Transcript NCDs: from treatment down to prevention

WHO Collaborating Centers In Iran
meeting with WHO Colleagues
June 4,2014
Reza Malekzadeh M.D
Professor of Medicine
Deputy for Research and Technology
MOHE IR Iran
1
WHO Collaborating Centres
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Digestive Disease Research Institute, TUMS
Endocrinology & Metabolism Research Institute, TUMS
Research Centre for Diseases of Ear, Nose Throat, IUMS
Mental Health Research Centre, IUMS
Centre for Nursing Care Research, IUMS
National Research Institute of Tuberculosis and Lung Disease, SBMU
Community Oral Health Department, School of Dentistry, SBMU
Ophthalmic Research Centre, SBMU
Tobacco Prevention and Control Research Centre, SBMU
Educational Development Centre, SBMU
Isfahan Cardiovascular Research Centre, MUI
Regional Knowledge Hub for HIV/AIDS Surveillance, KMU
National Public Health Management Centre, TBZMED
Rabies Research Department, Pasteur Institute of Iran, MOHME
Reference Health Laboratories, MOHME
Iranian Blood Transfusion Organization (IBTO)
WHO Collaborating Centres
Pending Status
1. National Nutrition and Food Technology Research Institute, SBMU
2. Research Institute for Endocrine Sciences, SBMU
3. Scientific Publication and Information Development Center, MOHME
Proposal for designation as WHOCC
1. National Institute of Health Research, TUMS
2. Institute for Environmental Research, TUMS
3. Safety Promotion and Injury Prevention Research Centre, SBMU
4. Toxicological research Centre, SBMU
5. Health Policy Research Centre, SUMS
6. Occupational Health Research Centre, IUMS
7. Institute for Futures Studies in Health, KMU
8. Malarial and Vector Research Group, Biotechnology Research
Centre, Pasteur Institute of Iran
9. Reference Food and Drug Laboratories, FDO
10. Noor Ophthalmology Research Centre
WHO Collaborating Centres
Potential Centres Candidates
1. Centre for Research and Training in Skin Disease and Leprosy,
TUMS
2. Sina Trauma and Surgery Research Centre, TUMS
3. Growth and Development Research Centre, TUMS
4. Psychiatry and Psychology Research Centre, TUMS
5. Food Security Research Center, MUI
6. Zahedan Health Promotion Research Centre, ZAUMS
7. Liver and Gastrointestinal Diseases Research Centre, TBZMED
Health in the
Islamic Republic of Iran
May 2014
6
Global Burden of Disease (GBD) Study Iran, 2010
Archives of Iranian Medicine May 2014
special ISSUE
7
History of GBD
• GBD is the largest study on health at global, regional,
and national levels
• GBD has been started since 1990 with collaboration of
486 researchers from 302 research center in 50
countries
• Methodologically, GBD is a systematic review of all
published and unpublished data at national levels in
188 countries from 1990 to 2010
• In GBD, novel statistical methods have been used to
estimate prevalence of diseases and risk factors in
places and times where no data is available
Main Features of GBD
• Innovation of indicators that make possible the comparison of
burden of diseases between different countries, in different
regions, and different time frames
• Innovation of indicators that measure not only diseases (289
diseases) and risk factors (67 risk factors), but also health, quality of
life, and disability
Epidemiological Transition
• In developing countries, a trend from
communicable diseases to non-communicable
chronic diseases has been observed
• The epidemiological transition is an evident
sign of development in a developing country
10
GBD 2010 Iran
• Burden of 67 risk factors and 291 diseases for
three time points (1990, 2005, and 2010)
during the last 20 years in Iran*
• The obvious finding is a shift away from
premature death to years lived with disability
and from infectious and communicable
etiologies to chronic non-communicable
diseases (NCDs)
*AIM 2014 May
11
Two Decades increase in Life
expectancy
• Despite post revolution conflicts, an 8-year
war, tight economic sanctions by Western
countries, and multiple earthquakes over the
last three decades:
• Life expectancy increased by 22 years for
women and 21 years for men
12
