Family Doctor Programme

The family doctor programme which was drawn up with the aim of all people’s fair access to health services and cost controls, initially in 2005 began in rural regions and urban regions with populations below 20,000. This programme has not fully been established due to unavailability of infrastructures.
In response to this programme not being operational, the Health Ministry points out to the time consumption of the implementation of a nationwide family doctor and referral system programme, and has stated that its necessary infrastructures are in the completion stages. The Health Minister has said that 10 provinces will in 2018 begin the family doctor programme universally. The Parliament’s Health Commission too resolutely wants the implementation and universalisation of this programme. This Commission believes that the implementation of this programme can to an extent reduce the hygiene costs.

Who is the family doctor and what are his or her responsibilities?
The family doctor is a doctor who is responsible to cover health services for individuals without age, gender, economic-social characteristics and health risk. He or she can if needed refer the patient to a specialist. The family doctor is the custodian of a health team too, and has a specified population under his or her cover. When signing a contract, each family doctor must introduce his or her replacement family doctor from the same neighbourhood so that the replacement doctor can accept the particular conditions of the patients and provide necessary health services to them. As well as the family doctor, by creating health teams, the government tries to promote the family doctor programme. In each neighbourhood one family doctor is responsible for managing and supervising the performance in that neighbourhood, who is called the family doctor in charge or in charge of the health of the neighbourhood.

Implementation method of the health doctor programme
The family doctor and the referral system taskforce of each town where the family doctor and referral system programme is implemented introduce the family doctors to those that are insured. Those that are insured and are heads of household with having a national code, can select through choice one of the family doctors in their area of access as their and their family’s family doctor and can in person register at the doctor’s office.
Furthermore, a group with knowledge and skills in the health, treatment and rehabilitation services, provide a first level services package to the defined individuals and the family doctor is responsible for these groups. To receive health and medical services all individuals of society must enter the health services cycle through this team, otherwise they must pay full related medical costs themselves.
This programme’s aim is to present medical services which include all out patient treatments, filling necessary prescriptions, doing tests for medical diagnosis, request for counselling and follow ups on cares that have been done or are to be done for patients and also basic and priority rehabilitation services.

Health and hygiene treatment services and health care services are in three categories:
Level one: includes the family doctor base and health treatment services of the executor of family doctor programme and referral system which form the health promotion, prevention and initial treatment services, registration of information in health files and referral and follow up on the patient, conducting educational programmes for the promotion of public health. Approximately for every 10000 people covered, there will be one executor of the family doctor and referral system centre. One nurse or midwife will present services alongside the doctor in the family doctor base of the programme executor.
Level two: specialised out or in patient medical and rehabilitation services, writing prescriptions, and request for para-clinic services will be made available to those referred from level one, and then the family doctor will inform the body that made the referral of the conclusion of his or her work.
Level three: includes ultra-specialised out or in patient medical and rehabilitation services, medicine supplies and other medical equipment and para-clinic services. The feedback of the services of this level will be made available to the one that has made the referral and the family doctor.

Family doctor programme highlighted points
- E-files
One of the special points of the family doctor programme is the creation of e-files, and the family doctor and the health team completes a health e-file for each individual. The health e-file is linked to the collective of information regarding the health of citizens which is digitally backed up continually throughout the lives of individuals and is accessible to authorised individuals without time and place restrictions.
- Referral system
The collective of family doctors alongside governmental and nongovernmental centres that in levels two and three present health, diagnostic, treatment and rehabilitation services either out or in patient form, make up the referral network. Referral is a collective of processes that determines the direction and communication of the individual in the three levels to receive required services.

Criticisms given to the family doctor programme
The family doctor programme also has its opponents and critics. Complaining about the unsuitable status of the general practitioner in the health system the senior advisor to the director of the Food and Medicine Organization believes that there is very clear difference between a general practitioner who is one of the most important lines of treatment with specialist or ultra-specialist doctor in the Health Ministry. Meaning that in the referral of patients the family doctor has no role and is forced to refer the patient to the specialist or ultra-specialist.
In response to this criticism, the director of the Health Ministry’s Network Management Centre pointed to a shortage of general practitioners and deemed the shortage of general practitioners and family doctors across the nation as one of the problems in the implementation of this programme and said: “the three training, treatment and health deputies in the Health Ministry launched a joint programme last year for training family doctors. Ten medical sciences universities at specialist levels, train family doctor students, the numbers of which will increase in the coming years.
Also budget shortage, lack of suitable culture building prior to the implementation of the family doctor programme and the coinciding of the health development programme with the referral system which causes confusion among the public is another one of the problems that this programme faces.

We believe that the family doctor and referral programme is potentially a practical and advanced programme and can be an important step towards the improvement and promotion of the right to health of the people of the country. In the event that this programme and solve part of the health problems with a correct practice, the right to health in Iran will enter a new stage. If this programme is implemented with care and appropriate policy setting, can notably help to create a suitable basis towards the promotion of a culture of good and apt use of para-clinical and medical services of the country. The improvement of the right to health situation can guarantee the advancement of the sustainable development indexes too.

* The referral of medical services system is a method of providing health and medical services where the patients in a series of processes go to medical centres which starts with the family doctor.

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