Chapter II

Medical Science in

2.1. Islamic Republic of Iran

2.2. province

2.3. History of medical science in Iran

2.4. Education system in Iran

2.5. Higher education in Iran

2.6. Health care system in Iran Chapter 11

Medical Sciences in Iran

2.1. Islamic Republic of Iran

Islamic Republic of Iran located in Middle East, bordering the Gulf of Oman, the Persian Gulf, and the Caspian Sea, is located between Iraq and Pakistan (shown in map 1). Area of Iran is 1,648,043 (sq km), [1] slightly larger than Alaska. Geographic features in Iran are rugged mountainous rim; high central basin with deserts, mountains; small, discontinuous plains along both coasts. Population of Iran is 69,018,924 (July 2004). Density of population is 39.8 Per sq km. Average of age structure in Iran for 0-14 years is 28% (male 9,935,527; female 9,411,647) and for 15-64 years is 67.2% (male 23,608,621; female 22,744,128) and finally for 65 years and above: 4.8% (male 1,645,246; female 1,673,755). Median age in Iran is 23.5 years that for the male it is 23.3 years and female 23.7 years. The rate of population growth in Iran is 1.07%). Tehran is the capital of Iran.

Administrative divisions in Iran comprise 28 provinces which include: Ardabil, Azarbayjan-e Gharbi, Azarbayjan-e Sharqi, Bushehr, Chahar Mahall va Bakhtiari, Esfahan, Pars, Gilan, Golestan, Hamadan, Hormozgan, Ham, Kerman, Kermanshah, Khorasan, Khuzestan, Kohkiluyeh va Buyer Ahmad, Kordestan, Lorestan, Markazi,

50 Mazandaran, , , Semnan, Sistan va Baluchestan, Tehran, , Zanjan (shown in map 2.1).

Caspian Sea Tiirkey A \ ' / Tui'kamajiestan ___—— Aig hajiis tan Iraq Iran '__p^,^ Persian.^ Oman Sea

%,

Map 2.1. Location of Iran in Asia

Major Cities in Iran are Meshad, Isfahan, , Ahvaz, and . is spoken by 58% of the people and it is also the national language. "Other languages are Turkic and Turkic dialects 26%, Kurdish 9%, Luri 2%, Balochi 1%, Arabic 1%, Turkish \%, and others 2%. Regarding literacy in Iran; people in the age group of 15 years and above can read and write. Number of Internet hosts were 5,269 in 2003 and the number of Internet users are 4.3 million in this year" [2].

"The government of Iran is Islamic republic and got the independence in 1979. The present head of government and leader of the Islamic Revolution is Ayatollah Ali Hoseini-Khamenei" [3] and President of Iran is Mahmoud Ahmadinejad.

TURKMENISTAN .N \y"'> Caspianisptun Q aOOkm Srfta •TatMTlz '-•'" 0 190 mi iMasul^ I Gombad-e Kavus • Maahhad Ali Sadr Tehran Caves m HBfnadon# o .V • IRAN Ersfahan IRAQ • ChoghaChogI , ZamO•lii • Yazd

^Karman KUWAIT SHTBz^p^rsepoHs Zahedani ^ P*f«a« Bushehr Bam Gulf Bandar-e SAUDI Bandar-« •Abbas ARABIA Maqam^ OMAN ©LooalyRanei Q^TAR Gulf of Oman

Map 2.2. DifTerent cities of Iran

2.2.

Covering an area of 105,937 square kilometers, Isfahan province is located in the central part of Iran. According to the latest divisions of the country, Isfahan province includes 17 townships which are: Isfahan, , Borkhar and Maymeh, Khomeini-Shahr, Khansar, , (Ghomsheh), Freidan, Freydoon-Shahr, Felavarjan, , Lenjan, Mobarake, Naein, Nadjafabad and . Map 3 shows different townships in this province. Isfahan, being the capital city of the province, is the most populated city of the province. The population of the province in 2002 was 4,316,767 with an area of 07,027 km of which 74.3% were urban dwellers and 25.7% were hving

52 in rural areas. Located in the central part of Iran plateau, Isfahan province, due to its vastness, consists of several mountainous and plain areas. These are: Ardestan mountainous area; north-east and east mountainous area with Natanz city located on its slope; western mountainous area encompassing Freidan and Freydoon-Shahr townships; and plain area which has come into existence from alluvium of Zayandeh Rood river and includes south-east parts of Isfahan.

