This debate article highlights that to perform efficiently and meaningfully, the structure and organization of a health system need to be adjusted to its philosophy, mission, and expected duties. Development of the required organizational structure, in line with the objectives and strategies of the national health policy are fundamental principles of healthcare stewardship. Despite several reforms and initiatives in the course of the last few decades, the Ministry of Health and Medical Education (MoHME), as the steward of the health system in Iran, has not been performing efficient enough to respond to serious emerging challenges. In order to move in line with sustainable health development agenda and reach universal health coverage (UHC), we advocate fundamental structural and institutional reforms within the MoHME in Iran.
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