Education as an Integrated Function in Ministry of Health and Medical Education

Dr. Shahram Yazdani

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.

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.

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.

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.

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

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

Objectives of Integration

To improve the quality of community oriented medical education

To improve the quality of health care servicesTo decentralizeTo utilize the resources of the provinces for

establishing new teaching basesTo support newly established universitiesTo increase the patient capacity of hospitalsTo unify management and decision-making.To expand research activities.

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.

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.

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.

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

Functional Integration in Health System through Cross-boundary

Process Management

Main Functions of Health System

Provision

Stewardship Finance

Resource Creation

Sub-functions of Stewardship

Provision

Stewardship

IntersectoralLeadership

IntrasectoralGovernance

Policy Making

Finance

Resource Creation

Sub-functions of Provision

ProvisionClinical

Care

Health Risk Factor Management

Social Determinants

of Health

Stewardship Finance

Resource Creation

Sub-functions of Finance

Provision

Stewardship Finance

Pooling

RevenueGeneration

Purchasing

Resource Creation

Sub-functions of Resource Creation

Provision

Stewardship Finance

Resource Creation

Research

Innovation &Industry

Education

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

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 IntegrationPolicy

RegulatoryStandard Performance

Monitoring

GoverningLevers

AlignedOperation

Horizontal Integration Between Sub-systems

Operation

Administration

Education

Policy

HorizontalIntegration

Communication

Cooperation

Coordination

Collaboration

Structural Integration

Operation

Administration

Public Health

Policy

Operation

Administration

Policy

Research

Operation

Administration

Clinical Services

Policy

Operation

Administration

Innovation

Policy

Horizontal Integration Between Sub-systems

HorizontalIntegration

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

Cross-Organizational & Cross-boundary Processes

Education

Intra-organizational Process

Cross-Organizational & Cross-boundary Processes

Education

Cross-organizational Process

Cross-Organizational & Cross-boundary Processes

Research

Education

Cross-boundary Process

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

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

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

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

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 workforceAcademy role in Monitoring and control of

service performance or qualityAcademy role in Coordination of services

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)