Arch Iran Med. 2019;22(10): 592-605.
PMID: 31679362
Scopus ID: 85074401743
  Abstract View: 2705
  PDF Download: 3339


So Near, So Far: Four Decades of Health Policy Reforms in Iran, Achievements and Challenges

Leila Doshmangir 1,2, Mohammad Bazyar 3, Reza Majdzadeh 4,5, Amirhossein Takian 6,7,8*

1 Tabriz Health Services Management Research Canter, Department of Health Services Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
2 Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3 Department of Public Health, School of Public Health, Ilam University of Medical Sciences, Ilam, Iran
4 Knowledge Utilization Research Center, Community Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran
5 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
6 Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
7 Department of Health Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
8 Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
*Corresponding Author: Email: takian@tums.ac.ir


The Islamic revolution of 1979 in Iran emphasized social justice as a pillar for development. The fundamental steps towards universal equitable access to high-quality healthcare services began with the creation of the Ministry of Health and Medical Education (MoHME) and the nationwide establishment of primary healthcare (PHC) network in 1985. Now, in the 40th anniversary of the Islamic revolution, the history of health system development in Iran is characterized by constant policy changes; i.e. structural and procedural transformations. Ever since and despite the imposed 8-year war with Iraq and continuous unfair sanctions against the country, noticeable progress has been achieved in the health system that has led to better population health including among others: self-sufficiency in training health workforce; advances in public health and medical sciences; establishment and expansion of health facilities within the hard-to-reach areas aiming to enhance equity in access to needed healthcare services; domestic production of most medicines and medical equipment; and meaningful expansion of health insurance coverage. These have led to admirable improvement in public health indicators; i.e. maternal mortality, child mortality, life expectancy, and vaccination coverage. Despite achievements, there still remain challenges in health financing, protecting the public against high expenditure of medical care, establishment of referral system and rationalization of service utilization, provision of high quality healthcare services to all in need, and conflict of interest in health policy making, all of which may hinder the goal to reach “universal health coverage”, identified as the main goal of the health system in Iran by 2025. Recently, the MoHME began structural and functional reforms to boost societal efforts and enhance intersectoral collaboration to address social determinants of health, improve actions for prevention and control of non-communicable diseases and other social health problems. Drawing upon the World Health Organization (WHO)’s “six building blocks” model, this article presents an analytical description of the main health policy reforms during the last four decades after the Islamic revolution in Iran, divided by each decade. Learning from the historical reforms will create, we envisage, a better understanding of health system developments, its advances and challenges, which might in turn contribute to better evidence-informed policy making and sustainable health development in the country, and perhaps beyond.

Cite this article as: Doshmangir L, Bazyar M, Majdzadeh R, Takian A. So near, so far: four decades of health policy reforms in Iran, achievements and challenges. Arch Iran Med. 2019;22(10):592–605.
First Name
Last Name
Email Address
Security code

Abstract View: 2706

Your browser does not support the canvas element.

PDF Download: 3339

Your browser does not support the canvas element.

Submitted: 01 May 2019
Accepted: 16 Jun 2019
ePublished: 01 Oct 2019
EndNote EndNote

(Enw Format - Win & Mac)

BibTeX BibTeX

(Bib Format - Win & Mac)

Bookends Bookends

(Ris Format - Mac only)

EasyBib EasyBib

(Ris Format - Win & Mac)

Medlars Medlars

(Txt Format - Win & Mac)

Mendeley Web Mendeley Web
Mendeley Mendeley

(Ris Format - Win & Mac)

Papers Papers

(Ris Format - Win & Mac)

ProCite ProCite

(Ris Format - Win & Mac)

Reference Manager Reference Manager

(Ris Format - Win only)

Refworks Refworks

(Refworks Format - Win & Mac)

Zotero Zotero

(Ris Format - Firefox Plugin)