GBD Results 2010
• Total number of deaths in 2010 in Iran: 351,814
• Deaths in men in 2010: 223,768
• Deaths in women in 2010: 128,045
• Transport accidents have been the main causes of YLL
NCDs in global scale
Causes of death, 1990
Non_communica
ble Diseases
8.8%
34.1%
Causes of death, 2010
57.1%
Communicable
Diseaes
Injuries
9.6%
24.9%
65.5%
GBD 2010
14
NCDs in Iran
Causes of death, 1990
22.0%
57.2%
26.8%
Causes of death, 2010
Non_communica
ble Diseases
Communicable
Diseaes
Injuries
9.2%
14.4%
76.4%
GBD 2010
15
Main NCDs in Iran
Fatal Diseases
Non-fatal disabling Diseases
1)
2)
3)
4)
5)
6)
1)
2)
3)
4)
5)
GBD 2010
Ischemic Heart Disease
Stroke
Hypertension
Diabetes
Transport accidents
Cancers
Mental Diseases
Musculoskeletal Diseases
Diabetes
Transport accidents
Chronic Respiratory
Diseases
6) Unintentional Injuries
16
Main causes of death in men in Iran, 2010
Other cardio &
circulatory
5%
Congenital anomalies
2%
Preterm birth
complications
1%
Lung cancer
2%
Lower respiratory
infections
2%
Ischemic heart
disease
26%
Stroke
10%
COPD
2%
Stomach cancer
2%
Hypertensive heart
disease
3%
Road injury
10%
Diabetes
2%
Other
33%
GBD 2010
17
Main causes of death in women in Iran, 2010
Congenital anomalies
3%
Preterm birth
complications
2%
Other cardio & circulatory
6%
Urinary diseases
2%
Ischemic heart
disease
25%
Lower respiratory infections
3%
Stroke
12%
Hypertensive heart
disease
4%
Other endocrine
2%
Diabetes
3%
Stomach cancer
2%
Road injury
4%
Other
32%
GBD 2010
18
Main causes of disability in men in Iran, 2010
Transport
Accidents: 3%
Unintentional
Events: 4%
Other: 17%
Mental Diseases:
28%
Chronic Respiratory
Diseases: 6%
Neurological
Diseases: 5%
Nutritional
Disorders: 5%
Musculoskeletal
Diseases: 25%
Diabetes: 7%
GBD 2010
19
Main causes of disability in women in Iran, 2010
Transport
accidents: 1%
Unintentional
Events: 2%
Chronic
Respiratory
Diseases: 5%
Others: 15%
Mental Diseases:
30%
Neurological
Diseases: 5%
Nutritional
Disorders: 7%
Musculoskeletal
Diseases: 26%
Diabetes: 8%
GBD 2010
20
Factors Influencing the Epidemiological
Transition
•
•
•
•
•
Increased Literacy Rate
Modernization
Increased Urbanization
Increased Socio-Economical Status
Change in life style towards Western Style
AND
• The efficiency of the health system in prevention
and control of communicable, maternal, and
neonatal diseases and nutritional disorders
21
Achievements of Health System in Iran
• Increased life expectancy at birth by 22 years despite war,
earthquakes, and economical sacntions
• Decrease in mortality rates in all ages
• Decrease in mortality rates among children under 5 years old
• Decrease in maternal mortality rates
• Decrease in fertility rates
Ministry of Health and Medical Education
22
Achievements of Health System in Iran
• The percentage of iodinated salt surpasses 95%
• The vaccination coverage of BCG, DPT, Polio, MMR, and
hepatitis B surpassed 99%
• Polio is eradicated
• The prevalence and incidence of main communicable
diseases including malaria, typhoid, and tuberculosis
has decreased
Ministry of Health and Medical Education
23
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Deaths per 1000 live births
Decreased Inequality in Under 5 Mortality Rate from
1981 to 2011
180
160
140
120
100
80
60
40
20
0
Farzadfar et al unpublished
24
The Trend in Control of Malaria from 1994 to 2012
Number of reported cases (thousands)
80
70
60
50
40
30
20
10
0
Ministry of Health and Medical Education
25
Trend in Control of Typhoid from 1962 to 2010
Ministry of Health and Medical Education
The Trend in Incidence of Tuberculosis
Ministry of Health and Medical Education
27
Trend in Detection and Control of HIV
• Prevalence of HIV/AIDS in patients suffering
from tuberculosis:
in 2010: 3.8%
in 2012: 2.5%
Ministry of Health and Medical Education
28
Improvement of Infrastructure
• The achievement of campaigns for construction
and literacy, increased GDP per capita, and the
establishment of primary health care system in
Iran:
•
•
•
•
Increased access to healthy drinking water
Increased access to healthy waste
Increased access to electricity and gas