Freydun slnaria

7575884.9 mi

Map 2.3. Different townships in Isfahan province Similar to the above-mentioned natural and topographical situation, the climate of the province is changeable as well. Although the province generally enjoys a dry and temperate climate, but it can be classified into three climatic regions depending on the distance from western mountainous area and desert (Kavir) plain in the east and south-east. These climatic regions are: arid, comprising of Naein, Biabanak and to the north of Ardestan; semi-arid consisting of Isfahan

53 Township; and semi-humid and cold encompassing west and southwest parts of the province.

According to the reports of Meteorological Organization, maximum temperature of Isfahan is 40.6 °C, while the minimum temperature is 10.6 °C and the average annual temperature is 16.7 °C. The annual freezing days of the province are 76 days and the average annual precipitation is 116.9 mm.

Photo 2.1. Siosehpol bridge (33 arches)

"As a result of geographical conditions of Isfahan province, its eco- tourism attraction is less than that of other provinces like Gilan, Mazandaran and Azarbayjan. But certain parts of Isfahan enjoy valuable eco-tourism potentials both from local and national points of view. The largest river in the central plateau of Iran called Zayandeh Rood, passes through this province, and creates many impressive sights. There are recreational facilities both on Zayandeh Rood while flowing

54 through Isfahan and also near the large dam constructed across the river, 117 km. south of the city" [4].

Isfahan province got attraction by tourists due to its historical significance and architectural monuments belonging to Saljoughi and Safavid periods. Most of these historical monuments have international value reflecting their antiquity and historical ups and downs in this territory. Among these monuments, some of them are Ali-Qapoo edifice, Chehel-Sotoon palace, Siosehpol (33 arches) bridge, Khajoo bridge, Shahrestan bridge, Menar Jonban (shaking minaret). Imam (Naghsh-e-Jahan) square, etc.

The other tourism potentials of the province are religious sites and buildings with their own antiquity, scattered throughout the province annually attracting so many pilgrims and tourists who have spiritual ties with them. Among them Jame' . Imam Mosque, Sheik Lotfollah mosque, Chahar-Bagh school, and tens of , shrines and tombs of luminaries can be pointed out.

Isfahan province, since a very long time ago, had been the residence of different peoples including Aryans, Semitic, Turks, Armenians and Georgians who were under the influence of Iranian culture. Cultural interactions of these people resulted in widespread rituals and traditions throughout the province including various ceremonies, mourning, celebrations, music, and local dances. In addition, existing tribes and nomads in the region including Ghashghai, Bakhtiari, Boyirahmedi, and Semirom, have retained major parts of their own native culture and are hung up on them.

55 Isfahan Township is located 424 km. south of Tehran and is the capital city of the province; Isfahan is situated between two mountain ranges. In the west, mountainous area runs upto Chahar Mahall Province and in the east there are Ghahrood and Karkas mountains. In Sassanides time, Isfahan was residence of and governed by "Sporrans" or the members of seven noble Iranian families who had major royal positions. Moreover, in this period Isfahan was a military center with strong fortifications. Arabs occupied this city after final defeat of Iranians. After Islam, Isfahan was under domination of Arabs, like other cities of Iran, till the early 4th century AH and it was paid attention to only by Caliph Mansour. In the reign of Malekshah Saljoughi, Isfahan was again selected as capital and began another golden age. In this period, Isfahan was one of the most thriving and important cities of the world. Mongols conquered this city in 639 AH and they massacred the people. After the invasions of Mongols and Taymour, as the result of its suitable geographic situation, Isfahan flourished again especially in Safavid time and developed considerably. After selection of Isfahan as capital by Shah Abbas in the year 1000 AH. it reached to its pinnacle of briskness. Defeat of Safavid dynasty by Mahmood Afghan and conquest of Isfahan in a 6-month siege started a degeneration period for this city. In Afsharieh and Zandieh times it flourished again but during Ghajars reign, due to them choosing Tehran as capital, Isfahan began to decline once more.

"Isfahan, regarding its historical and geographic conditions, was paid attention during Pahlavi time and some endeavors were made for repair and restoration of historical monuments. Moreover, Isfahan Township

56 and the province redeveloped and industrialized rapidly. During last two decades, Isfahan developed with a very high rate of acceleration from urban development point of view, with restoration of historical monuments. Isfahan was a hunting ground of royal family in Ghajar time and there are some vestiges belonging to this period" [5].

Researcher has studied seventeen health centers from the following townships:

Ardestan Township is located 416 km. south of Tehran on the eastern outskirts of central mountains adjacent to Kavir (desert). There are isolated mountains, extensions of Karkas Mountains, to the south of the city. The climate is warm in the northern parts of the city and cold in mountainous area of the south. According to different narratives, Ardestan is an old city founded by Dastan Saam, father of Rostam. Ardeshir, the founder of Sassanides dynasty built a fire-temple there. It is also the birthplace of Anooshirvan. In early 4th century AH it was a fortified city with 5 gates covering an area of 1 square mile.

Khansar Enjoyes a pleasant weather. This eye-catching city is located in the western part of Isfahan. According to existing historical evidences, the age of the city is more than 1000 years. Since Safavid time, Khansar was one of the large scientific centers and so many great Shiite scholars were educated there.

