study states that “a considerable burden of disease is attributable to rotavirus, Hib,
pneumococcus, influenza and varicella, and vaccines are available with known profiles of
efficacy / effectiveness against these diseases.”13 For example, data collected from sentinel
hospital-based surveillance indicates that over half of all admissions for diarrhea are related to
rotavirus.14 Yet insurance currently does not cover known and effective vaccinations for diseases
such as rotavirus, Hib, pneumococcus, influenza and varicella.15
During the last two decades, the Iranian authorities had implemented legislation to expand access
to healthcare services. With the implementation of HTP (a multidimensional policy in health
promotion that aims to enhance service quality), health insurance was expanded to 10 million
people who did not previously have insurance. Over 92% of the Iranian population is now
covered by at least one insurance scheme.16
The Iranian authorities provide temporary identification cards and medical insurance to accepted
refugees on the same basis as its own citizens; however, undocumented immigrants, such as
Afghans, are deprived of medical insurance and care.17 In Iran, as of 2016, all registered Afghans
became eligible to apply for public health insurance. Newly insured Afghans can now receive the
same health services as Iranian citizens. Unfortunately, health insurance access for
undocumented Afghans available. Despite the available health insurance for Afghans which
cover the basic maternity care, it appears that the majority of Afghan women do not have health
insurance and overall utilization of such services is not adequate to meet the healthcare needs of
the population. Reasons for underutilization by the population include financial constraints, lack
of affordable care including adequate prenatal care, personnel behavior, transportation issues,
stigma and discrimination, cultural concerns, and legal and immigration issues. The reports from
ministry of health (MOH) implicate higher prevalence of perinatal complications in Afghan
population. This mainly attributed to the inadequate prenatal care during pregnancy. The
financial constraints and lack of affordable health insurance with adequate coverage of prenatal
care services, particularly the diagnostic and screening tests, were the most frequent reported
obstacles by Afghan women.18
In 2012, the government announced that health insurance companies were required to cover the
full costs of sex reassignment operations. The State Welfare Organisation does cover the costs
for mandatory psychological consultation necessary for sex changes as well. However, some
forms of transition-care have been labelled as cosmetic rather than medical by insurance
13
Id.
Id.
15
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667923/
16
So Near, So Far: Four Decades of Health Policy Reforms in Iran, Achievements and Challenges, Arch Iran Med. October
2019;22(10):592-605
17
UNHCR
https://www.unhcr.org/en-us/news/stories/2019/7/5d31d63a4/refugees-need-medical-care-iran-health-care-programmelifesaver.html
18
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201652/
14
3