Health system vision of iran in 2025.

BACKGROUND: Vast changes in disease features and risk factors and influence of demographic, economical, and social trends on health system, makes formulating a long term evolutionary plan, unavoidable. In this regard, to determine health system vision in a long term horizon is a primary stage.
METHOD: After narrative and purposeful review of documentaries, major themes of vision statement were determined and its context was organized in a work group consist of selected managers and experts of health system. Final content of the statement was prepared after several sessions of group discussions and receiving ideas of policy makers and experts of health system.
RESULTS: Vision statement in evolutionary plan of health system is considered to be :"a progressive community in the course of human prosperity which has attained to a developed level of health standards in the light of the most efficient and equitable health system in visionary region(1) and with the regarding to health in all policies, accountability and innovation". An explanatory context was compiled either to create a complete image of the vision.
CONCLUSION: Social values and leaders' strategic goals, and also main orientations are generally mentioned in vision statement. In this statement prosperity and justice are considered as major values and ideals in society of Iran; development and excellence in the region as leaders' strategic goals; and also considering efficiency and equality, health in all policies, and accountability and innovation as main orientations of health system.

Introduction

A health system consists of all the organizations, institutions, resources and people whose primary purpose is to improve health. Its goals are” improving health and health equity in ways that are responsive, financially fair, and make the best or most efficient use of available resources”(1).

Demographic and epidemiologic changes along social and economic conditions, has encountered health system of all developing countries with serious challenges which necessitates revision of health system and programs (2).

Poor equitable access to health-medical cares, controlling ever-increasing costs of supplying services and financial risk protection of recipients, extensive and effective care systems and appropriate stewardship of health system, are some health system challenges particularly in developing countries (3).

Health system of Iran has experienced some developments in response to changes, the most important of which is establishing health networks and integrating educational system in health care system having important accomplishments after the Islamic Revolution (4–6). However, health system in Iran like other countries is faced with growing changes in socio-economic dimensions and additionally conversion of disease burden from communicable to non-communicable diseases. At present, accidents, cardiovascular diseases, cancers, and mental disorders are the highest rank in burden of disease (7); rising of health costs, non-coverage of major costs by insurance, incomplete coverage of Primary Health Care (PHC) networks in urban areas, lack of referral system and fragmentation of policy making foci, are some important challenges of the health system in Iran (4,5,8,9).

Changing community health needs on the basis of social and economic evolutions, made stewards of health system to compile a long term program in Iran’s health system with an anticipatory and reformatory look. One of the first steps in this direction is determining vision of the health system. Vision includes giving a favorite image and accessible ideal which prepares a long term outlook before general management of the society and is characterized as holistic, futuristic, value-oriented, and realistic (10). It can create the conditions to meet the imagined future by reinforcing common understanding and promoting social capital and declaration of upcoming goals (11).

In this study we attempted to compile vision statement of Iran’s health system evolutionary plan of 2025 utilizing strategic ideas of key decision makers, and experts of health system; and considering values and ideals of the Islamic society.

Method

This study is an action research in health system. According to previous studies and programs related to characteristics of ideal health system in the future, the study was planned in two stages, narrative review of these documentaries and receiving experts’ ideas. Purposeful sampling was applied to choose individuals and a workshop was formed. In this work shop participants in two groups presented those subjects and themes which had to be considered in health system vision using brainstorming technique.

After eliminating repeated cases and merging options, 52 criteria obtained which were categorized in 6 groups on the basis of concept similarity and group discussion; and participants were requested to prepare suggested context of vision statement according to attained criteria. After studying presented cases and integrating them, initial edit of the vision statement was carried out.

The documentary was e-mailed to the nominated experts of health system. It also was presented in numerous sessions of Ministry of Health and Medical Education (MOH&ME) policymaking council, high council of Academy of Medical Sciences, meeting of representatives from MOH&ME departments and representatives of different universities and also, work group for compiling “health system evolutionary plan of 2025”.

After studying received comments and suggestions and regarding abundance of given, proposed changes were implemented in every stage, and feed backed to members of initial work group and the other contributors to receive their comments In order to observe ethical issues, all recorded voices, written ideas, and sent e-mails were kept by project executive and individuals’ direct or indirect quotations were not used at all.

Results

The compromised vision for health map of Iran in 2025 is as follows:

“A progressive community in the course of human prosperity which has attained to a developed level of health standards in the light of the most efficient and equitable health system in visionary region and the regarding health in all policies, accountability, and innovation.”

In 2025, Iran possesses a healthy and powerful community to accomplish the vision. Enjoy health literacy (The ability to use and analyze information and required health services to consciously decide and select their health care opportunities), people are faced with least level of risk from health treats in a healthy environment, society and families following a healthy life style based on Islamic-Iranian doctrines and also man’s new scientific achievements. In this society there exists the highest level of social, economic, and cultural health protectors and a desirable level of social capital.

