Evolution of Iran’s health research system over the past 50 years: a narrative review

Abstract

BackgroundA substantial growth has been reported in Iran’s health research output over the last recent decades, throughout the times of economic, social, and political instability. This study reviewed the existing literature to provide a better understanding of the evolution of Iran’s health research system over this period.MethodsA narrative review of studies addressing health research system (HRS) in Iran was performed. The search strategy and categorization of the retrieved data was informed by the HRS framework of the World Health Organization (WHO). This framework proposes four functions for HRS: (i) stewardship; (ii) financing; (iii) creating and sustaining resources; and (iv) producing and using research. Searches in MEDLINE through PubMed (using MeSH terms) complemented with semantic searches through PubMed and Google Scholar were conducted.ResultsAfter removing the duplicates, 805 articles were retrieved, of which 601 were irrelevant, and 204 were reviewed.ConclusionsIran has made substantial progress in different components of its HRS over the last few decades, such as starting a discourse surrounding health research ethics, priority-setting, and placing monitoring mechanisms while increasing the capacity for conducting and publishing research. However, there is still room for improvements, or even a need for fundamental changes, in several components, such as regarding increasing the research budget and improving the funding allocation mechanisms; improving the education curriculum; and promoting the use of evidence. The findings emphasized that improvement of HRS functions requires addressing context-specific problems. This review provides essential lessons to share with other low- and middle-income countries and international organizations, eg, the WHO.

How to strengthen a health research system: WHO’s review, whose literature and who is providing leadership?

“…First, we can examine the papers published in HARPS, the specialist journal in the field of building NHRSs. Second, we can focus on two very different but detailed studies of individual NHRSsone conducted for a PhD thesis to show the 50 year history of the development of all the functions in the Iranian health research system [32] and the other an interview-based study to understand the factors behind the creation of the NIHR with its new strategy [33].…”

“…The authors of two single-country papers on the development of the health research system, Mansoori [32] about Iran and Atkinson et al [33] on the creation of the NIHR in England, both highlight the importance of context but also claim their findings could have wider application. Examining these two papers is also informative because of the differences between the studies, including one being located in a low-or middle-income country, and the other not.…”

“…Mansoori's narrative review of studies addressing the health research system of Iran included 204 relevant and mostly national records, categorised using an approach informed by the functions and components of WHO's NHRS framework [32]. The papers and grey literature documents included were all available in English or Persian, and mostly published in journals other than HARPS, and illustrate the vast literature available at a global level on the various components of a NHRS.…”

“…For example, the account of the development of the national level ethical overview includes a fully documented chronology of the progress over 25 years and some insightful analysis of how the progress was facilitated by the pivotal role of Professor Bagher Larijani, who was a prominent medical practitioner, leading researcher and founder of the Medical Ethics Research Centre in Iran. He was able to "use the confidence that Iranian authorities had in him as an opportunity" [32].…”

“…First, the full range of papers published in HARPS in the 30 months up to February 2020. Second, the range of data gathered from publications or interviews that is included in detailed studies of the national health research systems in two countries -Iran [32] and England [33]; between them, these two papers also illustrate diverse aspects of the additional material that could be drawn upon. 3.…”