Khomeini Shahr Khomeini Shahr city is one of the historical cities of the province with its antiquity dating back to Sassanides era. It is said that, Kohandezh (old castle), which is located on the way to Isfahan,

57 had been the capital of Sassanides. Atashgah (fire-temple) mountain, Menar Jonban (shaking minaret), and Jame' mosque of Khazan are among other historical monuments of the region. The old name of Khomeini shahr was "Sedeh", which was changed to Homayoun Shahr in Pahlavi period and after Islamic Revolution in 1979, it was named Khomeini Shahr .

Semirom Semirom Township is 590 km. away from Tehran located in a mountainous area and Denyar Mountain is situated on the southern part of it. The climate of this region is mountainous and temperate. This city is one of the countryside of Isfahan province having a famous waterfall and several springs.

Shahreza (Qomsheh) Shahreza township located 508 km. south of Tehran, with Zard Kooh mountain chain running from north-west to south-east of the city, enjoys a cold climate. It is an old city which was first named Qomsheh, but later on its name was changed to Shahreza due to existence of His Holiness Shahreza's Shrine over there.

Freydoon Shahr According to existing historic and geographical evidences, this city was a part of "Partikan" region that included Freidan and Freydoon Shahr. The remains of several ancient tombstones in Ghahestan farm indicates the long history of the region which is many thousands of years. This region is the center for summer quarters of Chahar Lang Bakhtiari tribes.

Felavarjan Township is one of the old and historical regions of the province. It was called Balavarjan due to construction of a bridge across

58 Zayandeh Rood in Safavid time. Then it was named Felavarjan, a name tliat continues till today.

Freidan, Located in a plain region 424 km. away from Tehran enjoys a mild and mountainous climate. The most important worth seeing things in this township are life style and traditions of Bakhtiari tribes who use it as their summer quarters

Kashan is located 258 km. south of Tehran. A part of this township is located in a vast plain and the other part in a mountainous area. The central heighlands of the country cross this township. The climate of the township, like other central parts of Iran, is variable depending on topography of the region. The mountainous areas are cold and the plain areas, especially the desert margins, are warm. Kashan is one of the oldest cities of Iran. According to archeological excavations in Sialk hills (located 4 km. west of the city) and vestiges found over there, indicate that this area was a home of pre-historic Man. It was a thriving city in Sassanides time. In Islamic period it was a famous city as well. The local architecture of the city is unique and very interesting.

"Natanz Township is located 338 km. south of Tehran in the eastern valley of Karkas mountain. The western and southern parts of it are mountainous, enjoying a cold climate. Northern and eastern parts are sandy with mild weather. According to writings of Moslem geographers, Natanz is one of the old regions of Isfahan province and "Vashagh" castle over there was named after its ruler (4th century AD.) The famous historian, Hamdollah Mostofi, talks about the craftsmen of

59 this city and their fame for making deUcate handicraft articles made up of ivory and ebony. Their products were exported to other cities" [6].

2.3. History of medical sciences in Iran

Science including medicine has a long history in Middle and Near East and goes back to the ancient Mesopotamian period (Beginning with Sumer 3000BC). There are many cuneiform tablets from cities as ancient as Uruk (2500 EC). The bulk of the tablets that do mention medical practices have survived from the library of Asshurbanipal at Nineveh (668BC) Assyria. So far 660 medical tablets from this library and 420 tablets from the library of a medical practitioner from Neo- Assyrian period, as well as Middle Assyrian and Middle Babylonian texts have been published. The vast majority of these tablets are prescriptions, but there are a few series of tablets that have been labeled "treatises". One of the oldest and the largest collections is known as "Treatise of Medical Diagnosis and Prognoses." The text consists of 40 tablets collected and studied by the French scholar R. Labat.

The first major Iranian dynasty Achaemenid (550 BC) promoted the development of culture and science extensively. The great scholars such as the philosopher Heraclites of Ephesus, the Babylonian astronomer Kidinnu and even the historian Herodotus were Persian subjects.

Achaemenid made Babylon one of their major capitals and extensively used the texts at the temple libraries. The library and museum at the was built to rival the Babylonian archives famous in the ancient world. Greek and Egyptian physicians were invited to join the

60 Achaemenid court and served the royal household. Persians also adopted the tradition of paying the physicians according to the rank and gender.

Science and technology flourished during the Sassanian period with establishment of major centers of learning including the famous Jundaishapur 'university'. The Sassanian king, Khosrow Anoshirvan is credited by many historians and biographers to have been a major promoter of all sciences including philosophy and medicine.

