Health workforce snapshot: Islamic Republic of Iran

Health workforce snapshot ISLAMIC REPUBLIC OF IRAN 1 2 ISLAMIC REPUBLIC OF IRAN AT A GLANCE1 Total population (2017) 7 992 600 Gross national income per capita (Int’l $, 2017)2 21 050 Unemployment (% of total labor force) (2018)2 11.9 Per capita current health expenditure (US$, 2017)3 475 Government health expenditure as % general government expenditure (2017)3 23.00 Out-of-pocket expenditure as % of current health expenditure (2017)4 32.4 Universal health coverage index (2017)5 72 Number of refugees (2016) 979 435 Number of internally displaced persons (2016) 0 Maternal mortality per 100 000 live births (2018)4 18 Under-5 mortality per 1000 live births (2018)4 14 Births attended by skilled health personnel (%) (2018) 99 Raised blood glucose (%, 18+ years) (2018) 12.1 Raised blood pressure (%, 18+ years) (2017) 19.7 Hepatitis B incidence rate per 100 000 (2018) 20 15.2 15.1 15.1 11.4 11.4 15.4 15.4 15.7 15.7 15.7 18.7 18.7 21.3 21.3 0 5 10 15 20 25 30 35 40 45 50 2013 2014 2015 2016 2017 2018 2019 Density of physicians, nurses and midwives (2013–2019) Physicians Nurses and midwives 0 20 40 60 80 100 120 Density per 10 000 population Density of physicians, nurses and midwives in the countries of the Region (2018) KEY FACTS  Health service delivery and health professional education are integrated under the Ministry of Health and Medical Education. Over 60 affiliated universities of medical sciences provide health care and are responsible for the education and training of 77% of the health workforce.  As a result of integration since the 1980s, the number of educational institutions for health professions has expanded and the annual number of undergraduates and postgraduates in medical and other health professional education has increased significantly.  Dual practice by health care providers is allowed, with some restrictions for faculty members of universities of medical sciences.  For almost 30 years, the country has hosted among the highest number of refugees regionally and globally, primarily from Afghanistan and Iraq. There are 1 million registered and almost 3 million non-registered refugees, presenting challenges for planning of the health workforce.  While there is a ratio of just over 2 nurses to every doctor, challenges remain in the distribution of the health workforce. With its well established behvarz programme, there is an effective primary care workforce serving the rural population in the country.  A comprehensive health workforce observatory is needed for better monitoring of the health workforce in the public and private sectors. D e n si ty p e r 1 0 0 0 0 p o p u la ti o n Source Eastern Mediterranean Health Observatory and Ministry of Health and Medical Education. Source: Eastern Mediterranean Health Observatory and Ministry of Health and Medical Education. Source: Regional Health Observatory Data Repository. 0 5 10 15 20 25 2013 2014 2015 2016 2017 2018 2019 D e n si ty p e r 1 0 0 0 0 p o p u la ti o n Density of selected health professionals (2013–2019) Physicians Nurses and midwives Denstists Pharmacists © World Health Organization 2020 WHO-EM/HRH/654/E 1. Eastern Mediterranean Health Observatory. 2. Ministry of Health and Medical Education, 2020. 