Improved roads between cities
29
The age structure in Iran 2013
Statistical Center of Iran
30
Population of Iran from 1956 to 2011
80000000
70000000
60000000
50000000
Both
40000000
Urban
Rural
30000000
20000000
10000000
0
1335
1345
1355
1365
1375
1385
1390*
Statistical Center of Iran
31
Urbanization in Iran from 1956 to
2011
80
70
60
50
40
30
20
10
0
1335
1345
1355
1365
1370
1375
1385
1390
Statistical Center of Iran
32
The literacy rate among people older
than 5 from 1956 to 2011
100
90
80
70
60
Both
50
Men
Women
40
30
20
10
0
1335
1345
Statistical Center of Iran
1355
1365
1370
1375
1385
1390
33
Access to Drinking Water and Healthy
Waste in Rural Areas from 2006 to 2010
100
90
80
70
60
Drinking Water
50
Healthy Waste
40
30
20
10
0
1385
1386
1387
1388
1389
Statistical Center of Iran
34
The Number of HIV/AIDS Deaths
300
250
242
248
1388
1389
196
200
172
150
132
100
50
0
1385
1386
1387
Ministry of Health and Medical Education
35
The Necessity of Change in the Health System
• The necessity of changing policies based on new needs
and priorities of the health system
• The necessity of integrating service packages into the
current health system to control NCDs and accidents
• The necessity of inter-sectoral collaboration
• The necessity of cost effective planning for optimal
allocation of limited financial resources
36
Non-Communicable Diseases
 NCDs are main threats to economy
 NCDs lead to inequality in income, decrease in household wealth, increase
in health care cost, and decease in productivity
Prevention is crucial
37
The Trend of the fraction of YLLs caused by
main NCDs, 1990 to 2010
35%
30%
25%
Cardiovascular
20%
Transport Accidents
Cancers
15%
Diabetes
10%
5%
0%
1990
GBD 2010
1995
2000
2005
2010
38
Mental Diseases
• Prevalence in different regions in Iran: 29%
• Prevalence in Tehran:
– In 1998: 21.5%
– In 2007: 34.2%
• Lifetime risk of incidence: 14.3%
• Prevalence in women: 14.3%
• Prevalence in men: 7.3%
39
The Trend in Prevalence and Burden of
Main NCDs
• Necessity of national surveys to measure and
monitor those diseases that impose most burden
on Iranians
• Necessity of improving the quality of routine data
• The Golestan Cohort Study is the largest
prospective study in Middle East has released
comprehensive results
40
*
*Gastro-Esophageal Malignancies In Northern Iran
Arch Iran Med. 2013 Jan;16(1):46-53. doi: 013161/AIM.0014.
T
41
Golestan
Cohort Study
(GCS)
• This is a prospective study
on 50,045 subjects 40 to
75 years old
• Recruitment of subjects in
326 villages and Gonbad
city, from 2004 to 2008
• Subjects consisted of 57%
women, 8% rural dwellers,
and 74% Turkmens
• Data collected:
• Demographic
• Life style
• Anthropometric
• Biochemical samples
• 10 year follow up
Prevalence of Hypertension
Area
Hypertension Prevalence
Urban
43.9%
Rural
42.3%
Sex
Male
36.4%
Female
47.2%
Age
GCS 2007
35-39
23.9%
40-44
27.1%
45-49
36.5%
50-54
45.9%
55-59
52.4%
60-64
57.3%
65-69
62.9%
70-74
65.0%
75-79
64.8%
80-84
33.3%
Treatment Coverage of Hypertension
Area
Hypertension Treatment Coverage
Urban
47.4%
Rural
39.4%
Sex
Male
29.2%
Female
47.7%
Education
GCS 2007
Illiterate
42.6%
<=5 years
34.6%
6-8 years
38.0%
High school
36.9%
University
41.0%
Prevalence of Diabetes
Area
Diabetes Prevalence
Urban
10.0%
Rural
6.4%
Sex
Male
5.3%
Female
8.4%
Age
35-39
2.5%
40-44
4.2%
45-49
6.1%
50-54
7.9%
55-59
9.8%
60-64
10.3%
65-69
9.5%
70-74
8.5%
75-79
10.6%
80-84
0%
GCS 2007
Treatment Coverage of Diabetes
Area
Diabetes Treatment Coverage
Urban
72.7%
Rural
67.3%
Sex
Male
68.5%
Female
68.9%
Education
GCS 2007
Illiterate
67.9%
<=5 years
72.5%
6-8 years
72.7%
High school
67.2%
University
69.5%
Prevalence of Overweight and Obesity
• Prevalence of overweight: 62.2%
• Prevalence of obesity: 28%
• Comparing to United States:
– Iranian women are more obese than American women
– Iranian men or thinner than American men
GCS 2007
47
The Prevalence of Overweight and Obesity in
Iranian and American men and women in GCS
Baharmi h,Malekzadeh R BMC public health 2006
GCS 2007
Epidemic of Overweight, Obesity, and
Lack of Physical Activity
