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Fakhrzad N, Yazdi-Feyzabadi V, Fakhrzad M. Drivers of vulnerability to medicine smuggling and combat strategies: a qualitative study based on online news media analysis in Iran. BMC Health Serv Res 2024; 24:383. [PMID: 38539159 PMCID: PMC10976728 DOI: 10.1186/s12913-024-10805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/29/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Medicine smuggling poses a serious public health threat, limiting patients' safe and timely access to this essential resource. Thus, this study aims to identify the factors contributing to the vulnerability to medicine smuggling and propose effective strategies to combat this issue in Iran. METHODS An analysis of news media was conducted using qualitative content analysis. News text items related to medicine smuggling were retrieved from various online news sources between March 21, 2017, and May 21, 2023. To select health-oriented and general online news stations, news agencies, and newspapers, the purposeful sampling method with a maximum variation strategy was used. The selected sources included Mehr News Agency, Khabar Online, Islamic Consultative Assembly News Agency (ICANA), Islamic Republic News Agency (IRNA), Iranian Students News Agency (ISNA), Hamshahri, Donya-e-Eqtesad newspapers, Webda, Sepid Online, and Iran's Food and Drug Administration News Agency (IFDANA). All data coding was manually done using Microsoft Excel software version 2016. RESULTS A total of 277 news articles were found to meet the established criteria for inclusion. The analysis revealed four main themes, each with several sub-themes, that shed light on the factors that drive vulnerability and the strategies to combat medicine smuggling. These themes are the economic environment, government and stewardship, information technology systems, and socio-cultural factors. The economic environment emerged as the most significant theme, encompassing medicine selection, reimbursement, and procurement, all of which affect the smuggling of pharmaceuticals in Iran. CONCLUSION To combat medicine smuggling, it is important to adjust policies based on the identified vulnerabilities. Effective strategies to reverse pharmaceutical smuggling include capacity building of pharmaceutical manufacturing companies, implementing regulated and enhanced supervisory and rulemaking policies, strengthening health insurance, improving e-infrastructure, and increasing public awareness through collaborative approaches involving various stakeholders within and outside the health system.
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Affiliation(s)
- NourolHoda Fakhrzad
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Yazdi-Feyzabadi
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Maryam Fakhrzad
- Virtual School, Center of Excellence for E-Learning, Vice-Chancellery for Education, Shiraz University of Medical Sciences, Shiraz, Iran
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Kiani MM, Mostafavi H, Ebrahimi F, Majdzadeh R, Mohamadi E, Kraemer A, Olyaeemanesh A, Takian A. The experiences and perceptions of people with chronic and rare diseases during political-economic sanctions in Iran: a qualitative study. BMC Health Serv Res 2024; 24:276. [PMID: 38444030 PMCID: PMC10913614 DOI: 10.1186/s12913-024-10786-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Economic sanctions aim to exert pressure on political and economic foundations. Hypothesizing that sanctions might affect various aspects of population health, this study, as a component of a broader investigation to ascertain the trend effects of sanctions on selected health outcomes in Iran, seeks to explore the experiences of Iranian citizens associated with the imposed sanctions. METHODS This is a qualitative study. We conducted 31 semi-structured interviews with randomly selected patients diagnosed with at least one chronic and rare disease from diverse backgrounds across four provinces in Iran. We analyzed data using an inductive content analysis approach, facilitated by the MAXQDA10 software. RESULTS We identified three primary themes: direct effects, side effects, and coping strategies. The immediate effects were perceived to be manifested through the restriction of healthcare service availability and affordability for citizens. The side effects included the economic hardships experienced in individuals' lives and the perceived devastation caused by these difficulties. Some coping mechanisms adopted by patients or their families/relatives included prioritizing comorbidities, prioritizing health needs within families with multiple ill members, and readjusting health/illness requirements in light of daily living needs. CONCLUSION In addition to the inherent burden of their illness, patients faced substantial healthcare costs as a result of sanctions, restricted access to medications, and availability of low-quality medications. We advocate considering these challenges within the healthcare system resilience framework as a crucial first step for policymakers, aiming to determine actionable measures and mitigate the adverse effects of sanctions on citizens, particularly the most vulnerable groups.
