According to the Director General of Human Resources at the Ministry of Health, there is a shortage of approximately ninety thousand personnel in the healthcare sector in the country; furthermore, during the peak of the COVID-19 situation, this ministry announced a shortage of approximately one hundred thousand nurses. What is the reason for this shortage of human resources at the Ministry of Health? While there is a high demand for medical and healthcare fields such as nursing, why does the Ministry of Health face a shortage every year? Why has the healthcare system of the Islamic Republic of Iran been unable to compensate for its shortage of medical personnel after forty-four years? This report takes a brief look at the reasons for the Ministry of Health’s inability to provide adequate medical personnel.

One bed for 1250 people.

Saifollah Moradi, the director general of human resources at the Ministry of Health, announced two weeks ago that there is a shortage of 24,000 medical personnel and 60,000 human resources in the field of health; (1) Also, about a year ago, Abbas Abdi, the deputy of nursing at the Ministry of Health, announced a shortage of 100,000 nursing personnel in the country; however, officials of the Islamic Republic consider the issue of shortage of human resources in the medical and health services sector to be the responsibility of the employment and budget organization for employment and say that the Ministry of Health, Treatment and Medical Education has no problem in hiring and employing personnel and the only issue is the delay in obtaining permits from other government organizations.

Before the start of the coronavirus, Iran had only one hospital bed for every 2,250 people, while the global standard is one bed for every 200 people. According to the healthcare laws of the Islamic Republic, there should be a minimum of 2.5 specialized and non-specialized nurses for every hospital bed, but in major cities like Tehran, this number is only 1.2 and in smaller cities it is 0.6, meaning there is less than one person available. (2) The shortage of human resources was not solved with the crisis of coronavirus, and it became more apparent due to the heavy influx of patients and high hospitalization rates. The Islamic Republic has not released accurate statistics on the healthcare services provided during the coronavirus period, but images and reports from various sources show that in government hospitals, the shortage of personnel and medical equipment such as hospital beds and medication has led to the loss of many lives.

It seems that the shortage of human resources in the structure of the Ministry of Health does not only require permission from places like the Organization for Planning and Budget, but also widespread migration of medical staff, including nurses and doctors, as well as difficult employment conditions and temporary contracts, are other issues that hinder the provision of medical personnel in the country.

The only remaining option: migration.

The image of a doctor or nurse sleeping with a mask and gown in a corner of the hospital has become one of the familiar images of the days of the coronavirus; the work pressure that has led to the exhaustion of the medical staff and even the loss of lives of some of them. Every Iranian doctor and nurse in the crisis of coronavirus was forced to endure long and heavy shifts and simultaneously take care of multiple patients, but these issues only intensified when the government prevented the entry of reliable vaccines. Undoubtedly, the exhausted minds and bodies of a part of the medical staff had no choice but to migrate after bearing such a cost. With the prolongation of the coronavirus peaks and the repetition of its waves, the request and desire for migration has increased more than ever in the medical staff.

In September of this year, the medical journal “Lancet” reported that in the first year of the coronavirus, only three thousand Iranian doctors and nurses have applied for immigration to Germany, Italy, and Canada. Since the beginning of the pandemic, there has been a 300% increase in the migration of medical personnel in Iran. This statistic only applies to specialized and experienced personnel and does not include requests from medical and nursing students. Various reports from domestic media and the Ministry of Health also confirm this issue, but the Ministry’s response to the increase in migration of medical personnel was to employ young and graduate workers on short-term contracts of eighty-one days. These contracts were not renewed after the peak of the coronavirus and were met with numerous protests.

The issue of temporary contracts, tariffs, and rights and benefits of nurses has been high since the outbreak of the coronavirus. Several months after the start of the pandemic, nurses in various hospitals gathered and demanded attention to their job situation, but received no response. In December of this year, after Nurses’ Day, a group of nurses from Imam Khomeini Hospital in Tehran gathered in protest against the way tariffs are determined, but their protest remained unanswered. Additionally, around ten thousand temporary contract or eighty-day contract workers were hired as nurses during the peak of the coronavirus, but their situation remains uncertain despite having two years and several months of work experience, and many of them have been laid off.

All of these problems together reduce the motivation to work in the field of healthcare in Iran for medical and nursing staff. They either prefer to work in hospitals and private centers or want to migrate.

How are medical staff not being hired?