• Prevalence of Overweight: 38%
• Prevalence of Obesity: 22%
• Significant decrease in physical activity especially
among women
• Prevalence of Diabetes: 10%
• Prevalence of fatty liver: 30%
GCS 2007
49
Diet
• Prevalence of excess consumption: 40%
• Iranian diet: 40% excess carbohydrate, 30% excess oil
• High consumption of white rice: Iran is the 13th country
in the world in terms of excess consumption of rice (46
kg per person per year)
Non-Communicable Diseases Surveillance Survey 2009
50
The Main Risk Factors of NCDs
100%
90%
80%
70%
60%
50%
Men
Women
40%
30%
20%
10%
0%
Low fruits and
vegetables
low activity
Non-Communicable Diseases Surveillance Survey 2009
Overweight or
Obesity
Hypertension
Smoking
51
The Most Prevalent of NCDs Risk Factors among
Adolescents and Youth
Second Hand
Smoking
Low Physical
Activity
Overweight
Smoking
Hookah
Consumption
0%
10%
20%
CASPIAN Kelishadi et al 2008, 2007
30%
40%
50%
60%
52
Risk Factors in Adolescents and Youth
• 10 to 18 years
– Second hand smoking: 50.6%
– Low physical activity: 36%
– Smoking: 12%
• 15 to 24 years
- Low physical Activity: 34.5%
- Overweight: 28%
- Smoking cigarettes and Hookah: 8%
CASPIAN Kelishadi et al 2008, 2007
53
Drug Abuse
• Iranians consumes 42% of all opium in the world (?)
• Transit from Afghanistan to Iran
• Drug abuse as a leisure or due to beliefs on its
therapeutic effects
Drug Abuse
• Prevalence of drug abuse in subjects 40 years old and older
in GCS: 17%
• The mean proportion of adolescents who abuse drugs
(Kerman, Zanjan, Shiraz, Tabriz):
– Boys: 12.7% - 26.5%
– Girls: 7.7% - 11.5%
Sequelae of Drug Abuse
• Increased all-cause mortality rate
• Increased mortality rate due to cardiovascular diseases and cancers
• Increased mortality rate due to asthma, tuberculosis, and chronic
respiratory diseases
GCS 2012
Alcohol Consumption
• High School Adolescents:
– Boys: 18%
– Girls: 8%
CASPIAN Kelishadi et al 2008, 2007
Environmental Risk Factors
• Expansion of slum areas without access to
health care and low sanitation
• Air and noise pollution in cities
• Exposure to poisons in work places
• Limited water sources and the risk of drought
• Use of fossil fuels
• Inequity in access to fuels
• Destruction of jungles and green spaces
58
Management and Quality of Health
Care for NCDs at National Level
Female
Male
diagnosed but not treated
Treated
Undiagnosed
1
1
0.8
0.8
Proportion
Number
Undiagnosed
0.6
0.4
0.4
0.2
0
0
35-44
45-54
Treated
0.6
0.2
25-34
diagnosed but not treated
55-64
Non-Communicable Diseases Surveillance Survey, 2005
25-34
35-44
45-54
55-64
Management of NCDs
• Necessity of research on prevalence of
Diseases, communicable and noncommunicable at provincial level for costefficient policy making
• Necessity of detecting risk factors for
prevention
60
The Coverage of Diabetes and Hypertension Diagnosis and
Treatment in Urban and Rural Areas of Iran, 2005
70%
60%
50%
40%
Urban
Rural
30%
Both
20%
10%
0%
Diabetes Diagnosis
Diabetes Treatment
Non-Communicable Diseases Surveillance Survey 2005
Hypertension Diagnosis
Hypertension Treatment
61
The Association of Risk Factors
with NCDs
62
GBD 2010
63
GBD 2010
64
The Pathway from Risk Factors to NCDS
Direct Health
Care Costs
Indirect Costs
due to
Income and
Productivity
Losses
NCDs
Raised Blood
Pressure, Obesity,
High Blood Glucose,
High Lipids
Unhealthy Diet, Smoking, Physical
Inactivity, Substance abuse
Social Determinants
of Health
Globalization, Urbanization,
Population Ageing
65
Impact on Socio-Economic Development: A
Vicious Circle (2)
High costs due to chronic nature of diseases
Needs to access drugs and health services
Treatments not part of core services
Probable needs to seek services and drugs in private sector
Increased Out-of-Pocket
Catastrophic Expenditure
66
Financial Turnover in Health System in Iran
•
•
•
•
Total Health Expenditure
The proportion of health expenditure out of GDP
Out of Pocket
The share of public and private insurance
organizations
• Insurance coverage
• Catastrophic expenditure
• Payment Mechanism
67
GDP (Billion Dollars) from 1999 to 2013
700
600
500
400
300
200
100
0