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Affiliation(s)
- Mohammad Mehdi Kiani
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hakimeh Mostafavi
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Fatemeh Ebrahimi
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Reza Majdzadeh
- School of Health and Social Care, University of Essex, London, UK
- Knowledge Utilization Research Center and Community-Based Participatory-Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Efat Mohamadi
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Alexander Kraemer
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Alireza Olyaeemanesh
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
- National Institute for Health Research, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Amirhossein Takian
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
- Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
- Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Poorsina Ave., Tehran, Iran.
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3
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Asadi‐Pooya AA, Nazari M, Damabi NM. Effects of the international economic sanctions on access to medicine of the Iranian people: A systematic review. J Clin Pharm Ther 2022; 47:1945-1951. [DOI: 10.1111/jcpt.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/02/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Ali A. Asadi‐Pooya
- Epilepsy Research Center Shiraz University of Medical Sciences Shiraz Iran
- Jefferson Comprehensive Epilepsy Center, Department of Neurology Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Majid Nazari
- Epilepsy Research Center Shiraz University of Medical Sciences Shiraz Iran
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Emami F, Cheraghali AM. Policies and measures implemented to reduce the impact of international sanctions on Iran's pharmaceutical sector. Res Pharm Sci 2022; 17:274-283. [PMID: 35531135 PMCID: PMC9075019 DOI: 10.4103/1735-5362.343081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/05/2022] [Accepted: 02/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purpose Continuous evaluation of the policies and interventions could explore their efficacies in improving the accessibility and availability of medicines in the local market. This study explained the health system policies of the Islamic Republic of Iran concerning the impact of the economic sanctions on the local pharmaceutical market and addressed the issue of whether these policies were able to improve patients' access to medicines. Experimental approach In this study, qualitative and quantitative research methods were used. In the qualitative part, semi-structured interviews with pharmaceutical system experts were used. In the next step, the structural analysis method was used. In the quantitative part, numerical sales data of the selected medicines were extracted and analyzed. Findings/Results Reported statistics regarding the presence of the medicines in the market indicates the obvious fluctuations in the numerical sales of medicines in the studied years. This may indicate that the policies implemented are not able to fully compensate for the negative effects of sanctions and improve access to medicine. In addition, according to some experts, policy, and management weaknesses are mainly rooted in unresolved domestic hurdles which have exacerbated the effects of international sanctions on the country's pharmaceutical market. Conclusions and implications Effective policy-making in response to economic sanctions can reduce the negative effect of international sanctions and result in drug shortages. Results of this study showed despite efforts made by the Iran health sector to subside the impact of sanctions on the pharmaceutical sector, there is an obvious disruption of the medicine supply chain in the market.
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Affiliation(s)
- Farideh Emami
- School of Pharmacy, Tehran Medical Science, Islamic Azad University, Tehran, I.R. Iran
| | - Abdol Majid Cheraghali
- Department of Pharmacology, Faculty of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, I.R. Iran
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5
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Bastani P, Dehghan Z, Kashfi SM, Dorosti H, Mohammadpour M, Mehralian G. Challenge of Politico-Economic Sanctions on Pharmaceutical Procurement in Iran: A Qualitative Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:152-161. [PMID: 35291429 PMCID: PMC8919311 DOI: 10.30476/ijms.2021.89901.2078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/11/2021] [Accepted: 06/05/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Politico-economic sanctions over the recent years have led to significant challenges in the pharmaceutical supply chain (PSC) in Iran. Given the importance of the chain's resilience for the health system and its impact on accessibility, equity, and public health, this study was conducted to determine the major challenges facing pharmaceutical procurement in Iran after the imposition of these sanctions. METHODS This study was a qualitative research with a content analysis approach conducted in 2019. Eighteen policymakers and administrative managers in food and drug administration of two Iranian Medical Universities and Iran's Ministry of Health were included in the present study via snowball sampling and semi-structured interview. The data were analyzed using the framework analysis of MAX QDA10. RESULTS Five main themes and 15 sub-themes were identified, which addressed pharmaceutical supply chain challenges under politico-economic sanctions. These included the challenges in financing, purchasing, importing, and manufacturing domestic products in addition to storing and distributing medicines, along with challenges facing the general public, particularly patients. CONCLUSION The results revealed that pharmaceuticals are not immune to politico-economic sanctions, although they are not directly subjected to them. Sanctions, similar to any economic crisis, can affect public health and limit their access to healthcare. Identifying supply chain challenges and planning to address them could help policymakers find solutions to enhance PSC resilience in the future.
