Document Type : Letter to the Editor

Authors

• Zahra Keyvanlo ¹
• Fatemeh Kokabisaghi ²
• Hossein Ebrahimipour ³

¹ PhD, Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran

² Associate Professor, Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

³ Professor, Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Dear Editor,
Economic sanctions, especially those that affect the supply chain of medicines, medical equipment, and financial resources of the health system, have consequences beyond the purely economic dimension and play a significant role in weakening the human resources infrastructure of the health system. Reduced access to medicines and equipment causes greater work pressure on staff and increases burnout. Limited financial resources also affect the job security and real income of health workers and reduce their motivation to remain. This relationship shows that health human resources management cannot be possible without considering the impact of sanctions on financial resources and equipment.
Health human resources, also known as human resources for health (HRH) or health workforce, are among the core functions of the health system, and their extreme vulnerability under sanctions highlights the need for urgent attention to this issue. In recent years, the Ministry of Health has pursued policies such as a fair distribution program for specialist doctors in deprived areas, incentive packages for the retention of health professionals, and the development of educational capacities in needed fields. However, evidence suggests that these policies have not been sufficiently effective under sanctions and have faced serious obstacles in achieving their goals. Therefore, reviewing existing policies and designing new strategies to adapt to sanctions is an inevitable necessity.
Based on the findings of futures study conducted in Khorasan Razavi Province, sanctions have been classified among the most important factors affecting political stability and freedom, which, due to their significance and uncertainty, has been placed within the category of key uncertainties for the future of human resources for anesthesiologists. These factors directly and indirectly affect job motivation, quality of services, access to equipment and medicine, and most importantly, the decision-making of health elites to emigrate. In other words, sanctions have not only disrupted access to essential resources but have also caused disappointment in the future of work and weakened the professional status of the health workforce. In the aforementioned study, components such as migration and brain drain, access to equipment, and international cooperation have all been analyzed as factors dependent on sanctions and the political situation. It should be noted that the selection of anesthesiologists as the target group of the study was due to the significant shortage of this specialized group both nationwide and Khorasan Razavi Province, in particular. This shortage, which has also been confirmed in official reports of the Ministry of Health and provincial statistics, has direct effects on the provision of vital services in hospitals.
In general, sanctions affect human resources through the following channels:

Reduced access to medical equipment and vital drugs, especially in critical situations and emergency surgeries, leads to a decline in the quality of care and increased workload, a situation that ultimately exacerbates burnout among health personnel.
Weakening of job security and real income of health personnel due to inflation, currency market fluctuations, and restrictions on attracting international resources.
Increased emigration of health personnel due to a lack of promotion opportunities and scientific connections.
Weakening of equity in the distribution of human resources, especially in deprived areas, due to reduced incentives to remain in these areas.

Therefore, it is proposed that in formulating health human resources policies under sanctions, the following are taken into consideration:

Designing retention packages and incentive benefits commensurate with the economic pressure resulting from sanctions. In addition to indicators of political stability, international status, and economic resilience, attention should also be paid to the expectations of the workforce from the employer and from their jobs, as these components play a decisive role in maintaining motivation, improving productivity, and retention of the workforce, and complement the macro considerations in strategic human resources planning models.
Creating alternative scientific networks with like-minded countries in order to continue the scientific and professional growth of employees.
Using the capacity of immigrant elites to redesign policies and take advantage of reverse migration.
Establishing a Health Human Resources Policy Research Institute in the Ministry of Health to continuously monitor the health human resources situation and design flexible policies.

Thus, while acknowledging the existing efforts in human resources policymaking, it must be admitted that without reviewing and adapting to the conditions of sanctions, the continuity and effectiveness of these policies will not be guaranteed. This letter aims to remind the scientific community and health policymakers of the necessity of reviewing health human resources policies with a realistic and forward-looking perspective.
 

Keywords

• sanction
• Health Workforce
• futures studies

Main Subjects

• The Imposed War