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Integration in health system
1. Education as an Integrated Function in
Ministry of Health and Medical
Education
Dr. Shahram Yazdani
2. Over the past two decades, significant
steps were taken to improve the quality of
health care delivery in Iran.
One major step was the stepwise
integration of medical education into
health services.
3. Early Years after Islamic Revolution
In early years after Islamic revolution, the
need for greater medical workforce was
critically felt because in some area there
was only one physician per 18,000
population, and that was why foreign
doctors were on the ground to render
medical services.
In addition, medical students were trained
in specialized hospitals with no affiliation
to the health care ministry and society.
4. The 1985 Reform
In 1985 The Parliament of the I.R.Iran
approved of the law integrating medical
and health education with the health
services forming the Ministry of Health and
Medical Education
Within this context, the main mission of
the Ministry of Health, Treatment and
Medical Education, set out in 1985, has
been to upgrade the quality of the health
care system of the country in the areas of
health, treatment, education and research.
5. The 1985 Reform
In terms of health, the aim was to improve the
overall health index. In terms of education,
the aim was to have an increase in medical
and paramedical student enrolment in the
universities to provide the necessary health
manpower.
It also included the revision of the curriculum
of undergraduate and postgraduate courses,
based on community needs. In terms of
treatment, there had to be an upgrade in the
quality of medical care services as well as a
better distribution of medical services over
the country.
6. The 1993 Reform
In 1993 The Supreme Council of
Government Administration declared the
integration of all Provincial Health
Organizations into the Universities of
Medical Sciences present in the province
and the outcome was the Province
University of Medical Sciences and Health
Services
7. The 1993 Reform
In 1995 a ministerial decree approved that
in each province the existing university of
Medical Sciences take over all
educational, research and health services
activities
8. Objectives of Integration
To improve the quality of community
oriented medical education
To improve the quality of health care
services
To decentralize
To utilize the resources of the provinces for
establishing new teaching bases
To support newly established universities
To increase the patient capacity of hospitals
To unify management and decision-making.
To expand research activities.
9. Organizational Changes
In organizational terms the integration is
expressed at the central level in the dual
role of the Minister and then the existence
of Deputy Ministers for both Education and
University Affairs and Health.
At the provincial level it is the role of the
Chancellor of the Universities of Medical
Sciences and Health Services to integrate
the two functions.
10. Organizational Changes
It should be said that in international
terms, such functional integration is far
from being common.
Medical universities and faculties are
usually under a formal relationship with the
Ministry of Education but enjoy a special
relationship with the government health
services.
11. Universities of Medical Sciences and Health
Services
As an important point, Article 29 of the
Constitution of the Islamic Republic of Iran
emphasizes that every Iranian has the right to
enjoy the highest attainable level of health.
The Ministry of Health and Medical Education
is mandated to fulfill this goal through
designing and implementing a national-level
health policy.
Yet, the Ministry of Health and Medical
Education delegates its implementation to
medical universities across the country.
12. Universities of Medical Sciences and Health
Services
There is at least one medical university in
every province.
The president of a medical university is the
highest health authority in the province who
reports to the Minister of Health and Medical
Education.
The president of the medical university is in
charge of public health, health care provision
in public facilities, and medical education.
Health care and public health services are
provided through a nation-wide network
19. Sub-functions of Resource Creation
Provision
Stewardship
Finance
Resource
Creation
Research
Innovation &
Industry
Education
20. Different Levels for Each Sub-system
Clinical Services Public Health Education Innovation
Policy Policy Policy Policy Policy
Administration Administration Administration Administration Administration
Operation Operation Operation Operation Operation
Research
21. Operation Operation Operation Operation Operation
Administration Administration Administration Administration Administration
Vertical Integration within Each Sub-system
Clinical Services Public Health Education Innovation
Policy Policy Policy Policy Policy
Research
Vertical
Integration
Policy
Regulatory
Standard Performance
Monitoring
Governing
Levers
Aligned
Operation
22. Horizontal Integration Between Sub-systems
Operation
Administration
Education
Policy
Horizontal
Integration
Communication
Cooperation
Coordination
Collaboration
Structural Integration
Operation
Administration
Public Health
Policy
Operation
Administration
Policy
Research
Operation
Administration
Clinical Services
Policy
Operation
Administration
Innovation
Policy
23. Horizontal Integration Between Sub-systems
Horizontal
Integration
Operation
Administration
Education
Policy
Communication
Cooperation
Coordination
Collaboration
Structural Integration
Operation
Administration
Public Health
Policy
Operation
Administration
Policy
Research
Operation
Administration
Clinical Services
Policy
Operation
Administration
Innovation
Policy
Throughout The
Cross-organizational
or Cross-boundary
Processes
27. Project Steps
Listing Main Processes in MOHME & UMS
(more than 500 processes)
Selecting Main Cross-organizational and
Cross-boundary processes (more than
150 CO&CB Processes
28. Research Sub-system: CO&CB Process
Feedback of health system to academy about research
needs
Involvement of health system in the process of research
priority setting in academy
Research on policies of health system in academy
Research on management (administration) of health
system in academy
Funding of academic research by health system
Joint research projects and corporate R&D by academy
and health system
Knowledge management (appraisal, synthesis and
customization) by academy for health system usage
Utilization of new academically generated knowledge by
health system
29. Innovation & Industry Sub-system:
CO&CB Process
Role of academy in protecting intellectual property (e.g. patent office)
Venture nurturing activities and units in academy (Searching for ideas
that can be commercialized, creating fertile ground for spin-off activity,
protecting the technology base, business coaching, and facility
management)
Science and technology parks, business parks
University consultancy and contracting services
Knowledge brokering in academy
Knowledge purveyering in Academy
Supply of scientific and technical services to third parties (business
sector and public administration)
Diffusion of information, knowledge and technology towards economic
and public operators acting at the interface between suppliers and
users. (Innovation centers and liaison units at universities)
Technology Policy making (technology assessment offices)
Diffusion of scientific culture through science museums, science
centers
30. Education Sub-system: CO&CB Process
Involvement of academy in community needs
assessment
Involvement of academy in workforce planning
Involvement of academy in service gap analysis
Defining and approving new educational programs
according to community needs
Community orientation (alignment of objectives and
content with community needs) in academic educational
programs
Community based (authentic educational settings) in
academic educational programs
Continuous education of providers or producers by
academy
Continuous professional development of providers or
producers by academy
31. Provision Sub-system: CO&CB Process
Academy role in Setting standards and
norms of services
Academy role in Licensure and
certification of providers
Academy role in Distribution of workforce
Academy role in Monitoring and control of
service performance or quality
Academy role in Coordination of services
32. Project Steps
Listing Main Processes in MOHME & UMS
(more than 500 processes)
Selecting Main Cross-organizational and
Cross-boundary processes (more than
150 CO&CB Processes
Identifying main interventions to improve
integrity of Cross-organizational and
Cross-boundary processes (more than
300 interventions)