1. Some Policies & Strategies for Maximizing Positive Synergies between Global Health Initiatives and Health Systems: The I.R. IRANs perspective By: Payman Hemmati, MD Ministry of Health & Medical Education I.R. IRAN Venice, Italy - June 22 nd, 2009 hemmatipayman@yahoo.com

2. The objectives of the High Level Dialogue: To improve Health outcomes through strengthening synergies between GHI & Health systems To improve Health outcomes through strengthening synergies between GHI & Health systems To set national, regional, and global policies to strengthen the synergy To set national, regional, and global policies to strengthen the synergy To seek strategies to address those policies To seek strategies to address those policies

3. Map of collaboration between the GHIs & MOHME in IRAN Global Health Initiatives (Global Fund, WB,) Other GHIs? Ministry of Health & Medical Education Improve Health Outcomes (In the area of Major Health Issues of the Globe)

4. Two main factors, which influence the health Outcome in Iran (An Integrated Medical Education & Health Care System Educational Program (Curricular model) at Medical School Health Programs especially PHC programs Health Care System Manpower Processes

5. Problems arisen by backward-reasoning-based models (Bolded items share in decreasing quality of health care) HDR-based Curricula Curricula 1 continuing cyclical process) continuing cyclical process) 5 Time consuming so inconsistent with magnitude of clinical professors non- educational responsibilities 2 Burden of education on residents and FFCC by students (Residents see interns as extra pairs of hands) Long-lasting (slow) clinical inference 6 Shortage of beginner physicians knowledge & skills for clinical practice 3 Diagnostic & therapeutic errors by junior physicians 8 4 Long list of investigations, procedures and questions 9 Elongation of clinical practice time for ambulatory (rotation between different offices) & inward patients (Bed occupancy time) 10 Rising the countrys health care system expenses 11 7 12 16 Medical students dissatisfaction (Attitude toward curriculum) 17 Self-esteem loss (avoiding to involve with patient) Medical students depression then attrition or changing field of study 18 18 Patients feel junior physicians incompetence and dissatisfies then resist against them to acquire skills 19 Increased Morbidity & Mortality rate (decreased community health) 13 15 14 Uncoope rative patient 20 21 21

6. Possible roles of GHIs in strengthening the programs in Health Systems Modern Curricular model at Medical Schools Health Programs especially PHC programs Health care system More Competent Manpower Fostered programs Integration Material (Vaccines, medicines, etc GHIs

7. To set global policies at the following domains: To improve Health outcomes, it is necessary that GHIs: To improve Health outcomes, it is necessary that GHIs: 1. Have policies to restrict bans on supplying the vaccines, medicines and health products to all countries Otherwise the health systems may be weakened and communicable diseases expand in some countries, which is against IHR 2005

8. To set global policies at the following domains: To improve Health outcomes, it is necessary that all GHIs: To improve Health outcomes, it is necessary that all GHIs: 2. Foster investments in the Public Health Programs It is necessary that all GHIs participate, e.g. recently WB has decided to disconnect collaborations with I.R. IRAN (IS Removing some GHIs is helpful in maximizing synergies between GHIs & the Health System of the country ??!!)

9. To set global policies at the following domains: e.g. the fruitful collaboration of I.R. Iran & WB to prepare the NPP of Avian/Pandemic Flu which is a global concern and not a national concern

11. To set global policies at the following domains: To improve Health outcomes, it is necessary that all GHIs: To improve Health outcomes, it is necessary that all GHIs: 3. Start investments in Development of modern Curricular Programs at Medical Schools Thus, by benefiting the capacities of the medical schools graduates in Public Health Programs, a huge & more competent Human resources will be added to PHC system and programs

12. To set global policies at the following domains: To improve Health outcomes, it is necessary that all GHIs: To improve Health outcomes, it is necessary that all GHIs: 3. Invest in integration of the modern Curricular Programs with PHC programs Thus, It will provide unique opportunities for medical schools graduates to be trained in Public Health Setting and PHC programs will be incorporated in medical schools curriculum

13. Strategies of I.R. IRAN to address those policies PHC programs : PHC programs : –To prepare a National Preparedness Plan to fight Avian/Pandemic Influenza through collaboration with the World Bank –To run programs to fight Malaria, TB, HIV/AIDS through collaboration with Global Fund –To run programs by national funds in the following areas, which can be used by other regional countries due to similar cultures : Womens Health, HIV and STI prevention & care, Harm reduction in prisons Womens Health, HIV and STI prevention & care, Harm reduction in prisons Elimination program for Malaria Elimination program for Malaria Safe Community : A selected strategy to prevent civil injuries Safe Community : A selected strategy to prevent civil injuries

14. Other Suggested programs of I.R. IRAN to address those policies (based on Irans experiences in recent years) To foster synergies between Health System of the countries and GHIs by the following actions: To foster synergies between Health System of the countries and GHIs by the following actions: –Develop modern Curricula for medical schools especially the fifth generation of curricular models (Clinical Presentation Curriculum, CPC) –Integration of Health System with Medical curriculum

15. Acknowledgement Prof. Peter H. Harasym (WHO Consultant) Prof. Peter H. Harasym (WHO Consultant) Dept. of Community Health Sciences, University of Calgary, Canada Dr. Mubasher Sheikh Dr. Mubasher Sheikh WHO Representative in Iran, MOHME Dr. Bahram Einollahi Dr. Bahram Einollahi Deputy Minister for Educational & Student Affairs, MOHME Dr Nader Momtazmanesh, MD Dr Nader Momtazmanesh, MD Director General, Medical Education Development Center, Undersecretary of Educational & Student Affairs, MOHME Dr. Mohammed M. Gooya Dr. Mohammed M. Gooya The head of Center for Disease Control, Deputy Ministry of Health Affairs, Ministry of Health and Medical Education Dr. Mohammed H. Nicknam Dr. Mohammed H. Nicknam Director General, Dept. of International Affairs, MOHME

16. Thank you Questions ?