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Enhancing service delivery in health and education for refugees in Iran
by supporting their incorporation into public services provided
by the Government of the Islamic Republic of Iran

Synopsis

The project aimed at widening and improving the access to affordable national health care services at primary, secondary, and tertiary level of the Afghan refugee¡¯s population, which represents the second largest in protracted displacement under UNHCRS¡¯s mandate; and developing educational infrastructures for refugee and Iranian students at primary and secondary education level.

The project was successfully completed and contributed to the progressive policies of Government of the Islamic Republic of Iran (GIRI) to provide refugees in Iran with health care and education by:

• Extending and improving access of extremely vulnerable refugees to the Universal Public Health Insurance (UPHI), which is a GIRI owned and led Initiative to include refugees in the national insurance scheme which gives access to health services in all public country-wide hospitals affiliated with the Ministry of Health and Medical Education (MoHME). The UNHCR country target of including 110,000 vulnerable refugees into UPHI by covering 100% of their premium was achieved with a total of 112,735 most vulnerable refugees fully covered. Approximately 95% of this over-achievement was possible thanks to the contribution provided through this project; 
• Improving the quality of primary health care for refugees in remote provinces. UNHCR complemented the activities of MoHME by providing support for the procurement of essential goods/services to 93 identified health posts where a high number of refugees reside, of which 23 health posts in prioritised locations were provided with additional financial incentives and transportation support to medical staff (physicians, nurses, midwives, technicians, etc.) as well as procurement of essential drugs. While the overall UNHCR target of additional support to 23 health posts was met, it is reported that the contribution through this project particularly improved and enhanced the access of a population of 4,972 refugees residing in Saveh Settlement in the Markazi province. During the project life it is estimated that approximately 13,000 consultations and treatments were provided to the above-mentioned target population;
• Extending quality primary and secondary education to refugee children of school age in public schools.  UNHCR continued addressing the issue of refugee¡¯s access to schools and shortage of classrooms by supporting MOE to construct 11 primary and secondary schools in areas hosting high numbers of vulnerable Afghan refugees. The school located in the city of Dilijan in the Markazi province benefited from the contribution of this project. It is estimated that the school will serve up to a population of 800 students from both refugee and host community. It should be noted that considering the UNHCR multi-donor approach, the 2030 ASD Sub-Fund contribution to UNHCR country programme was acknowledged on all the 11 schools.

The national government strong engagement and commitment to the project implementation as well as early information campaigns targeting end beneficiaries and international community were mentioned as key factors for a successful and sustainable delivery of the project.

Spotlights

The Afghan refugee population is one of the largest and most protracted refugee situations in the world. The Islamic Republic of Iran hosts one of the largest urban refugee populations worldwide, primarily Afghans.

Afghan refugees find it increasingly difficult to find affordable health care options in Iran due to Socio-economic hardships combined with rising health care costs. While all refugees¡¯ children have access to primary and secondary education, the government of Iran faces difficulties to accommodate education for school-age refugee children due to the large number of refugee students in Iran.

With this backdrop, in 2017 the project entitled ¡°Enhancing service delivery in health and education for refugees in Iran by supporting their incorporation into public services by the Government of the Islamic Republic of Iran¡± was implemented by UNHCR under the 2030 ASD Sub-Fund. Through a partnership agreement with the Bureau for Aliens and Foreign Immigrants¡¯ Addaris (BAFIA) and the Iran Health Insurance Organization (IHIO), UNHCR supported the efforts of the Government to enable the access of all refugees to the Universal Public Health Insurance (UPHI). The project aimed at widening and improving the access of the Afghan refugee¡¯s population in Iran to both affordable national health care services equivalent to that of the host population, and to quality primary and secondary education including safe learning spaces for refugee children.

UPHI, the above-mentioned tripartite agreement, has been designed to allow any refugee registered with the government to have access to public hospitals affiliated with the MoHME and benefit from the same services and level of treatment as Iranian nationals at the same cost regardless of their place of residence or registration. Targeted vulnerable refugees including those with special diseases and their family members receive financial support. Non-vulnerable refugees must pay the monthly premium on their own same as Iranian nationals. Through the project, UNHCR country target of including 110,000 vulnerable refugees into UPHI by covering 100% of their premium was achieved with a total of 112,735 most vulnerable refugees fully covered. Thanks to a public awareness campaign using a variety of media, refugee communities were informed and encouraged to enrolled. Some messages recorded while the refuges were on hold awaiting their turn when calling UNHCR hotlines are here reported.

Stories from beneficiaries

? UNHCR/Tehran Masoumeh, who was able to receive a surgery thanks to UPHI, Tehran, 2017

Masoumeh, a small Afghan refugee girl, received a surgery. Her mother Zahra, a 26-year-old Afghan refugee said: ¡°Having access to UPHI allowed my daughter, Masoumeh, to have a successful surgery and a second chance at living a healthy life. The surgery cost 150,000,000 IRR (~ EURO 4,200) and insurance covered 90% of the expenses (hospital bills and other medical costs)¡±. (Tehran, June 2017)

? UNHCR/Tehran Ajab Khan, whose family also benefited from him receiving support of UPHI to his medication, Tehran, 2017.

Ajab Khan, a 22-year-old Afghan refugee who suffers from hemophilia. He said: ¡°I always wanted to contribute to the society that I am living in and to the livelihood of my family. Every time I wanted to get my medication, I had to see if I could borrow money from friends and relatives. I no longer must worry about the repeated painful bleeding in my hands and legs. I am relieved that I now have affordable access to health assistance¡±. With UNHCR support to the nationally-owned GIRI initiative, Ajab had his medical expenses 90% covered by UPHI, and allowed his family to do not seek negative coping strategy in order of generating sufficient cash for his medical needs. ¡°

? UNHCR/Tehran Refugee registered for UPHI, with his insurance booklet, Tehran 2017

Third story is from Habibollah, a 48-year-old Afghan refugee with kidney failure in Ravazi Khorasan province. He said: ¡°The costs of treatments for dialysis were outrageous. It was a big shock to my family, I found myself in a desperate situation before discovering UPHI. I believe the value of insurance is only understood when the malevolent side of life comes to light. This insurance brought hope and relief to our family, and peace and joy back into our house¡±.