Being responsible and accountable, Iran’s health system in 2025 is completely reliable by people since has achieved the highest level of healthy life expectancy and for all people, and executes “health in all policies” approach with support of all organizations and institutions. Giving priority to health promotion and prevention approaches, the system embarks on people’s enjoyment of effective physical and mental health care, regarding social health, and moving towards spiritual health. Equity in all aspects (in supplying and distributing resources and fulfilling health) and absolute compliance with codes of professional ethics and principles is a basic principle. All people will benefit health care according to their needs and participate in financing based on their ability to pay. This creative system makes the best decisions to fulfill actual health needs using reliable evidences and maximum benefit from all capacities including social participation, organizational contribution (cooperation of all stakeholders), scientific and technological progresses, in a way that through international communications and interaction with regional countries (particularly Islamic countries) creates an inspiring model for other countries.

Discussion

In this action research, it was attempted to consider ideas of health system stakeholders and contribution of experts during different stages. In order to compile the vision statement, near 1000 person-hours participated in group discussion, expertise consultation, and discussion in workgroups have contributed. Eventually we were saturated with comments after receiving those ideas which were related only to editing sentences.

During this study ideas of two groups, experts and policy makers, were systematically investigated while opinions of lay people and general public were less paid attention to; even though review of the Iran’s institutional law and cultural and religious literature which is believed as reflection of society’s reasonable values, were taken into consideration at the stage of reviewing documentaries.

Vision statement in general, consisted of a few clear and explicit sentences, is a description of social values and ideals, leaders’ strategic objectives, and strategists’ creativity and their recommended orientations; and is composed so as to show a meaningful relation between challenges, aims, existing requirements, and upcoming image (12). The vision of some studied countries is presented in Table 1.

Table 1:

Health system vision in selected countries

Country	Vision
Bahrain 2002–2010	“The Ministry of Health works in partnership with stakeholders to improve the health of the population of Bahrain and ensure that everyone has access to a high quality, responsive health service throughout their lifetime (13)”.
Saudi Arabia 2010–2020	“An efficient, effective, and sustainable 2020 Saudi health system would embody: an effective policy-making structure, policies to maximize population health status, equitable and efficient financing, cost-effective health spending, a cost-effective service delivery system, and an appropriate public-private mix of services(14).”
Cambodia 2003–2007	“all people in Cambodia, of whatever gender, age, place of residence or ability to pay, should have equal access to good-quality, basic and essential specialized health services, staffed by competent health professionals, and at a cost people can afford; that they should have information that empowers them to make informed choices about matters affecting the health and well-being of themselves and their families” (15).
Zambia 2006–2010	“provide the people of Zambia with equity of access to cost-effective, quality healthcare as close to the family as possible”(16).
US 2007–2012	“Healthy and generating Individuals, families, and communities constitute the basis of US present and upcoming security and success. Through leading medical sciences plans, public health, and human services, MOH will improve health and welfare of all Americans throughout the world “(14).
Norway 2005–2025	“Health East shall provide good and equal health services to all who need them, when they need them, regardless of age, domicile, ethnic background, gender and economy” (17).

Main core of these statements is achievement of best health indicators with a futuristic view and what is emphasized for approaching this vision is equitable access, fair financial contribution, and satisfaction. It seems that what is introduced by WHO as ultimate goals of health systems are considered in composing long term health system vision (18).

This issue has been regarded in compiling vision of Iran’s health system too. What is considered in this statement is organizing an equitable, best health system in visionary region which its main orientations are efficiency, accountability, health in all policies and innovation. These orientations have been stated in” Iran’s Health Innovation and Science Development Plan by 2025” too which is another long plan focus on science and technology (19).

Since the “health system evolutionary plan” lies in the same direction as Iran’s vision document whose main criterion is excellence in visionary region (20), accessing a developed level of health indicators and superiority of health system in the mentioned region have been considered as strategic view of health system governors (Fig. 1). In addition, from the Islamic view and in Iranian social value, human prosperity is the ultimate goal of all social systems which is deemed to be perfection of human being capacity in the shadow of closeness to God (21).

Fig. 1:

Component Of Visionary Statement In Health System Vision of Iran In 2025

In this way, vision statement of” health system revolutionary plan in2025”, is based on strategic orientations of health system experts, which is compatible with governors’ strategic goals and social value and ultimate goal of Islamic community namely prosperity and attaining entity in the shadow of Divine esteem.

Ethical considerations

Ethical issues (Including plagiarism, Informed Consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc) have been completely observed by the authors.