Statistical Center of Iran
68
Trend of Health Expenditure by
Financial Sources (Billion Rials)
140000
120000
100000
80000
Total Household Expenditure
Household out of pocket
Governmental Resources
60000
Employers' Resources
40000
20000
0
1381
1382
1383
1384
1385
1386
1387
Ministry of Health and Medical Education, National Health Accounts
69
Trend of Health Expenditure by Health
Care Functions (Billion Rials)
140000
120000
100000
Treatment Care
80000
Outpatient Care
Training
60000
Investment
Research and Development
40000
20000
0
1381
1382
1383
1384
1385
1386
1387
Ministry of Health and Medical Education, National Health Accounts
70
Trend of Health Expenditure by
Providers (Billion Rials)
100000
90000
80000
70000
60000
Hospitals
50000
Outpatient
Providers
40000
30000
Drug Stores and
Medical Equipment
20000
Related
Organizations
10000
0
1381
1382
1383
1384
1385
1386
1387
Ministry of Health and Medical Education, National Health Accounts
71
The Proportion of Total Health Expenditure out of GDP in Iran
Data: WHO (Global Health Expenditure Database)
Total Health Expenditure Per Capita
Data: WHO (Global Health Expenditure Database)
Out of Pocket Expenditure as % of Total Health
Expenditure
Data: WHO (Global Health Expenditure Database)
Percentage of Catastrophic Expenditure
Data: Household Expenditure Survey
Challenges in Health System (1)
• Limited Financial Resources
• Lack of accordance between the capacity of
health system and the need for prevention,
control, and treatment of NCDs
• Incomplete insurance coverage and high
percentage of out of pocket and catastrophic
expenditure
• Increase in induced demands
• No implementation of referral system in urban
areas
76
Challenges in Health System (2)
•
•
•
•
•
No insurance coverage in slums areas
Inequity in access to health care
Low quality of health care
Low satisfaction of health care
Lack of an appropriate approach towards Health
Technology Assessment
• Focus on treatment instead of prevention
• Lack of evidence-based policy making
• Low quality of health data infrastructure
77
What should we do?
• Reconfigure the current primary care system
to be responsive to the new burden estimates.
• Fast and cost-effective move toward a system
that focuses on preventing NCDs and road
injuries
78
The alternative no-action
scenario :
• Is secondary and tertiary prevention of these
conditions that will impose enormous
financial costs on the system and, indirectly,
on the population.
79
IR PHC is not
well prepared for NCD challenges
• The PHC in Iran, similar to several other health
systems in LMIC, is not well prepared for
confronting the challenges caused by the
epidemics of NCDs because of its typical policy
direction toward preventing maternal-child
conditions and infectious diseases
80
The policy message
• Nationwide, low-cost, early, and
sustainable interventions are needed
to mitigate NCDs’ increasing burden
81
NCD Challenge
• Prevention, early diagnosis and care of NCDs
need a different and well prepared health
infrastructure to avert huge co-morbidities
which contribute greatly to rising health care
costs and compromise of economic
productivity
82
Ministry of Health and Medical Education (MoHME)
Undersecretary of Research and Technology
Strategic Plan (2014-2019)
June 2014
Strategic Plan (2014-2019)
Strategic Aim One
Strategic Aim One:
Strengthening Health Research Infrastructure
1-1- Reestablish of the National Research Center for Medical
Sciences
1-2- Disease Registries Program
1-3- Cohort Studies
 in adult (min. 100,000 population per study)
 in neonates and children (min. 2,000 population per study)
Why Cohort Studies?
 UK Medical Research Council (MRC) has a 50-year history of
supporting population cohort studies, including:
 British 1946 Birth Cohort: the world’s longest continuously
running birth cohort
 UK Biobank: which tracks half a million participants.
 Million Women Study: the largest longitudinal study of
women’s health
 2·2 million people in the UK are currently taking part in these
large population cohort studies—one in 30 of the general
population
Why Cohort Studies?