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Affiliation(s)
- Peivand Bastani
- Health Human Resources Research Center, School of Health Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Dehghan
- Vice-Chancellery for Food and Drug, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyyed Mansoor Kashfi
- Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hesam Dorosti
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Gholamhossein Mehralian
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Darvishi B, Behzadifar M, Ghanbari MK, Ehsanzadeh SJ, Bakhtiari A, Behzadifar M, Azari S, Bragazzi NL. Financial Protection Indexes and the Iranian Health Transformation Plan: A Systematic Review. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:465-476. [PMID: 34602884 PMCID: PMC8461582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: On May 5, 2014, the Iranian Ministry of Health and Medical Education launched the Health Transformation Plan (HTP) as a major healthcare reform to curb out-of-pocket (OOP) expenses and protect people from catastrophic health expenditures (CHEs). Therefore, in this study, we conducted a comprehensive literature search with the aim of systematically investigating the impacts of HTP on OOP and CHE after the implementation of the plan. Method: Web of Science, PubMed, Scopus, Embase, and Iranian bibliographic thesauri and repositories such as MagIran, Elmnet, and Scientific Information Database were searched. Studies published between May 2014 and December 2020 that reported the impact of HTP on the financial indicators under investigation in this study (OOP and CHEs) that were conducted in Iran. Estimated pooled change both for OOP and CHEs was calculated as effect size utilizing meta-analytical techniques. Also, heterogeneity among studies was assessed with the I2 statistics. Results: Seventeen studies were included, nine of which evaluated the OOP index, six studies assessed the CHEs index, and two studies examined both the OOP and CHEs indexes. The OOP was found to decrease after the implementation of the HTP (with an estimated decrease of 13.02% (95% CI: 9.09-16.94). Also, CHEs experienced a decrease of 5.80% (95% CI: 3.85-7.74). Conclusion: The findings show that the implementation of HTP has reduced health costs. In this regard and in order to keep reducing the costs that many people are unable to pay, the government and other organizations involved in the health system should provide sustainable financial resources in order to continue running HTP. However, there remain gaps and weaknesses that can be solved through discussion with all the actors involved.
