Wednesday, December 15, 2010

WHO-Iran Relationships & Iran's Health System: the Opportunities, the Challenges / An Interview with the Outgoing WHO Representative in Iran, Dr. Mubashar Sheikh

WHO-Iran Relationships & Iran's Health System: the Opportunities, the Challenges / An Interview with the Outgoing WHO Representative in Iran, Dr. Mubashar Sheikh
Date: 4/29/2008

TUMSPR News: On April 14, 2008 Dr. Mubasher Sheikh was invited to Tehran University of Medical Sciences, to be commemorated for his 4-year long undertakings in Iran. At the end of the session TUMS Public Relations' representative asked him for an interview and here is the interview in full:


On April 14, 2008 Dr. Mubasher Sheikh was invited to Tehran University of Medical Sciences (TUMS), to be commemorated for his 4-year long undertakings in Iran. At the end of the session TUMS Public Reklations' representative asked him for an interview. Here is the interview in full:

Dear Sir, I thank you for the opportunity you gave us (TUMS Public Relations) to conduct this interview.

Q - Would you please, elaborate on your educational achievements and the places as well?

A- I am a medical doctor and I am also holding the fellowship in community medicine as well as masters in public health from Yale University in the United States.

Q- Thanks. And when did you know Iran? I know you have been here for four years.

A- Actually, Iran has been very close to me and I’ve been engaged with Iran for many years_ almost 15-20 years. Before I join WHO, when I was working with the government of Pakistan, we were in touch with the brother, Iran, and I even visited Iran before WHO (mission), to study the model of primary health care, as well as its medical education in. And I have a number of friends in Iran from when I was studying.


Q- What’s your overall assessment of the health system in Iran, considering health indicators such as maternal mortality rate, < 1 and < 5 year-olds mortality rate, national nutritional status, medications, coverage of rural and urban health centers and especially those indicators that you have been in touch with? A – You know, as for as the health info system and the health infrastructure system concerned in this country, we believe in WHO, and this is may own experience while I’ve been working in Iran for the last four years now and form years of experience working in other parts of the world, I believe Iran has one of the best health systems, especially at the level of primary health care. Actually, WHO use it as a model and sort of promote other countries to follow it, and actually the infrastructure is good because it provides almost universal coverage to the people in this country. But you have also a very unique medical education and health service and that’s the integrated model of university of medical sciences that are both responsible for medical education as well as health services. But the important thing is that it has a very positive effect on the health indicators, you know, and that is very important. What are the outcomes? What are the impacts of the system? You can have a good system but if it does not produce good results, then it’s not important. So, I believe that this system has produced good results and most of the indicators in this country are in good shape and actually they are even better than many countries in the developed world, in the west, considering infant mortality, maternal mortality and under 5 mortality. And they have been in the last 15 to 20 years. If you compare the figures of early 80 s or late 70s to the figures now, there is almost a reduction of ¾ and the same is true for all other health indicators including nutrition, immunization, etc. This country has already eradicated polio, and now just working for the elimination of malaria, and actually many many others like measles, hepatitis and others. So, I think this country has done quite well and other important thing is the good support structures like good water and sanitation system which has already reduced the incidence of water-born diseases and I believe the country has done quite well and sort of, has shown that with a good infrastructure, well-trained human resources and good political commitment you can bring about good positive changes in the health system in a short time.



Q- As you have been here for sometime and been working closely with the health system, what are the weaknesses that we have to take care of and get help from WHO in Iran?

A- I think they are not necessarily weaknesses but challenges, because of different factors and the most important factor is that this country is undergoing transition; you know, there is an epidemiological transition. The population is very young in this country and the epidemiological transition because of the change in the health indicators, as well as better economic situation, life expectancy has gone up which has resulted in some of the burden of disease shifting from communicable to non-communicable or chronic diseases and people are living longer but at the same time the life styles, the behaviors are not very conducive to maintain good health and that’s why physical activity, diet and other things are affecting our health situation. That’s why burden of disease is more on chronic diseases like diabetes, cancer and cardiovascular problems.

Injuries and accidents are a major problem in this country and so on and so forth. So, these are the areas where the country now has to address these issues, in a way which, basically, the health system has to adjust itself and the human resources have to be trained for these issues. They have been mostly trained to address communicable disease issues in the past. We also need to have a good technology to address these issues but the technology which is cheap but of good quality, so that people could have access to that.

The availability of drugs and most importantly the prevention and that’s where the health notion is very very critical. These are some of the areas. But at the same time we have some unfinished tasks like malaria and TB that are still problem in some parts of the country and we have to continue working for that. And I think another major area is the emergencies, the disasters and earthquakes, because Iran is a high disaster country and again the preparedness level has to be emphasized so that whenever there is an emergency we can reduce the negative effects of the disaster.

Q- Regarding the collaboration centers, which areas are of more interest to WHO in Iran?

A- Actually, WHO is working in Iran on a number of areas and we have almost 12 collaborating centers at this stage which includes medical education, primary health care, some specific diseases like diabetes, cancer and cardiovascular diseases, but we have some other centers like (center) on osteoporosis which is in this university and many many more, on tobacco, on vaccines, etc.

These are important areas of collaboration between WHO and Iran, but at the same time we believe there is the potential for many more collaboration because this country, especially Tehran University of Medical Sciences is very strong in research and, basically, in a number of medical sciences. So, we are looking for more opportunities to work together and to increase the number of collaborating centers so that not only Iran but other countries in the region at a global level could benefit the expertise and knowledge which is available in this country.