The famous university and the hospital at Jundaishapur built earlier reached its peak during Anoshirvan's time. The hospital and the medical center were to become the model on which all-later Islamic Medical Schools and hospitals were to be built. Earlier Muslim historians such as Maqdisi (10th century) mention the medical school in Khuzestan and name its famous associates and practitioners. The famous writer and translator, Borzoi who translated the Indian book of fables the Panchatantra (later, Kalila wa-Dimna) for Anoshirvan was also a well-known physician from . The first recorded Muslim Physician Harith bin Kalada had studied at Jundaishapur Medical School. In Jundaishapur Greek, Indian and Persian scientific traditions were assimilated. Indian scientific material in astronomy, astrology, mathematics and medicine were also translated into Pahlavi along with Chinese Herbal medicine and religion. The books were kept at the university and the royal libraries and Greek medicine based on works by Hippocrates and Galen dominated the discipline . The later Muslim historians refer to the Sassanian Imperial library as the House of Knowledge (Bayt al Hikmat). The library is a place for documents of Iranian history and literature that were transcribed and preserved. At the same time it was a place where qualified hired translators, bookbinders and others worked to preserve, purchase, copy, illustrate, write and translate books.

Christian and Jewish learned families of Sassanian Persia such as Bukhtishu and Hunyan families were also great translators of Syria Greek Pahlavi and other texts into Arabic. Both families had served at Jundaishapur University for generations and were instrumental in founding the Adudi Hospital and Medical School in Baghdad .

"The Nestorian physician, Jabrail ibn Bakhtishu was the head of the Jundaishapur University when he was called to Baghdad in 148 AD as the court physician to Caliph al-Mansour. He was later credited for building the first hospital in the city based on the Syro-Persian model already established at Jundaishapur. He went back to Iran but many members of his family served the Abbasids for a long time. The Adudi hospital was buih under the instructions of the great Iranian Physician Razi (Latin Rhazes, he was from Ray) and resembled the great hospital in Jundaishapur" [7].

The celebrated Iranian physician and philosopher Abu AH Sina (Avicenna, 980-1037) wrote 100 books in many subjects including his most famous compendium, Canon of Medicine. His magnum opus is one of the classics of medicine ever written. He extensively studied herbal medicine from China, India and Persia. Avicenna like his

62 predecessor Farabi (another well known Iranian) was an outspoken empiricist and insisted that all theories must be confirmed by experience. He argued against the blind acceptance of any authority and improved distillation techniques.

Religious leaders fiercely opposed anatomy and no new knowledge emerged till the advent of modern medicine and importation of European medical knowledge into the Muslim countries in the 19th century. The second half of the 19th century is the beginning of major political and ideological transformations in Iran and the start of modernization processes. Modern sciences and western ideas of democracy, civil society, enlightenment, human rights, and, emancipation of women, were introduced through translation of European texts into Persian. The Armenians of Isfahan for their exclusive use imported the first printing machine in 1641. However the first printing machine in Persian started work in Tabriz in 1813 and the book industry was changed forever.

Since the beginning of the modern era, the idea of founding a university in Iran and Tehran had occupied the minds of a great number of Iranian experts. All these experts believed that establishing a university in Iran was one of the ways to provide modern sciences and technology to this underdeveloped land of the Qajar dynasty. The first modern school, Dar-ul-Fonoun (House of technology) started in 1851 with a few European instructors, and texts were translated from a number of European languages to introduce Iranian pupils to modern sciences. Also, the Dar-ul Fonoun (House of Technology) School was the first

63 scientific building to be built in Iran in a modern style. In the beginning, medical sciences, chemistry, military sciences, engineering, and mining were taught at Dar-ul Fonoun, but some other courses like physics, literature, and political science were later added to the curriculum.

Afterwards, in the year 1298 (1919), Dar-ul Mo'alemin (House of Teachers) was founded in Tehran to educate teachers. This teachers' education center was later transferred to Bagh-e Negarestan in 1311 (1932) and its name was changed to Danesh Saray-e A'li (The Higher Education Academy).

The idea of establishing Tehran University was discussed in the Majlis several times and on May 1934, was ratified by an absolute majority. After being ratified by the Majlis, as the building of the university was not ready, some temporary buildings were selected to host the different faculties of the university in the interim period. The Danesh Saray-e A'li building in Bagh-e Negarestan was chosen to host the two universities of literature and sciences. The universities of law, political, and economic sciences were set up in a building in Atabak Alley, which later became the Adib High School, and finally the house of Dr. Hossein Mo'tamed was selected to host the University of Medical Sciences.

Reza Shah Pahlavi attended the groundbreaking ceremony of the university on Bahman 15, 1313 (February 3, 1935), and the cornerstone of the first faculty of the university was laid on the same day. The first faculty to be built in the complex of Tehran University was the faculty of Medical Sciences. This faculty is still located in the northern part of

64 the university campus. The autopsy hall of the faculty, built in Khordad 1314 (May-June 1935), was the first building of the university.