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Affiliation(s)
- Banafshe Darvishi
- Social Determinants of Health Research Center, Lorestan
University of Medical Sciences, Khorramabad, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan
University of Medical Sciences, Khorramabad, Iran
| | - Mahboubeh Khaton Ghanbari
- Health Management and Economics Research Center, Health
Management Research Institute, Iran University of Medical Sciences, Tehran,
Iran
| | - Seyed Jafar Ehsanzadeh
- School of Health Management and Information Sciences,
Iran University of Medical Sciences, Tehran, Iran
| | - Ahad Bakhtiari
- Department of Health Economics and Management, School
of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Meysam Behzadifar
- Social Determinants of Health Research Center, Lorestan
University of Medical Sciences, Khorramabad, Iran
| | - Samad Azari
- Hospital Management Research Center, Iran University of
Medical Sciences, Tehran, Iran
| | - Nicola Luigi Bragazzi
- Department of Health Sciences (DISSAL), School of
Public Health, University of Genoa, Genoa, Italy
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Abbasian H, Yousefi-Zenouz R, Abdollahiasl A, Toroski M, Nikfar S, Siahi-Shadbad M, Kebriaeezadeh A. Risk Factors of Supply Chain in Biopharmaceutical Companies in Iran. PHARMACEUTICAL SCIENCES 2020. [DOI: 10.34172/ps.2020.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Supply chain risk management can help companies detect potential hazards,mitigate potential risks, and thereby increase supply chain efficiency. The biopharmaceuticalindustry in Iran has a generic-based pharmerging market. Therefore, identifying risksassociated with the supply chain of those drugs can significantly boost the possibility of successof biopharmaceutical companies. This study is conducted to determine the supply chain riskfactors of biopharmaceuticals companies in Iran. Methods: The current research work is a qualitative-quantitative study. A systematic review andinterview with experts (n=14) were conducted to identify potential supply chain risks in thebiopharmaceutical industries. To determine the significance of identified risks, Fuzzy screeningmethod was employed to collect the opinions of experts (n=16) in the biopharmaceuticalindustries. Results: By systematic review and interviews with the biopharmaceutical industry experts, 100potential risks in the biopharmaceutical industry supply chain were identified. These risks weredivided into two general categories namely macro and micro risks. Based on experts’ judgment,77 out of 100 identified risks were eliminated and 23 significant risks were determined. Themost important risks are the Ministry of health (as the regulatory body) conflict of interest, USsanctions, lack of domestic suppliers of essential materials, pseudo-productivity, and moneytransfer related to the bank’s sanctions. Conclusion: Due to the multitude of present risks and the impossibility of controlling all ofthem, it is recommended that managers and producers focus more on controlling the identifiedsignificant risks.
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Affiliation(s)
- Hadi Abbasian
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Yousefi-Zenouz
- Department of Information Technology Management, Kharazmi University, Tehran, Iran
| | - Akbar Abdollahiasl
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Toroski
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shekoufeh Nikfar
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Abbas Kebriaeezadeh
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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9
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Mehtarpour M, Takian A, Eshrati B, Jaafaripooyan E. Control of antimicrobial resistance in Iran: the role of international factors. BMC Public Health 2020; 20:873. [PMID: 32503497 PMCID: PMC7275379 DOI: 10.1186/s12889-020-09006-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 05/27/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is currently causing various challenges for all countries around the world. Accordingly, the WHO is placing a great emphasis on the global partnership and allinaces to drive countries towards developing policy guidances and a strategic framework for AMR contatiment. This study thus seeks to elaborate on the international factors underlying AMR management in Iran. METHODS Semi-structured interviews were conducted with managers from the Ministry of health (n = 14), Iran veterinary organization (n = 4), the national professional associations (n = 3) and researchers (n = 3), between November 2018 and July 2019. Participants were selected using purposeful and snowball sampling. Interviews were recorded and transcribed verbatim and were subsequently coded and analyzed thematically using MAXQDA software (V.18) and reported. RESULTS International enabling and predisposing factors were identified in relation to the AMR control in the country. Enabling factors included knowledge transfer, facilitation in policy agenda setting, formulation and implementaion process, and AMR monitoring. Predisposing factors, alternatively, encompassed the migration of infectious patients, trafficking of medicine and livestock from neighboring countries, and the imposed sanctions. CONCLUSION Nowadays, AMR is taken cognizance of as a global challenge, thus to be addressed effectively, needs an international consensus more than ever. This harmony would not certainly underrate national efforts, but instead, is needed to reinforce such efforts through e.g. technical and financial assistance. It is suggested for policymakers to use all available political and legal means such as health diplomacy to establish humanitarian channels in order to enhance global convention and remove possible barriers as the sanctions and reduce their adverse consequences for AMR control.
