Who Would Be the Ideal Minister to Run the Current Health System of Iran?

In the course of progress toward achieving universal health coverage in the new term of President Rouhani, the health system of Iran will face with several challenges that have to be appropriately addressed. Sustainable financing, good governance, and comprehensive and fair health service delivery are examples of such challenges. A key issue is, therefore, who as a minister of health is qualified for this position? In this editorial, we answer this question based on the challenges that our health-care system has to go through and the criteria that have to be considered to deal with these challenges.

Introduction

Selecting the most appropriate person to govern the Ministry of Health and Medical Education (MOHME) is one of the most crucial decisions that the new government of Iran has to take. In our opinion, there are at least three major reasons why this decision is important. First, the health system of the country is still disunified[1] and needs strong coordination of a variety of sectors, including sectors whose first priority is not peoples’ health. Second, the last decades’ experiences show instability in the decisions made by the health-care system.[2] Hence, the knowledge that exists within the health-care organizations is not substantial and cannot be handed over to future members of these organizations. And last, but not least, the implementation of policies is quite weak and highly dependent on the leadership.[3]

Iran's health system has been experiencing some extent improvement toward health care, being strengthened by implementing one of the most prominent social plans (called Health Transformation Plan [HTP]) during the presidency of Mr. Hassan Rouhani (the 11th president) over the past 4 years. According to the World Health Organization HTP evaluation group,[4] an opportunity has been created to speed up the process for health care toward universal health coverage. Nevertheless, the health system still suffers from some challenges that, if not solved, would regress the health system to the unfavorable situation that it was in at the beginning of the 2010s. It is a crucial time for tough decisions to be made by the right person with special leadership and managerial skills.

Thus, the question is “what should be considered to select the best option for the minister of MOHME?” In order to answer this question, we will explain what challenges our health-care system has to go through, which should be addressed by the next minister of MOHME. Then, we will point out the criteria required for a minister of MOHME to deal with these challenges.

The Challenges of Iran Health System

The health system of Iran is now dealing with three challenges: sustainable financing, good governance, and comprehensive and fair health service delivery.

Sustainable Financing

Fortunately, in light of the many efforts made to set health as the priority of the government, there has been a significant increase in the health budget. However, there is ample evidence to suggest that it is now important to determine how this money should be spent. This issue is widely referred to in policy discussions, and in some cases, it can play a valuable role in advocating for greater investments in the health sector budget.[5] Hence, the next minister of MOHME must be sagacious in seeking innovative ways to spend the allocated resources more efficiently, put her/his priority to manage, and control the health expenditure in regard to safety and quality of health services, and have a comprehensive plan to contain health expenditure and increase the efficiency of the health system. All these together will accelerate achievement of the goals of the health system. Furthermore, making the health system more efficient will be a substantial movement to implement a resilient economic development in the country.

Good Governance

The stewardship role of the MOHME has been underlined more than at any time by the announcement of mega health policies, endorsed by the Supreme leader of Iran, and the 6th National Development Plan. These policies have clearly stated what should be done to strengthen this role of the MOHME. With respect to this clarification, it is expected that the next minister of MOHME can recognize the importance of good governance and leadership, which are prerequisites for achieving sustained development.[6] Furthermore, she/he should create multisectoral strategies and public-private partnerships for sustainable health. Hence, it is demanded that she/he should actively keep strong and powerful stakeholders engaged in health issues. In this regard, improving the health policy-making process through active stakeholder participation and proper use of evidence, upgrading the mechanisms of oversight and supervision of the health market, and defining a clear and on-time responsiveness system should be well addressed in the proposed plan of the next minister of MOHME. These all will make the health system enable to delegate operational and administrative responsibilities to peripheral departments and focus more on strategic issues. It is also important to consider that strengthening the stewardship role of the MOHME not only depends on constructive interaction with different health stakeholders but is also related to the personal characteristics of the minister and her/his leadership style. Hence, the next minister of MOHME needs to be a strong and charismatic leader, who can inspire health actors to respect and trust each other and play her/his mentorship and advocacy role well.[78]

Comprehensive and Fair Health Service Delivery

Regarding the experience of establishing a health network and following a qualitative and quantitative increase in health inputs (health workforce, health facilities, and information infrastructure), we believe that it is time to invest more in improvement of the service delivery processes. This improvement should be concentrated on ensuring the delivery of required health services with respect to continuity, comprehensiveness, and quality of health care, for the lowest price with the highest effectiveness in the shortest time. Since such improvement needs the full participation of the key process owners from different departments and levels inside the MOHME, any attempt in this regard calls for internal coordination, especially between primary health care and hospital care. Hence, it is suggested that the next minister of MOHME should consider some strategies to attract the active participation of the process owners (e.g., establishing contingency structures or committees, cultivating team working), resulting in a synergy that can be very productive to meet health needs.

The Next Minister

According to the above challenges and strategic priorities, we propose the following specific selection criteria, besides general qualifications, that must be considered for the next health minister:

political maturity and acumen to assess and balance various health-related interests[9]

diplomatic skills to identify and select competent collaborators from different disciplines and to organize multidisciplinary working teams[910]

credibility with health advocates[9]

no conflicts of interest[10]

deep knowledge and understanding of the way the ministry, and the government at large, is working,[1011] especially with regard to its economic and social aspects[8910]

sufficient experience in working inside the health system[11]

having a comprehensive system of thought and vision to look at health in its entirety.[8912]

It should be kept in mind that the next minister of MOHME should not only be close to the plans and policies of the 11th government but also be involved in executing them. She/he must be aware of the previous plans, and try hard to eliminate defects and continue moving toward strengthening the health system by creating further health reforms. Now, the middle managers who have been executing the reform policies and plans should document all the processes and determine the health priorities and deliver them to the next minister. It must be done so that the next minister can at least follow the objectives in a shorter time toward improving global health by using sufficient and up-to-date information. It is hoped that by selecting the right candidate to assume the MOHME responsibilities as a health minister, we will have an enhancement in the health sector and consequently, a help to the government in fulfilling its mission.