"The first chancellor of the university was AH Asghar Hekmat, the former minister of education. But the first independent chancellor of the university was Dr. Ali Akbar Siasi. During Dr. Siasi's term in office, the numbers of faculties were increased. In 1327 (1948), the university was scheduled to begin the new educational year on Bahman 15 (February 3), but it was postponed until Mehr 1 (September 22) due to an assassination attempt against Mohammad Reza Shah Pahlavi.

The Tehran University of Medical Sciences was later separated from Tehran University, and, as an independent university, trained a great number of professional physicians" [8].

Educated Iranians joined and in no time tons of books in Geography, Engineering, Medicine, Military, Biology, Mathematics and other disciplines were translated. The modernization movement resulted in the constitutional revolution (1906) and secularization movement began in the country. The medical School at Tehran was the first faculty and soon more modem universities followed in other parts of the country. In 1936 for the first time 12 women were admitted into Tehran University. The medical schools at the major universities enjoyed a high standard and graduates of these universities had no problems continuing postgraduate studies in any of the major medical schools in Europe or North America.

65 2.4. Education system in Iran

"Since the Islamic Revolution of 1979 in Iran, the educational system of the country has undergone qualitative and quantitative changes. As far as quantitative changes are concerned, this education profile provides an overview of the Iranian education system. A critical assessment of the strengths and weaknesses of the Iranian education system requires an in-depth analysis of its structure, which goes beyond the scope of this profile. This profile, nevertheless, seeks to provide basic information about the education system in Iran for those who are interested in becoming familiar with this system, particularly those post-secondary institutions abroad, which have admitted many Iranian students in recent years. According to the Iranian Ministry of Culture and Higher Education, there are approximately 50,000 Iranian students currently studying abroad" [9].

Also, higher educational system has an important role in training human resources, in developing individual capabilities and in bringing about social, cultural and economic changes. Given this significance, its efficient functioning and productivity are matters for permanent study and scrutiny. Conducting research and evaluating the system to promote the quality of education and to increase its effectiveness have become essential objectives in any educational system. This is particularly true in the case of medical education that is concerned with the provision of national health care.

In spite of the constructive efforts made after the integration of medical education with the health services in Iran, "there are still many pitfalls

66 and barriers in the educational system of the country which warrant urgent attention. One objective of the integration was to increase the admission to medical schools and as a result, number of students in each class increased dramatically. Teachers dealt with this difficult situation by relying more on a lecture-based teaching format rather than having the students' active participation in the learning process. This was seen more in the basic sciences, which is more theory driven, than in the chnical sciences, which is more practically oriented. Consequently, a gap was created between basic and clinical sciences and Mirzabeygi addressing this problem, called for an integration of basic sciences with clinical sciences which would serve as a bridge between theory and practice" [10].

This profile, thus, describes the structure of the higher education and medical education system in Iran.

2.5. Higher education in Iran

During the reign of Nasser al-Din Shah of Qajar Dynasty, the Ministry of Science was established by E'tezad al-Saltaneh. He was appointed the first minister of science in 1858. Between 1925 and 1934, when the University of Tehran was founded, many schools, institutes of higher education, colleges and other similar institutions were set up and started operating. In 1935, women began to be admitted to centers of higher learning.

During the reign of Reza Shah the first king of Pahlavi Dynasty (from the establishment of the provisional government in 1925 to the Shah's

67 downfall in 1941), Iran witnessed one of the most eventful epochs in its history. World developments and the need to secure the interests of the great powers, coupled with the strategic location of Iran, brought about a need for a transformation in the social structure. The first steps were taken during the Qajar period, but these were not comprehensive measures. Thus, the "modernization" or the "modernist" program was launched in Iran.

Promoting higher education inside the country and the need for establishing institutions for this purpose, were considered primary objectives, especially since specialists in science and technology were required for various projects. In the beginning, schools from the Qajar period, in addition to a number of newly established ones, carried on with their activities in the field of education. Later on, some of these schools merged to form the University of Tehran. Subsequently, other centers of advanced learning began operating, some of which were also absorbed into the University of Tehran after August 1941 .

The 'Vezarat-e Ulum' (the Ministry of Science) was organized by Ali- qoli Mirza (Etezad al-Sahaneh) during the reign of Nasser al-Din Shah. He was appointed the minister of science in 1858. The Ministry of Science was responsible for overseeing the activities of all institutions of learning in the country. In 1868, it was renamed the 'Vezarat-e Maaref va Oghaf va Sanayeh-e Mostazrafeh' (the Ministry of Science, Endowments and Fine Arts), keeping this name until the last years of the reign of Reza Shah, when it was started to be called the 'Vezarat-e Farhang' (Ministry of Culture). From the onset of the Pahlavi dynasty

68 until the downfall of Reza Shah in August 1941, seven persons succeeded each other as minister of science. Mirza Yusef Khan Mushar-e A'zam held the first post in the 1925 cabinet headed by Furooghi. His title was "Kafil-e Vezarat-e Ma'aref (the acting head of the Ministry of Science), eventually becoming the minister of science in 1926.