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Affiliation(s)
- Mojtaba Mehtarpour
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Eshrati
- Center For Preventive Medicine, Department of Social Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Jaafaripooyan
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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10
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Yousefi N, Moradi N, Dinarvand R, Ghiasi G, Inanloo H, Peiravian F. Policies to improve access to pharmaceutical products in shortage: the experience of Iran food and drug administration. Daru 2019; 27:169-177. [PMID: 30903556 PMCID: PMC6593011 DOI: 10.1007/s40199-019-00259-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 03/06/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In the past decades, economic sanctions imposed on Iran for its nuclear program. The embargo made difficulty in foreign trade and led to lack of timely access to medicines. As the internationally-led sanctions caused to the shortage of medicine there, healthcare systems need to applied the new policies for maintaining health service quality especially in pharmaceutical sector. OBJECTIVES This paper is about policies applied in Iran health system during the crisis reached its peak in 2012 as a good experience for guarantying access to pharmaceutical products. METHODS Through interviewing experts and managers in pharmaceutical regulatory system, the implemented policies in targeted historical period were extracted, then quantitative data were analyzed to show the impact of the policies on the access and affordability of medicines before and after their implementation in Iran food and drug administration (IFDA). This paper tries to show strategies employed by to tackle the crisis caused by sanctions and to offer practical policies to make medicines more accessible at the time of crisis. RESULTS In order to reduce the harmful effects of this crisis, IFDA proposed some changes at different levels ranging from organizational procedures to parliament legislations. The main achievements of IFDA were making drugs easily available are as follows, significantly reducing prices, decreasing the share of market regarding the imported medicines, facilitating the manufacture of domestic medicines, encouraging foreign investment in manufacturing drugs domestically, controlling the shortage of drugs, and finally giving financial support to all patients in general and to those patients who had problem paying for drugs in particular. CONCLUSION These experiences which made the Iran pharmaceutical sector survive during the international sanctions, can be considered as a good example of resilience strategies in similar situations. Graphical abstract IFDA policies to improve access to pharmaceutical products in sanction.
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Affiliation(s)
- Nazila Yousefi
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Najmeh Moradi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rassoul Dinarvand
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Farzad Peiravian
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Perehudoff SK, Alexandrov NV, Hogerzeil HV. Access to essential medicines in 195 countries: A human rights approach to sustainable development. Glob Public Health 2018; 14:431-444. [PMID: 30187828 DOI: 10.1080/17441692.2018.1515237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In 2008 the UN Special Rapporteur on the Right to Health published 72 right to health indicators in 194 health systems. We present a follow-up report of eight indicators for access to medicines to serve as a reference point for progress towards SDG Target 3.8 on essential medicines. Data for these eight indicators in 2015 were collected and compared with the 2008 report. Between 2008 and 2015 we observed increased numbers of constitutions recognising access to medicines (7-13 countries), countries with a national medicine policy (118-122) and with a national list of essential medicines (78-107). Public spending on pharmaceuticals decreased or rose modestly in most of the 44 countries. Median availability of a basket of lowest-priced generics increased in the public (63%-70% n = 9 countries) and private (84%-92% n = 10) sectors. Median child immunisation rates remained constant for measles (around 90%) and improved for three doses of diphtheria-tetanus-pertussis (79%-86%). These eight indicators are useful and feasible, but should be further strengthened and expanded. Future monitoring exercises should use these indicators to screen progress and guide national governments' action to ensure universal access to essential medicines as part of the right to health.