Every year, about seventeen thousand people retire from the Ministry of Health, Treatment, and Medical Education; as well as between eleven to fifteen thousand nurses and close to seven thousand graduates from medical and other medical science fields finish their studies at universities. If all of these graduates were to start working in healthcare centers every year, they would only be replacing retired personnel and the shortage of personnel in this field would still remain strong. However, getting employed or starting work right after graduation is not a dream for nurses and doctors, it is a difficult and exhausting process.

The Ministry of Health, Treatment, and Medical Education, like other government ministries and organizations, hires human resources every year through a recruitment exam. However, the hiring permit includes currently employed individuals who have several years of work experience and are transitioning from a temporary contract to a permanent one. If someone is able to pass the major hurdle of recruitment through the exam, they must wait at least five years for a permanent contract.

The employment exam for ministries and government organizations has general and specific conditions; for example, all participants in this exam must adhere to the system and laws of the Islamic Republic and men must have completed mandatory military service or have a permanent exemption; also, all participants must believe in Islam or one of the religions recognized by the system in the law. If applicants meet all the general and specific conditions, which include a 40-page booklet, they must answer general questions in the exam such as Islamic teachings and ideological questions of the system. Finally, if an applicant is able to pass the exam, they will participate in a face-to-face interview which will also be evaluated ideologically; meaning they must answer selection questions, not be improperly veiled, be knowledgeable about the pillars of the Islamic religion, and officially prove their belief and commitment to the system in this conversation.

On the other hand, there are age requirements for employment. If the applicant is single, they must be between twenty-five and forty years old, and if they are married and have children, they can apply for employment until the age of forty-five. Nursing graduates have an easier path compared to medical graduates; although they are still required to go through a program and ultimately take an exam, if they can pass all the stages and are lucky enough to be hired by a medical center, they can hope to be officially employed by the government after about five to ten years.

General medical graduates in their final years of study are required to complete an 18-month program known as “internship”. Alongside them are “residents” or those who are in their specialized assistantship period. It can be said that these two groups bear the heaviest burden in government hospitals; they do not receive any insurance, benefits, or significant salaries and many of them work shifts of approximately 30 hours every 48 hours. In December 2019, the news of the suicide of medical students at Jundishapur University of Ahvaz made headlines. After that, many students in the general and specialized medical programs spoke out about the difficult working conditions in hospitals. One of the medical graduates from Jundishapur University, in an interview with Khabaronline, had said about the reason for the suicide of medical students: “The intern and resident shifts are extremely difficult. During the 18-month internship, which is the final stage of medical education, each person is

Therefore, the path that lies ahead for many medical or nursing students is either employment in private centers or immigration; and that is if they can complete their studies through the normal process.

Intentional killing

Human resources are the most important factor in quality and service delivery in the medical and healthcare sector; in addition, free, affordable, and easy access to healthcare, hygiene, and medical services is one of the responsibilities of every government and ruling authority that governs a country. The shortage of human resources in the Iranian healthcare system, along with a lack of equipment, medicine, and access to free medical services, has reduced the quality of service delivery to the people; services that are crucial for the lives and health of citizens.

For the year 1402, a budget of 273 trillion tomans has been allocated for the Ministry of Health, Treatment, and Medical Education as the second largest ministry in the country. (4) This is while the pharmaceutical and medical equipment sector receives separate subsidies from government resources, and the government has no problem in producing and importing drugs and medical equipment if it wants to take the right path and cut the hand of the pharmaceutical mafia. Therefore, it should be questioned where this amount is being spent. Why do the employees of this ministry have difficulty in receiving their salaries despite the large budget allocated to the Ministry of Health? Why can only a portion of the medical staff and some government specialists and super-specialists benefit from the large revenues in the healthcare sector? Who is threatening the people and patients despite the shortage of human resources, medical equipment, and drugs, despite the money that is allocated to this ministry from oil revenues? If the delay in solving the problems of the healthcare system is not intentional

Notes:

1- Shortage of staff in the Ministry of Health and chaos in hospitals, ISNA, 10 Dey 1401.

2- Shortage of nurses, an old problem in the healthcare system, the Nursing Organization of the Islamic Republic of Iran, 25 Bahman 1400.

3- “Lancet Medical Journal: Iran’s Healthcare Workforce Migration Increased by 300% After the Coronavirus Pandemic, Radio Farda, 27 Shahrivar 1401.”

4- Proposed budget of 270 trillion for health, ISNA, 24 Dey 1401.