off record
Shaukat Ali Jawaid

Iranian model of
medical education
and healthcare

For the last couple of months the Advisor on Health to the Prime Minister Dr. Zafar Mirza has repeatedly referred to the Iranian model of medical education and healthcare while speaking at various forums. There is no denying the fact that despite sanctions and numerous other hardships, Iran has been able to survive with dignity and made commendable progress in the field of medical education as well as healthcare. Iran has one of the best primary healthcare and its accomplishments in the field of undergraduate as well as postgraduate medical education, research has been praiseworthy. It has earned appreciation for all this from international agencies as well including the World Health Organization. If on one hand, it has a good functioning primary healthcare as well as secondary and tertiary healthcare, all its medical and dental schools, their teaching and training, Evaluaiton programmes have been recognized by the World Federation of Medical Education for the next ten years but if we compare ourselves with Iran, we stand nowhere near that.

While it is heartening to note that our health planners have realized the importance of finding indigenous solutions to our problems in medical education and healthcare as no Western model can be transplanted and implemented here, to copy and follow the Iranian model also calls for taking some important basic decisions which require wisdom, foresight and political will. Let us not forget the fact that Islamic Republic of Iran and its leadership had taken some of the following steps in 80s which had far reaching effects and helped the government to achieve its set targets. These included:

  1. Separation of medical education from higher education and renaming the Ministry of Health as Ministry of Health and Medical Education.
  2. Appointment of professionals as Health Ministers as well as Vice or Deputy Minister of Health and Medical Education.
  3. Appointment of Chancellors/President of medical universities on merit from amongst the healthcare professionals, medical educationists who have proven record of their accomplishments in these fields.
  4. Designating one or two medical universities in each province with their defined catchment areas and making them responsible for not only medical education but also provision of healthcare in the respective provinces. A strong system of monitoring and accountability was also put in place.
  5. These medical universities also monitor the drug manufacturing, manufacturers of medical devices etc., in their respective provinces though there is some central monitoring mechanism as well.
  6. Introducing health insurance scheme to provide free or highly subsidized healthcare to those who cannot afford and also introducing a proper referral system linked with primary healthcare centers, secondary and tertiary care centers.
  7. Inclusion of professional medial editors in the Commission on Recognition and Evaluaiton of medical journals in the Ministry of Health and Medical Education with the result that it has gone a long way in promoting the research culture. There has been a manifold increase in good quality, peer reviewed standard biomedical journals many of which are now covered by Web of Sciences enjoying Impact Factor, are covered by PubMed or PubMed Central and other important databases. There has also been a remarkable increase in the number of papers being published from Iran which has increased their contribution to world medical literature.

All this is a very tall order for the Government of Paksitan and one does not know whether it is capable of taking such important decisions, drastic measures which are a pre-requisite before one can think if making any progress. We have a tradition of political Governors being appointed Chancellors of universities irrespective of their competence, ability and suitability for the job and most often they have made a mess of it. Are our health bureaucracy and political leadership prepared to appoint Chancellors of Medical Universities on merit and empower them? Can they separate medical education and all other health related mattes form the higher education commission to the Ministry of Health and also rename it? Can they give powers to these Chancellors to appoint heads of the hospitals as is done in Iran and make them accountable? Higher Education Commission of Paksitan at present has perhaps no one with a medical background with the result that the mess it has created by revising the Guidelines for recognition of Health Science journals recently has showed its incompetence and inability. If on one hand they lack professional capability on the other hand they are reluctant to get or seek help from professional medical editors or their recognized bodies like Paksitan Association of Medical Editors (PAME).

The government had invited a number of highly qualified healthcare professionals by making them advisors or members of the Healthcare Task Force but do they enjoy any power or are they encouraged to take decisions independently is a big question mark. Their performance so far is highly disappointing. The way the government disbanded the Pakistan Medical & Dental Council and established Pakistan Medical Commission was a biggest joke with the Constitution and everyone knew that it is not going to survive. Then a critical look at the people who were selected for the PMC and its related bodies also showed that its lacks vision and foresight, decisions were taken on personal likes and dislikes rather that going for professionals with good standing known for their intellectual honesty and credibility, though there were some exceptions.

The government gives proof of its incompetence and inability to Govern every day with the result that it is faced with self created crisis may it be the Sugar and Flour crisis, strained relations with the judiciary or issues with governance. When the government is round the clock busy in harassing, victimization, character assassination, coming up with cooked up cases and terming its political opponents as thieves and dacoits without any solid evidence, they should not and cannot expect any soft corner from its political foes. This is one of the reasons that it has so far miserably failed to legislate and come up with some measures which could have offered some relief to the common man. Increase in interest rate, devaluation of the currency, harassing the businessmen and traders has its own impact with the result that economic progress is not visible, many industries are either closed or have reduced their production. No one can do business or go for further expansion or modernization of their manufacturing plants at such a high interest rate, Electricity and Gas charges with the result that inflation is very high. The industrialists are opting for downsizing or asking the employees for voluntary reduction in their salaries. Pharmaceutical industry is also faced with crisis and there exists a communication gap between the industry, drug regulators and government functionaries with the result that they cannot convince each other of their view point. The authorities find itself in crisis mostly because of its foolish advisors and as the things stand today, one fails to see any light at the end of tunnel. However, miracles do happen and may be the government realizes its follies, succeeds to make amends with its political opponents and create a business friendly environment lading to revival, growth and expansion of the industry which alone will create more job opportunities. Otherwise the frustration among the public will keep on increasing. The government must realize that at the end of the day it will be their performance which will be judged and measures taken to crush, punish, victimize, harass and jail its political opponents will be of no use and in fact it will prove counterproductive.

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