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Affiliation(s)
- S Katrina Perehudoff
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Nikita V Alexandrov
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Hans V Hogerzeil
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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12
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Kokabisaghi F. Assessment of the Effects of Economic Sanctions on Iranians' Right to Health by Using Human Rights Impact Assessment Tool: A Systematic Review. Int J Health Policy Manag 2018; 7:374-393. [PMID: 29764102 PMCID: PMC5953521 DOI: 10.15171/ijhpm.2017.147] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 12/27/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Over the years, economic sanctions have contributed to violation of right to health in target countries. Iran has been under comprehensive unilateral economic sanctions by groups of countries (not United Nations [UN]) in recent years. They have been intensified from 2012 because of international community's uncertainty about peaceful purpose of Iran's nuclear program and inadequacy of trust-building actions of this country. This review aimed to identify the humanitarian effects of the sanctions on the right of Iranians to health and the obligations of Iran and international community about it. METHODS To assess economic sanction policies and identify violated rights and the obligations of states according to international human rights laws, in this study, Human Rights Impact Assessments (HRIA) tool is used. Applying this tool requires collection of evidences regarding the situation of rights. To provide such evidence, a systematic review of literature which involved 55 papers retrieved from the web-based databases and official webpages of Iran's government and UN' health and human rights committees and organizations was done. All articles about the consequences of economic sanctions related to nuclear activities of Iran on welfare and health of Iranians published from January 2012 till February 2017 in English and Persian languages were included. Search terms were economic sanctions, embargoes, Iran, welfare, health and medicine. Additional studies were identified by cross checking the reference lists of accessed articles. All selected papers were abstracted and entered into a matrix describing study design and findings, and categorized into a framework of themes reflecting the areas covered (health and its determinants). According to HRIA framework, related obligations of Iran and other states about adverse effects of the sanctions on Iranians' right to health were extracted. RESULTS The sanctions on Iran caused a fall of country's revenues, devaluation of national currency, and increase of inflation and unemployment. These all resulted in deterioration of people's overall welfare and lowering their ability to access the necessities of a standard life such as nutritious food, healthcare and medicine. Also, the sanctions on banking, financial system and shipment led to scarcity of quality lifesaving medicines. The impacts of sanctions were more immense on the lives of the poor, patients, women and children. Humanitarian exemptions did not protect Iranians from the adverse effects of sanctions. CONCLUSION Countries which imposed economic sanctions against Iran have violated Iranians' right to health. International community should have predicted any probable humanitarian effects of sanctions and used any necessary means to prevent it. Furthermore, Iran should have used any essential means to protect people from the adverse effects of sanctions. Now, they should work on alleviation of the negative effects of sanctions. Even though, some of the effects such as disability and death cannot be compensated. In future, before imposition of sanctions, decisions makers should advice an international order to prevent such impacts on targeted countries' populations.
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Affiliation(s)
- Fatemeh Kokabisaghi
- Healthcare and Law Department, School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Science, Mashhad, Iran
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13
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Homaie Rad E, Delavari S, Aeenparast A, Afkar A, Farzadi F, Maftoon F. Does Economic Instability Affect Healthcare Provision? Evidence Based on the Urban Family Physician Program in Iran. Korean J Fam Med 2017; 38:296-302. [PMID: 29026491 PMCID: PMC5637222 DOI: 10.4082/kjfm.2017.38.5.296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/11/2017] [Accepted: 02/17/2017] [Indexed: 11/27/2022] Open
Abstract
Background The main aim of this study was to evaluate the achievements of some important goals of Iran's urban family physician plan. This plan was implemented when the country experienced economic instability. We examine whether an economic crisis affects the efficacy of a healthcare program. Methods We used the household income and expenditures survey data for 2011 (before program implementation) and 2012 (after program implementation). Changes in out-of-pocket payments and healthcare utilization were investigated using the propensity score matching estimator. Furthermore, changes in inequality in these two dimensions were examined. Results No changes in out-of-pocket payments and healthcare utilization were found after the implementation of this program; however, inequality in out-of-pocket payments increased during the reform. Conclusion The urban family physician program was not implemented completely and many of its fundamental settings were not conducted because of lack of necessary healthcare infrastructure and budget limitations. Family physician programs should be implemented under a strong healthcare infrastructure and favorable economic conditions.
