The document discusses the integration of education and health services in Iran through the Ministry of Health and Medical Education (MOHME). Some key points: - In 1985, a law was passed integrating medical and health education under MOHME to improve healthcare quality. This led to increased enrollment, curriculum revisions, and upgraded care services. - In 1993, provincial health organizations were integrated into universities of medical sciences to decentralize and expand teaching bases and services. - The objectives of integration were to improve community-oriented education and healthcare quality, decentralize services, establish new teaching bases, and increase research activities. - Integration occurs through dual roles at the central level and chancellors overseeing education and services at

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

14. Functional Integration in Health
System through Cross-boundary
Process Management

15. Main Functions of Health System
Provision
Stewardship
Finance
Resource
Creation

16. Sub-functions of Stewardship
Provision
Stewardship
Intersectoral
Leadership
Intrasectoral
Governance
Policy
Making
Finance
Resource
Creation

17. Sub-functions of Provision
Provision
Clinical
Care
Health
Risk Factor
Management
Social
Determinants
of Health
Stewardship
Finance
Resource
Creation

18. Sub-functions of Finance
Provision
Stewardship
Finance
Pooling
Revenue
Generation
Purchasing
Resource
Creation

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

24. Cross-Organizational &
Cross-boundary Processes
Education
Intra-organizational Process

25. Cross-Organizational &
Cross-boundary Processes
Education
Cross-organizational Process

26. Cross-Organizational &
Cross-boundary Processes

Research
Education
Cross-boundary Process

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)