"In the Ministry of Science's yearbook, two schools are listed as being for higher education; namely, "Tebbi" (Medical School), and "Hughoogh"' (Law School). In addition, two other schools with the names "Ulum-e Siasi" (School of Political Science) and "Dar al- Mu'allemin-e Markazi" (Central School for Teachers' Training) are mentioned. But as classes of the School of Education had not started during the preceding three years, and the School of political science was run by the Foreign Ministry, they were not counted among the state institutions for higher education" [11].

Saeed Nafissi wrote [12] : "In the period from 1925 until the establishment of the University of Tehran, there existed in Iran one medical school, one school of law and political science, one school of education, one for agriculture, and one for business. These conferred knowledge to the Iranian youth at a higher level than that which could be gained from the high schools." But it must be mentioned that apart from these institutions, there were other centers for higher learning, such as the Officers' College, the State School of Art, the School of Engineering, the Higher School of Midwifery, and the Alborz College, which was established by the Americans and after the banning of

69 foreign schools in 1940, came under the Jurisdiction of the Ministry of Culture .

In general, until 1923, only men were admitted to the higher educational levels, with the schools located in Tehran. Some centers of learning though were not under the jurisdiction of the Ministry of Culture as they were formed to satisfy the personnel needs of some ministries. In particular, the Foreign Ministry initially ran the School of political science, the School of Law was under the jurisdiction of the Ministry of Justice, and the Ministry of Economy was running the School of Business ("Vezarat-e Favayed-e'Ammeh"). These were later turned over to the Ministry of Culture. In these schools, the expertise and knowledge of foreign instructors were also availed of for the purpose of reforming and updating the curricula. It should be mentioned that the establishment of many of these schools, including the School of Medicine and Pharmacy, the School of Political Science, and the School of Law, went back to the Qajar period, and during the reign of the first Pahlavi, they expanded and developed further .

"Another factor that characterized these schools was that they charged fees: in 1920 at the suggestion of the Ministry of Science, all state -run high schools and centers for higher learning started collecting a specified amount from students, with some exceptions allowed for special cases" [13].

Comprehensive universities, specialized universities, universities of technology, medical universities, teacher training centres and private institutions, provide higher education in Iran. Most universities are

70 State institutions. Particularly, the Ministry of Culture and Higher Education and, particularly, the Supreme Council on Higher Education Planning (SCHEP), and the Ministry of Health and Medicine coordinate university activities.

In the present, all Public Universities and Higher Education Centers are affiliated with Ministry of Science, Research and Technology. Of course, all Universities of Medical Sciences are supervised and organized by "Ministry of Health, Treatment and Medical Education". Furthermore, there are other higher education institutes that are affiliated with other ministries including the Ministry of Education, Ministry of Foreign Affairs, Ministry of Communication and Technology, Ministry of Roads and Transportation, etc. Students in the Daytime system of education pay no tuition fee to public universities but the so-called Night time students have to pay their relevant tuition fee. Tehran University was the first university of its modem style founded in Iran in 1934.

Distance Education (Payam-e-Nour University): Payam-e-Nour University was established in 1987 to offer distance education courses at undergraduate level. Payam-e Noor University admitted students in 18 disciplines level in the academic year 1998-99 through nationwide entrance examinations. Of a total of 146,990 students in the academic year 1998-99, 76,437 (52%) were female and 70,553 (48%) were male.

71 Table 2.1. Higher Education in Iran

Type General Title #Canipuses #Students Male Female

Public Governmental 189 446,135 64% 36% University Public Payam-e-Nour 130 146,990 48% 52% University Private Islamic Azad 126 613,476 68% 32% University Private Nonprofit Higher 33 23,000 Education Institute Total number of 478 1,229,601 Higher Education centers

Islamic Azad University (lAU): As the first private university established in 1982, lAU is presently active with over 126 branches in Iran with more than half a million students. All campuses are supervised and governed by the Central Organization of Islamic Azad University", located in Tehran. Students are required to pay the relevant tuition fee based on the entering year, major and level of study.

Non-profit Higher Education Institutes: At the moment, some 33 "Non­ profit Higher Education Institutes", offering both undergraduate and postgraduate courses, with about 23,000 students is active in Iran.

Statistics of Higher Education in Iran: "In this Section, statistics of higher education in Iran for the academic year 1998-99 is presented in

72 both public and private sectors. Statistics of public sector includes universities and higher education institutes of the Ministry of Science, Research and Technology and Ministry of Health, Treatment and Medical Education and statistics of private institutes includes Islamic Azad University and other private institutes.