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Affiliation(s)
| | - Sajad Delavari
- Health Human Resources Research Center, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afsoon Aeenparast
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Iran
| | - Abolhassan Afkar
- School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Faranak Farzadi
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Iran
| | - Farzaneh Maftoon
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Iran
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14
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Hosseini S, Rashtchi V, Kamali K, Moghimi M. Epidemiology and outcome of 2,590 burned patients in Northwest Iran. ANNALS OF BURNS AND FIRE DISASTERS 2017; 30:85-90. [PMID: 29021718 PMCID: PMC5627557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 06/25/2017] [Indexed: 06/07/2023]
Abstract
Burns are calamities with considerable morbidity and mortality rates. We attempted to examine the epidemiology of burns in Zanjan city, in northwest Iran, by a systematic study of existing information. The medical files of 2,590 thermal burn patients treated in our hospital in Zanjan city, Iran, from December 2010 to November 2016 were studied. Patient information, including age, sex, burn degree, season, cause of burn, hospital stay and treatment results were analyzed. About 65% of the patients were male (n=1691). Most burns (92.8%) were less than 30% total body surface area. Mean age and hospital stay were 25.4 years old and 9.1 days, respectively. The most common causes of burn were hot liquids, gas explosion and fire, respectively. Except for self-immolation, which was more common among men, there was no significant relationship between cause of burn and the studied variables. The six-year mortality rate was 2.9%, and was more common in the years 2011 to 2013. In addition, distribution of causes of burn had a significant trend (variation). Fire burn had a decreasing trend and gas and chemical burn had increasing trends in this period. In northwest Iran the causes of burn changed over the six years. Chemical burns, gas explosion burns and burn mortality increased. Some of these results were due to economic and pharmaceutical sanctions in Iran. Because of Iran's industrial development, it is recommended that preventive measures for chemical, gas and electrical burns be conducted.
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Affiliation(s)
- S.N. Hosseini
- Department of Surgery, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - V. Rashtchi
- Department of Anesthesiology, Faculty of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - K. Kamali
- Department of Public Health, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - M.H. Moghimi
- Department of Surgery, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
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15
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Setayesh S, Mackey TK. Addressing the impact of economic sanctions on Iranian drug shortages in the joint comprehensive plan of action: promoting access to medicines and health diplomacy. Global Health 2016; 12:31. [PMID: 27267898 PMCID: PMC4897941 DOI: 10.1186/s12992-016-0168-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The U.S Congress initiated sanctions against Iran after the 1979 U.S. Embassy hostage crisis in Tehran, and since then the scope of multilateral sanctions imposed by the United States, the European Union, and the United Nations Security Council have progressively expanded throughout the intervening years. Though primarily targeted at Iran's nuclear proliferation activities, sanctions have nevertheless resulted in negative public health outcomes for ordinary Iranian citizens. This includes creating vital domestic shortages to life-saving medicines, leaving an estimated 6 million Iranian patients with limited treatment access for a host of diseases. Sanctions have also crippled Iran's domestic pharmaceutical industry, leading to the disruption of generic medicines production and forcing the country to import medicines and raw materials that are of lower or questionable quality. DISCUSSION Countries such as the United States have responded to this medical crisis by implementing export control exemptions with the aim of easing the trade of humanitarian goods (including certain pharmaceuticals and medical devices). However, despite these efforts, pharmaceutical firms and international banking institutions remain cautious about doing business with Iran, leaving the country faced with continuing shortages. We conducted a review of key characteristics of the Iranian drug shortage that identified 73 shortage drugs that closely tracked with the disease burden in the country. Additionally, 44 % of these drugs were also classified as essential medicines by the World Health Organization. A vast majority of these drugs were also covered under export control exemptions that theoretically should make them easier to procure, but nevertheless will still in shortage. Based on our review of the sanctions regulatory framework and key characteristics of the Iranian drug shortage, we propose policy intervention leveraging the recently negotiated P5 + 1 agreement that begins the process of providing Iran relief from the international economic sanctions regime. This specifically includes advocating for the application of "health diplomacy" in ongoing multilateral negotiations following commencement of "implementation day," by advocating for an additional set of reform measures incorporated into this historic negotiation that will finally address the humanitarian and medical crisis of drug shortages in Iran.
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Affiliation(s)
- Sogol Setayesh
- Joint Masters Degree Program in Health Policy and Law, University of California, San Diego School of Medicine - California Western School of Law, San Diego, CA, USA
| | - Tim K Mackey
- Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA, USA. .,Department of Medicine, Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA. .,Global Health Policy Institute, 6256 Greenwich Dr., Room 137, San Diego, CA, 92122, USA.
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