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Table 2 Summary of mitigating measures to improve the performance of the health system in terms of sanctions identified via review

From: Health system to response to economic sanctions: global evidence and lesson learned from Iran

The targeted function of the health system

Mitigating measures

Source

Type of measure

Financing arrangement

1. Mobilizing latent resources in education and health

[21]

Implemented

2. Providing additional clarification that Iranian oil revenues can be freely used for medicines procurement without reservations

[9]

Proposed

3. Supporting local production

[22, 23]

Implemented

4. Price reduction of imported medicines

[22]

Implemented

5. Optimizing the domestic market

[15]

Proposed

6. Centralized and strategic purchasing

[23]

Proposed

7. Rationalization of the prices of medicines

[23]

Proposed

8. Strengthening the insurance system

[23]

Proposed

Governance arrangement

9. Establishing uniform criteria and definitions for exemptions as well as operational criteria for sanctions committees to facilitate improved effectiveness of exemptions

[24]

Proposed

10. Developing dual policies of equity and priority for vulnerable groups

[25]

Implemented

11. Mobilizing public participation to compensate for reduced access to capital goods

[21]

Implemented

12. The use of public systems to motivate behavioral change, with a focus on the needs of women and children

[21]

Implemented

13. Refocusing health policy toward maximizing scarce resources

[21]

Implemented

14. Professional organizations, especially those concerned with children's health, must advocate for children in countries experiencing economic sanctions

[26]

Proposed

15. Advocating for global health diplomacy to ensure that ongoing multilateral negotiations do not neglect public health and humanitarian need

[9, 27]

Proposed

16. Establishing regulatory export harmonization

[9]

Proposed

17. Amending the OFAC EAR99 classification system to make it easier for US companies to export medicines

[9]

Proposed

18. Exempting vaccine products from stringent export controls

[9]

Proposed

19. Allocating a protected SWIFT line specifically for humanitarian medicines trade

[9]

Proposed

20. Exempting medicine and medical commodities from “snap back” provisions;

[9]

Proposed

21. Providing a national policy with measures to prevent the suffering of people from the adverse effects of sanctions

[12]

Proposed

22. Preventing third parties; black market dealers, pharmacies, and health facilities that provided unsafe medicines, as well as smugglers who sent scarce medicine to neighbouring countries

[12, 23]

Proposed

23. Refraining from imposing embargos and other measures that restrict the supply of medicine and medical equipment

[12]

Proposed

24. Developing policies and laws to alleviate the negative impacts of their agreements on the human rights of the population in the target country

[12]

Proposed

25. Designing some international intermediate organizations and certain companies and financial institutions to facilitate the implementation of exemptions

[12]

Proposed

26. Permitting immediate release of medicines from customs by minimum financial documents

[22]

Implemented

27. Determining a memorandum of understanding (MOU) between the IFDA Iran’s Food and Drug Administration) and the Central Bank

[22]

Implemented

28. Determining a memorandum of understanding (MOU) between the IFDA and health insurance organizations for the extra financial protection of special, incurable, and chronic patients with high pharmaceutical expenditures and for allocating the additional budget to over-compensate unaffordable pharmaceutical products based on the equity-based criteria

[22]

Implemented

 

29. Developing the national essential medicines list

[22]

Proposed

 

30. Using use all available political and legal means, such as health diplomacy, to establish humanitarian channels to enhance global convention and remove possible barriers as the sanctions and reduce their adverse consequences for antimicrobial resistance control

[28]

Proposed

31. Creating efficient food assistance programs by the government and the international community, funding food banks with the assistance of charities and non-governmental organizations, and participating individuals in nutritional education programs and learning how to plan a cheap and balanced diet

[29]

Proposed

32. Boosting the morale, knowledge, skills, and innovation of managers can potentially increase resilience

[15]

Proposed

33. Creating mutual trust among different organizations

[15]

Proposed

34. Revisions in Iran’s health management

[23]

Proposed

35. Delegation and privatization

[23]

Proposed

36. Strengthening of inter-sectoral cooperation

[23]

Proposed

37. More attention to mass media

[23]

Proposed

38. Interactions with neighbouring countries

[23]

Proposed

39. Management and development of health tourism

[23]

Proposed

Information and evidence

40. Improving means of monitoring the impact of sanctions on civilian populations in targeted countries, particularly concerning water purity, food availability, and infectious disease control

[24]

Proposed

41. Advocating prospective studies to generate the data needed to provide better information and monitoring capacity than presently exists

[24]

Proposed

42. Strengthening health monitoring systems

[21, 23]

Implemented

43. Advocating for the integration of Health Impact Assessments (HIAs) that identify the health consequences of sanctions

[9]

Proposed

44. Monitoring human rights situations and utilizing the maximum resources available to eliminate suffering with low-cost programs, international assistance, and cooperation

[12]

Proposed

45. Assess the effects of the policies and international agreements on the health of people in the target country

[12]

Proposed

46. Observing the situation of human rights and implementing humanitarian and human rights laws

[12]

Proposed

47. Employing cost-effectiveness evidence for pricing and reimbursement

[22]

Proposed

48. Developing an integrated information system for monitoring the market

[22]

Proposed

49. Determining the exact magnitude of the impact

[30]

Proposed

50. Electronic health record

[23]

Proposed

51. Electronic prescription

[23]

Proposed

Service delivery arrangement

52. Rationing, universal access to primary health care, a highly educated population, and preferential access to scarce goods for women and children

[25]

Implemented

53. Emphasizing preventative over curative medicine

[21]

Implemented

54. Protecting vulnerable groups of the population, such as children and the poor

[12]

Proposed

55. Facilitating the delivery of necessary items for life and health, such as medicine, food, and medical equipment

[12]

Proposed

56. Proactive inventory control

[22]

Implemented

57. Providing clinical guidelines for rational prescribing

[22, 23]

Proposed

58. Proper implementation of the referral system

[23]

Proposed

59. Medication tracking

[23]

Proposed

60. Informing the medical community

[23]

Proposed

61. Use of alternative medicines and methods

[23]

Proposed

62. Consumer–patient collaboration

[23]

Proposed