Original Research‘Linking research to action’ in Iran: Two decades after integration of the Health Ministry and the medical universities
Introduction
Since the Islamic revolution in 1979, significant measures have been taken to improve the healthcare system in Iran. One of these measures was the integration of medical and health education into health services, forming a new Ministry of Health and Medical Education (MOHME).1 Integration was undertaken initially to increase medical admissions. This objective was achieved, such that in 1994, the number of medical students had increased 5.8 fold compared with 1970.2 Following the approval of integration, the system passed through three organizational phases. In Phase 1, all activities related to health care, medical education and research were assigned to the new ministry, and two distinct organizations were formed within that ministry: the universities of medical sciences and the provincial health organizations. In Phase 2, the provincial health organizations were integrated into the universities present in the province, and the chancellors were given the authority to function as the minister’s representatives as service providers. In Phase 3, the universities in the province took over all educational, research and health service activities, and the provincial health organizations were dissolved.3
MOHME consists of deputies of health, education, research, student affairs and logistic services. There are 40 medical universities in the country which are responsible for the health care and management of 30 provinces (some large provinces such as Tehran have more than one university). Each university has deputies of health (public health and curative affairs are usually separate), education, research, student affairs and logistic services. The same university is in charge of the health network. In all, the universities cover approximately 400 districts. Medical universities can make decisions regarding the following issues through their board of trustees: budget, allocation of local revenues, contracts with the private sector, financial and materialistic aid, contractual and financial regulations, how affiliated units are run, granting research and provision of fees for compilation, teaching and translation, and approval of faculty members’ employment criteria.4 On the other hand, different schools (medical, public health, dentistry) are all under the university’s authority. There are more than 13,000 faculty members working in MOHME.5
Integration has received a lot of attention to date. Many measures have been taken for and against integration; in 2004, the Parliament passed a resolution that would hand over medical education to the Ministry of Science, Research and Technology again, and a few weeks later voted otherwise.6 This issue was raised again in June 2009 with the new government proposal to decrease the number of ministries in Iran.7 Although the topic has been discussed many times, there are not many published studies available on the topic, which is somewhat unique. Currently, two important reports on this field are available: a study carried out at MOHME’s request in 1997 to examine the effect of dissolving regional organizations and integrating their responsibilities into medical universities by studying the changes over a 4-year period8; and the assignment report on integration presented by the World Health Organization’s (WHO) consultants in 2006.3 Both studies placed more emphasis on medical education and service delivery, and less emphasis on research.
In its 2004 report, WHO placed more emphasis on ‘linking research to action’ which is now a global challenge, and demanded that countries take serious measures for utilization of evidence.9 The report recommended that countries should focus on bridging the knowledge-do gap by enforcing knowledge translation. The Canadian Institute of Health Research defined knowledge translation as ‘the exchange, synthesis and ethically-sound application of knowledge – within a complex system of interactions among researchers and users – to the capture of the benefits of research through improved health, more effective services and products, and a strengthened health care system’.10 The global ministerial forum of 2008 in Bamako emphasized the issue through ‘promotion of knowledge translation and exchange through the application of effective and safe interventions, evidence-informed policies, policy-informed research, and publication.11
The aim of this study was to examine the impact of integration of the Health Ministry and medical universities on ‘linking research to action’ or ‘knowledge translation’.
Section snippets
Methods
A qualitative study was carried out on two groups: medical and non-medical professionals. Two issues were taken into consideration while defining the subgroups of the study: the position of the individuals (macro–micro); and being part of the research system (policy maker and/or manager of research systems or researcher) or not being part of the research system (other than research system policy makers, managers or practitioners). The study’s subgroups are shown in Table 1.
Researchers were
Results
The four core categories extracted were the positive aspects of integration, the negative aspects of integration, barriers to the success of integration and recommendations.
The following presents the opinions of individuals by group. Excerpts of individuals’ statements which demonstrate their outlook towards the study categories are shown in italics.
Discussion
Generally speaking, whenever a change is to be evaluated, it is better to have a comparison between the effect on indicators before and after the intervention (especially by means of controlled groups). However, evidence in policy making is quite different from clinical settings.14 Hence, the authors did not expect to determine the impact of integration on the basis of a comparison study. Moreover, the necessary data were not available, therefore explaining the qualitative nature of the study.
Conclusion
There is no unanimous agreement on the impact of integration on ‘linking research to action’. However, most agree that through distribution of manpower, integration has met communities’ health needs in far-flung areas. However, there is doubt regarding the sucess of other aspects. Where the negative aspects of integration are concerned, overshadowing of universities’ educational and research commitments by service delivery was mentioned.
From the health research system perspective, the country’s
Ethical approval
The study proposal was presented to TUMS Deputy of Research Affairs and was approved by the ethics committee which functions in compliance with the Helsinki declaration. Individuals were briefed on the objectives of the study and verbal consent was obtained at the beginning of each session.
Funding
WHO’s East Mediterranean Regional Office, Contract No. EM/07/050402.
Competing interests
None declared.
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