3. Domestic general government health expenditure (GGHE-D) as percentage of general government expenditure (GGE) (%). The Global Health Observatory [website]. Geneva: World Health Organization; 2020 (https://www.who.int/data/gho/data/indicators/indicator-details/GHO/domestic-general-government-health-expenditure-(gghe-d)-as-percentage-of-general-government-expenditure-(gge)-(-) 4. Monitoring health and health system performance in the Eastern Mediterranean Region: Core indicators and indicators on the health-related Sustainable Development Goals 2019. Cairo: WHO Regional Office for the Eastern Mediterranean; 2020 (https://rho.emro.who.int/sites/default/files/booklets/EMR-HIS-and-core-indicators-2019-final_0.pdf%20). 5. UHC Index of Service Coverage (SCI). The Global Health Observatory [website]. Geneva: World Health Organization; 2020 (https://www.who.int/data/gho/data/indicators/indicator-details/GHO/uhc-index-of-service- coverage). Source of specialists and GP count: Bayat M, Shokri A, Mirbahaeddin E, Khalilnezhad R, Khatibi S, Fattahi H, et al. Geographic distribution of active medical specialists in Iran: A three-source capture-recapture analysis. Arch Iran Med. 2020;23(1):15–22; Shokri A, Akbari-Sari A, Bayat M, Khodadost M, Rahimi Foroushani A, Mirbahaeddin E, et al. Estimate general practitioners active supply in Iran: Capture-recapture method for three data sources. Iran J Public Health. 2019;48(12):2240–2248. Source of population data: National census 2016. Statistical Center of Iran. 4 .6 3 .9 5 .3 5 .3 1 6 .3 8 .4 7 .3 7 .3 1 .4 1 .4 1 .8 1 .8 1 .1 1 .1 1 .3 1 .3 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 Density of graduates per 100 000 population (2015– 2018) Physicians Nurses and midwives Dentists Pharmacists 1 2 9 6 0 4 8 6 3 0 0 4 3 3 0 4 4 2 2 3 1 3 3 6 5 7 2 6 3 6 1 2 4 0 0 0 8 4 8 9 7 4 5 0 0 0 3 9 8 9 7 4 2 2 3 1 3 3 6 5 7 2 0 4 0 7 2 0 0 0 0 00 000 20 000 40 000 60 000 80 000 100 000 120 000 140 000 160 000 Physicians General medical practitioner Specialist medical practitioner Ob/Gyn Nurses Dentists Pharmacists N o . o f h e a lt h p ro fe ss io n a ls Registered and professionally active health professionals (2018) Total Professionally active Source: National Health Workforce Accounts and Human Resources Study Center Database, Ministry of Health and Medical Education. Source: Ehsani E, Ghadakchi A, Yazdi F, Sadrossadat S, Mahi A, Mehrolhassani M, et al. Investigating availability and distribution trend of human resources affiliated to the Ministry of Health and Medical Education in Iran from 2009 to 2015. Iran J Epidemiol. 2018;14:60-71. Source: Eastern Mediterranean Health Observatory. 3 .5 2 .9 2 .6 3 .4 4 .3 4 .3 4 .3 3 .2 3 .2 1 .8 3 .4 4 .6 3 .0 2 .7 4 .1 2 .9 3 .2 2 .4 2 .1 3 .7 4 .4 2 .4 3 .8 4 .9 5 .5 1 .3 2 .6 7 .3 2 .6 5 .1 2 .9 2 .9 3 .4 2 .5 3 .4 3 .4 4 .0 5 .0 3 .7 2 .9 2 .0 3 .1 4 .4 3 .1 3 .3 3 .4 2 .6 3 .5 2 .7 2 .5 3 .0 4 .7 2 .4 2 .9 2 .9 3 .9 1 .7 3 .0 3 .7 2 .5 5 .5 2 .3 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 H e a lt h w o rk e rs d e n si ty p e r 1 0 0 0 0 p o p u la ti o n Geographical distribution of specialists and general physicians (2016) Density of active specialists Density of active general physicians 34% 9% 1% 4% 37% 5% 10% Distribution of physicians employed in the Ministry of Health and Medical Education by field of specialty (2017) General practitioner Dentist Doctorate in laboratory science Pharmacist Specialist Sub specialist Professional doctorate Source: Iran Statistical Yearbook 2017–2018 (1396), Statistical Center of Iran. 1 3 0 6 6 4 1 3 1 7 5 5 1 6 6 8 8 1 1 8 2 9 4 2 1 8 4 6 1 7 1 8 7 2 0 7 1 8 5 7 1 2 1 5 0 4 3 1 1 6 5 0 5 2 1 9 4 2 8 3 2 1 7 2 7 0 2 2 6 0 3 9 2 3 2 5 0 5 2 3 6 2 6 3 00 000 50 000 100 000 150 000 200 000 250 000 2009 2010 2011 2012 2013 2014 2015 N o . o f h e a lt h p ro fe ss io n a ls Gender distribution of health workforce (2009–2015) Male Female