EHR system, and a few villages also are using the system offline.

The system could significantly help us in the successful implementation of the national campaign for controlling hypertension, which was taking the blood pressure of target groups, registering their information, and referring the patients to specialists held on May 17- June 6, 2019.

It once more came to help us in COVID-19 screening, and we could test those in remote areas and present certain data on the new cases across the country.

Countries that started e-health records much earlier than us had to work offline due to the technology of that time, but we did not go that route, and from the first day launched e-health records online", Shariati said.

Family Physician program to promote health and reduce unnecessary costs

The Family Physician Program was launched in 2005 in all villages and cities with a population of less than 20,000 people. Rural insurance funds were provided by the government. But the family physician program in cities with a population of more than 20,000 people for the first time in 2012 in Fars and Mazandaran provinces based on version 02 of the instructions of the family physician program and referral system by employing trained physicians and health care providers to provide comprehensive and continuous health services.

“The physician assumes medical coordination of care with other physicians for the patient with multiple health concerns, which reduces the unnecessary diagnostic and treatment processes along with reducing patient’s spending on treatment and care.

Because of the variety of medical services a family physician can provide a broad scope of expertise much less expensive than a specialty doctor. If a specialty doctor is necessary, family physicians can consult with a specialist.

Part of a family physician’s job is helping the patients navigate the increasingly more complicated healthcare industry.

When family physicians are covering the societies, hospital visits, emergency rooms, and surgical hospital visits are all lowered, which can help lower the cost of medical care within the communities.

Their preventive, as well as chronic care, can cause health growth in the country,” he explained.

Challenges facing health system

Pointing to the challenges to the health network expansion, he said that high reliance on hospitals, special practitioners, providing services based on the characteristics of the provider instead of paying attention to the needs of the people, lack of participation of physicians in the risk imposed and additional costs on the ward, therapeutic insurance instead of health insurance, and are the main challenges in on the development path.

"Insufficient attention of some managers to the issue of prevention and payment system for specialized services in the specialized services sector, which can lead to induced demand from the service provider is another challenge.

Another barrier to the expansion of health networks is a conflict of interest among some of the decision-makers.

Since the payment system for family physicians is based on Capitation Adjusted by Performance, there is no longer any reason for them to induce demand," he noted.

Such conflicts of interest threaten the quality of patient care, but family doctors can lead to the closure of many health facilities, and many financial ties that increase patient spending on treatment and bring the health centers high profit, he added.

The FP program is the largest socio-economic reform in any country, and its development requires government action, Shariati further highlighted.

PHC network full of knowledge and experience

Although it may seem very simple that two health care practitioners are offering primary health care to a limited population of villages, it is fully applied knowledge, thy use various procedures and analytical tools to generalize concepts to solve diverse problems and situations.

Many times that we were trying to find a solution for a specific condition or problem, we came to a conclusion that there is not been any research that can provide us with a fine answer, so we started conducting researchers to create the knowledge, which is simply used in the network infrastructure, he said.

Smart Health Network

Shariati went on to say that "We have designed a model called the Smart Health Network, which is a model for providing, maintaining, and promoting integrated health with a focus on the government, not just the Ministry of Health.

This model not only requires cross-sectoral cooperation but also a coordinated health approach in all sectors. 

According to this model, to promote personal health, people should be empowered and we should provide them with the necessary tools and facilities to achieve personal health promotion, while also providing them with a health-supportive environment.

Fighting risk factors alone is not enough, but we must also improve protective factors, health, vitality, and productivity.

The model suggests that instead of entering people's health data into the systems, data related to people's health must be extracted from the servers of various organizations automatically.

Instead of providing health services to people based on pre-determined health plans, we should design and provide the most appropriate services for the individuals.

All these personalizations are not possible but with the use of artificial intelligence, therefore, the vision, mission, goals, and tasks need to be redesigned.

This model proposes to integrate the information islands of organizations that are currently separated; it can lead to significant growth in health factors."

"The system works based on an integrated but distributed database, for instance, if a person refers to a health center and is diagnosed with a certain disease that needs a change in position or task, the system immediately informs the patient’s workplace and asks them to change his task.

If they resist doing that, the system will notice and announce the violation to the legal authorities and the company would be fined.

So, this is what we expect to happen for the country’s health network," Shariati concluded.

FB/MG