34 largest UK population cohort studies:
 Almost £30 million is spent per year on the 34 largest UK
population cohort studies
 50% of these cohort have been followed for more than
20 years
 92% of cohort participants are aged 45 years or older
 62% are female
Why Cohort Studies?
What are the strength of Cohort study?
• Ability to identify multiple risk factors over time
• Assessment of exposures that cannot be randomized (smoking, alcohol,…)
• Collection of serial measurements and samples that enables measurement of
changes in exposure and their effect on health outcomes over time
• Identifying the effect of one risk factor on multiple outcomes
• Cohorts are generally more inclusive than RCTs which are usually highly
selective
• Findings from cohort studies can, therefore, be more generalizable to the
population as a whole
• Feasibility of further research through linkage to routine data and further
laboratory and genetic study
Why Cohort Studies?
Cross-cohort collaborations
• An effective way to increase statistical power
• The Healthy Ageing Across the Life Course (HALCyon)
collaboration merged data from nine cohorts to undertake
studies of ageing that would not have been feasible using any
single cohort
• Cohort and Longitudinal Studies Enhancement Resources
(CLOSER) initiative, funded by the MRC and Economic and Social
Research Council, brings together nine cohorts with the aim of
combining variables across these studies
• Cohorts should use standardized and validated approaches,
where possible, to facilitate cross-cohort comparisons
Strategic Plan (2014-2019)
Strategic Aim One
1-4- To Build Core Laboratories in 10 Medical
Universities
1-5- Development of Cutting-Edge Science

Iran National Brain Mapping Center

Regenerative Medicine Centre

Iranian Genomes Project
1-6- Application of Electronic Health Records in Clinical,
Epidemiologic and Health Management Research
Strategic Plan (2014-2019)
Strategic Aim Two
Strategic Aim Two:
Capacity building for academic and research staff
2-1- Clinician Scientist Training Program
2-2- Postdoctoral Research Program
2-3- Improving the Quality of PhD by Research Program
2-4- Research Grant for Top Scientists (with high ranked h-index)
2-5- International Collaboration with Health and Biomedical
Research Centers
International Collaboration of Medicine Documents in Iran
SCImago Journal & Country Rank
Strategic Plan (2014-2019)
Strategic Aim Three
Strategic Aim Three:
Health Technology Development
3-1- Clinician Scientist Training Program
3-2- Development of Incubators in Medical Universities
3-3- Supporting Knowledge-Based Companies in Health and
Biomedical Field
Strategic Plan (2014-2019)
Strategic Aim Four
Strategic Aim Four:
Development of Sources of Health Research
Funding
4-1- Allocation of at least one percent of a medical university’s
budgets for research
4-2- Supporting establishment of non-governmental health and
biomedical research centers
4-3- Development of health and biomedical research charities
4-4- Absorption of funds for health research from other
governmental sources
“Development of Research and Technology” Budget Chapter
in Ministry of Health Compared to Ministry of Science (1393)
Chapter
proportion
Million Rial
Ministry of Science, Research
and Technology
38%
8,767,638
Ministry of Health, and Medical
Education
13%
3,047,645
Other governmental
organizations
49%
11,265,293
Development of Research and
Technology Budget Chapter
100%
23,080,576
Research Budget in Iranian Medical Universities, Research
Centers and Ministry (1393 compared to 1392)
Title
Medical Universities
Research centers and
Pasteur Inst.
Ministry of Health and
Medical Education
Total
Research Budget (Year)
Change
1392
1393
559,562
645,523
4.15%
1,487,360
1,540,745
6.3%
797,377
861,377
0.8%
2,844,299
3,047,645
1.7%
Charitable spending on research in the UK 2008-2012
Medical research charities have consistently spent more than £1bn on
research in each of the past five years
See more at: http://www.amrc.org.uk/our-members/sector-data/research-spend#sthash.U2ZGARpv.dpuf
Strategic Plan (2014-2019)
Strategic Aim Five
Strategic Aim Five:
Enhancing the Quality of Health Research
5-1- Improving assessment of health research and researchers
5-2- Quantitative and Qualitative Development of “Health System
Research”
5-3- Supporting Iranian Medical Journals for Indexing in MEDLINE, ISI
Web of Science and Scopus as well as Enhancing Their Quality
5-4- Improving Peer-Review System in Health Research and
Technology Assessment
5-5- Shifting Authority of Medical Journals from Public Universities
to Scientific Medical Associations and NGOs