Q- Talking about Tehran University of Medical Sciences, which from now on I shorten it to TUMS, what’s your opinion on the recent scientific innovations, for example IMOD last year, and this year, Angipars? And, how can we visualize them for other people in the world by the help of you as we have published papers on them but how can we reach other people who are in grave need for them, for example for diabetic foot ulcers?


A- Actually, TUMS is a mother university of Iran and it’s not only a major university or institution in Iran, but we in WHO believe that it is a center of excellence and a leading institution for the entire Mediterranean region and that’s why we have a close working relationship with Tehran University of Medical Sciences. Because it is very proactive and innovative in research, it is innovative in medical sciences and it is documenting a lot of the products that are the outcomes of research, as well as the lessons learned.

You know 46% of all the research which is published from Iran, comes from this particular university. So, that is a very very important area where WHO and TUMS are working together.

As far as these specific products are concerned, again it just shows the potential of this university because it has taken these steps which are unique in the world. And again from WHO’s perspective, we are quite happy that these things are coming out and we can use them for the benefit of people outside the country. But we have a process in WHO for registration and for qualification of medical products for patency and other things. So, I think now if the country feels appropriate and TUMS feels appropriate maybe they can approach WHO, negotiating with us or approaching us and share with us all the information, because there are standards and the information we have to fulfil all those criteria. So, if the university can, basically, share that information with us and, basically, apply for the pre-qualification and registration with WHO, I am sure that WHO will be very keen to look into this area very sympathetically, very positively, and I hope if every thing goes well these drugs will be pre-qualified and registered with WHO, so that they can be used in other parts of the world.

Q- What do you think of Iranians in general?

A. Iranians in general (He smiles) I personally believe, as you must have heard that I feel that I am like an Iranian. I mean, I don’t think any to say more than that, but I am originally from Pakistan and Pakistan and Iran have a long history of brotherhood and close relationship. So, I have a close relationship and affinity and likeness for the people of Iran.

To begin with, it’s a wonderful country. It’s a beautiful country, it’s rich in heritage, it’s rich in culture and, basically, I have learned a lot in this. But I think the best thing about this country are the people. They are so hospitable, they are so friendly, and they are so positive in their approach. I and my wife and my family really enjoyed staying here. Four years just passed so quickly. But I must say we are leaving with a heavy heart. We really enjoyed staying here and we made a lot of friends and I am sure, I will maintain these friendships in future and will meet this country and the people a lot.

Q- By leavening Iran, the opportunity is lost to use your knowledge and expertise, but in your new position, would you continue doing the good job, regarding Iran?

A- Actually, in my new job, I will be working as the executive director of the Global Health Workforce Alliance and the Global Health Workforce is intended to work with the countries to address the issue of human resources and, basically, when we are looking at the situation, we are facing severe shortage of human resources in different parts of the world, especially in Africa, as in some parts of Asia and Latin America, and also in the developed world, in the US, in the West, there are lots of people migrating from the developing world and that is creating a big burden and a problem for the heath services in these poorer countries, because they are investing in these people then they are leaving to other parts of the world.

So our job and my mandate will be to work with both levels, work with poorer countries, as well as rich countries to overcome this crisis of human resource. And we need to work together to make sure that enough human resources are of good quality, they have good working environment and conditions, so that they can work within their own countries. I think Iran again can provide a very good example and a model and a very good partner in our efforts to do that, because this country has achieved very well in human resource production in the last two decades and it has a very strong system of medical education, so, my intention is to work very closely with Iran, especially TUMS, so that, not only we benefit both with each other for research and promotion and generation of knowledge but also to use the expertise and the faculties of this particular institution for the production of health workers in Africa, as well as in neighboring countries like Afghanistan and some central Asian republics.

Q- What would be your message, especially for those involved in the health sector?

A- My message for the people who are active in health is that, it’s a noble area, what we are and all who are engaged in the health works, regardless of the category, starting from volunteer or community health workers level or all the why to the chancellor and the minister, I think all of them are contributing to a cause which is basically very close to our religion. Our religion says, if one person is benefited or if you save the life of ore person, then you save the life of the entire humanity, so, I think it sums up the nobility, as well as the seriousness of the profession. So, I think all of us should be proud of what we are trying to do. But, I think we need to continue our efforts. We need to work even harder to make sure that, basically, we make sure that the health services are accessible to each and everyone, to those people who need and at a price which is affordable and of quality.

I think we can work together and we can save more and more lives and we will go with high head or high face in front of God on the day of judgement.

Q- You have been working closely with Iranians, especially with the health system in the last four years. What would be your message for your successor, Dr. Ambrogio Manenti?

My message will be very simple for my successor. That you come to this country; this country has such a rich experience, knowledge and great people, not only in the general term but in the health sector as well.

So, take full advantage of this opportunity, enjoy yourself when you are here but make good friends, develop partnerships, increase the collaborations between WHO and the country, find out various institution where you can mutually benefit each other. The best thing is that, this country has so much to offer, sort of, identify those opportunities and then try to benefit other countries from the skill, the knowledge and the competence which is available in this country.

Q- As the last question, if you may wish to be remembered for one thing (when you’ve left Iran) what would that be?

A- (He laughs) one thing. That’s a tricky question. I think, what I can say, is the satisfaction, both at professional and at personal levels which I received while working at this position.

Professionally, I really got a lot of satisfaction and a lot of challenge (and) at the same time, the kind of response, the kind of friendship and the activities we could do together. That gave me that incentive to continue working, but also that satisfaction that we eventually managed to do something together, between Iran and WHO, which was not only beneficial for this country but for other countries of the region as well.

- Dear sir, I appreciate very much for the time you provided.

Dr. Mobashar Sheikh: My pleasure. Thank you very much. I really appreciate.

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