‘Linking research to action’ in Iran: Two decades after integration of the Health Ministry and the medical universities

Summary

Objective

To examine the impact of integration of the Iranian Health Ministry and medical universities, which took place in 1985, on ‘linking research to action’.

Study design

A qualitative study including 18 in-depth interviews and 10 focus group discussions with different stakeholders ranging from researchers, policy makers and service providers in medical and non-medical groups.

Methods

A thematic framework was used to identify various positive and negative aspects of the integration on ‘linking research to action’ to date.

Results

The positive influences on universities that have been established since integration and/or in the peripheral provinces are more prominent. Distribution of health manpower in various parts of the country has almost unanimously been stated as a positive aftermath. On the other hand, the negative influence most agreed upon was the deviation of larger universities from their main commitment of knowledge production, due to overindulgence in service delivery.

Conclusions

Before making any decisions about changing the current structure of the health-research system, the country’s national innovation system should be defined. This is because national research problems are not confined to integration and health research, and cover more general aspects. Therefore, any change in integration and health research should be considered secondary to the latter.

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’.