Enrollment: As shown in Table 2.2, the highest number of students were admitted in the humanities with 47.98 percent, followed by engineering with 21.64 percent, pure sciences with 11.4 percent, medical sciences with 10.01 percent, agriculture and veterinary medicine with 6.28 percent, and the arts with 2.95 percent.

Table 2.2. Enrollment by field of study In public and private sectors (1998-99)

Institute Public Private Total Field No. Percent No. Percent No. Percent Humanities 62367 38.83 104480 55.84 166847 47.98 Pure 21942 13.66 16781 8.97 38723 11.14 sciences Agriculture 9698 6.04 12139 6.94 21837 6.28 &vet Engineering 33161 20.65 42073 22.49 75234 21.64 Medical 26065 16.23 8761 4.67 34826 10.01 Sciences Arts 7382 4.60 2873 1.54 10255 2.95 Total 160615 100 187107 100 347722 100

73 B. Students: Table 2.3 shows the number of students in pubhc and private sectors by field of study. The highest percentage of students belongs to the humanities group (50.54 percent), while the lowest percentage of students belongs to the arts group (2.41 percent). The number of students in public sectors in the medical sciences group is (15.54 percent) and the number of students in private sectors in the medical sciences group is (5.54 percent). In total the number of students in the medical sciences group is (10.29 percent).

Table 2.3. Number of students by field of study In public and private sectors (1998-99)

Institute Public Private Total Group No. Percent No. Percent No. Percent Humanities 258810 41.55 402376 58.71 661186 50.54

Pure sciences 90996 14.61 52386 7.64 143382 10.96

Agriculture 37952 6.09 41655 6.08 79607 6.08 i&vet

Engineering 117342 18.74 140507 20.50 257849 19.72

Medical 96760 15.54 37960 5.54 134720 10.29 sciences

Arts 20962 3.37 10444 1.52 31406 2.41

Total 622822 100 685328 100 1308150 100

C. Graduates: As shown in Table 2.4, humanities had the highest number of graduates with 128,985 (52.34 percent) and arts had the

74 lowest number, with 4,819 (1.95 percent) and for medical sciences it was 26900 (10.92 percent).

D. Faculty members: In 1998, the total number of full-time faculty members in public universities and higher education institutes was 22,236, including 673 (3.03 percent) full professors, 1,441 (6.48 percent) associate professors, 8,605 (38.69 percent) assistant professors, 10,726 (48.25 percent) lecturers and 787 (3.54 percent) tutors" [14,15].

Table 2.4. Number of graduates by field of study

In public and private sectors (1997-98)

Public Private Total Institute No. Percent No. Percent No. Percent Field Humanities 31358 34.94 97628 62.31 128985 52.34 Pure sciences 10398 11.59 9740 6.22 20138 8.17 Agriculture & 6480 7.25 14903 9.51 21383 8.68 vet Engineering 18436 20.54 25776 16.45 44212 17.94 Medical 20117 22.41 6791 4.33 26900 10.92 sciences Arts 2865 3.30 1854 1.18 4819 1.95 Total 89746 100 156691 100 246437 100

75 2.6. Health care system in Iran

"Rural households in Iran have traditionally been the most disadvantaged segment of Iranian society, not only in terms of income and political power but also in accessing basic public services, including health. A major achievement of public policy in Iran over the past 20 years has been the improvement of rural health and the near elimination of health disparities between higher-income urban populations and the rural poor. For example, in 1974 the infant mortality rate was 120 and 62 per thousand live births for rural and urban areas, respectively. By 2000, however, both the level and the differential of infant mortality had declined considerably, to 30 for rural areas and 28 for urban ones" [16].

The Iranian primary health care (PHC) system was established to improve access to health care for the disadvantaged and reduce the gap between health outcomes in urban and rural areas. To improve access in remote areas in the face of shortages of human and capital resources, the system has relied on three main components: (1) establishing health houses in remote and sparsely populated villages; (2) staffing the health houses with health workers, known as Behvarzan, recruited from local communities; and (3) developing a simple but well-integrated health information system.

The health house, usually the only health facility accessible to the rural population, is the most basic unit of the Iranian PHC network. Located in individual villages, it is designed to cover a target population of about 1,500; each health house also serves several satellite villages

76 selected with careful attention to their cultural and social compatibility. The distances between the village in which the health house is located and the satellite villages served by it are typically, by design, no more than a one-hour walk.

Tasks performed by the health house include record keeping and data collection; public health education and promotion of community participation; antenatal, prenatal, and postnatal care; care of children fewer than five and of school-age children; family planning services; immunization; and disease control services. The second and third levels in the hierarchy of the rural health network provide backup for the rural health houses, offer diagnostic and treatment services, and refer those needing more specialized care to district health centers or hospitals.

There are also urban counterparts of these organizations. One male and one or more female health workers (Behvarzan) run each rural health house. The health workers are chosen from among local people familiar with the households in the village. Such a close relationship between Behvarz and his or her community facilitates the accurate collection of health information, among other things. Behvarzan have had a pivotal role in the success of Iran's PHC network. Although the primary responsibilities of the health workers are divided along gender lines, with the female Behvarz generally responsible for tasks performed within a health house and the male Behvarz for tasks outside the health house, both genders are trained for and expected to cover all duties, as necessary. Training occurs at the district level; students receive free training and financial support throughout the two-year training period.

77 In return, they are formally obliged to remain and serve at the village health house for a minimum of four years after completing their study.

The health information system (HIS) enables the Behvarzan to collect detailed information on rural communities. The main components of the HIS are the household file (containing demographic and health information), various logbooks in which daily activities are recorded, and monthly report forms.

The impact of the PHC system: The effectiveness of resources invested in the PHC system with reference to the improvements in the health status of the Iranian population in general, and the rural population in particular, the results are impressive. The PHC system is funded entirely by the national government, and the pattern of public health spending is oriented towards rural public health services—a fact that may partly explain the good performance with respect to rural infant mortality rates. The specific measures taken by the PHC system are almost certainly responsible for reducing infant and child mortality, eliminating major infectious diseases of childhood, and improving the health of mothers.

"These measures include the promotion of healthy attitudes and behaviors; the universal immunization of children; and encouraging mothers to breastfeed, use iodated salt, and provide appropriate treatment for children suffering from diarrhea and acute respiratory infections (ARI). A Multiple Indicators Cluster Survey (MICS) conducted in 1997 suggested a narrowing gap between urban and rural areas in terms of basic health interventions, including immunization

78 coverage and infant, child, and maternal health care intervention. Despite these advances, however, some disparities remain, for instance in areas such as health insurance coverage" [17]. Figure 2.1 shows district health system in Iran.

The presence of the community-friendly Behvarzan in the village, with their constant interaction with the community, has helped to ensure that health messages have not gone unheeded. Moreover, the ability of the PHC system to support the health messages by providing easy access to the means needed (vaccines, oral dehydration therapy, essential drugs, and so on) where and when they were required has also helped to bridge the gap often found between knowledge, attitudes, and practice.

"The family planning program in existence before the 1979 Revolution was revived in 1989. The program has been extremely successful. By 1996, more than 74 percent of eligible couples were using a contraceptive, and the total fertility rate had dropped from 6.5 to 2.6.

The traditional gap between urban and rural areas has also been substantially narrowed. Iran is making good progress toward the Millennium Development Goals, especially Goal 4, which aims to reduce child mortality and Goal 5, which aims to improve maternal health" [19].

Two Factors for success: political commitment and institutional innovation, the two factors, have been critical to the success of the Iranian experience. The first is the political commitment for change after the Revolution, expressed in a Constitutional mandate to provide

79 universal access to basic health services. This political commitment has been combined with institutional innovation and the broader involvement of communities and local governments in rural health system decisions.

Figure 2.1. District Health System in Iran [18]

Chancellor of University ofm| Sciences and Health Ser^^ #

Directorate of District Health Network

I District Health center

BTC : Behvaii Tiaiiiiiig Center HH :Healdi Houses SP : Specialized Polycbiiif \\'H\': Woman Healdi Volmiteeis

WHV i ml Health Center

HH HH rT~i

80 Culturally sensitive and cost-effective service delivery features—rural health houses, the Behvarzan. and the simple health information monitoring system, each of these institutional elements has been adapted and implemented in a way that has improved the chances of success.

Without the locally recruited Behvarz, staff turnover, absenteeism, and lack of knowledge about local circumstances could have rendered the physical facilities of the health houses much less effective. Simple health status tracking methods have made it possible to keep up with the evolving health needs of individuals as well as to detect village- level trends and disparities. These factors have helped Iran to develop a distinguished primary health care system.

Drawbacks in PHC system: "There are some weaknesses in Iran's PHC system. Most of the improvements seen so far are the result of outstanding efforts of the workers and health houses; other facilities are lagging behind. Also, institutions at the second and third tiers of the system do not support the health houses sufficiently. Urban health centers must tackle even more serious constraints, and the problem of limited building space in cities can be overcome only with increased government support. Finally, there is no transparent policy for collaborating with the private sector, training managers, and providing a sustainable mechanism for improving the quality of services" [20].

Next chapter deals with "IT & medical libraries and information centers" and contains the subjects such as medical libraries, hospital libraries, information technology and libraries, IT and medical library collection, IT and medical library services, IT and university libraries in Iran, university libraries collection in Iran, university libraries services in Iran, medical information & technology, medical informatics, and medical information in Iran. References

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