Iran’s parliamentary health commission has disclosed that 560 pharmaceutical items are now in a critical shortage and another 180 in an acute state, a crisis that persists despite a subsidised exchange rate of 28,500 rials to the dollar for drug and raw-material imports. The announcement, made during a meeting with the national inspection agency, signals that currency allocation alone has failed to stabilise supply. Lawmakers in Tehran are demanding accountability for the distribution of these funds and have pledged to hand over the list of recipient companies to investigators, while also probing “golden signatures” — alleged rent-seeking practices within the health ministry and food-and-drug administration.

Viewed from Brasília, the strain takes a different shape. Brazil’s public Unified Health System (SUS), which serves three-quarters of the population, operates on a budget of R$254 billion for 2026, yet the health minister acknowledges that some states still fail to meet the constitutional minimum spending threshold. The OECD reports that Brazil’s public health expenditure stood at 4.3% of GDP in 2024, well below the roughly 7% seen in Spain. In São Paulo, the Hospital das Clínicas complex has added 264 high-complexity beds since 2024 and now runs 2,611 beds, but its superintendent notes that sustainability hinges on relentless cost-reduction in procedures. Meanwhile, the philanthropic Einstein organisation now manages 34 public units with over 2,000 beds, channelling R$491.5 million in 2025 alone into SUS support projects — a model that, its leadership argues, scales clinical expertise across the public network.

In Canada, the crisis is measured in hours spent in emergency rooms and the absence of a family doctor for millions. A parent in St. John’s describes arriving at an urgent-care clinic before opening and still receiving number 20 of 30 daily slots, ultimately abandoning the wait for a children’s hospital. The shortage is not accidental: Canada maintains one of the lowest medical-school seat-to-population ratios in the developed world, and thousands of internationally trained physicians remain in licensing limbo, a reality satirised in the film Dr. Cabbie but lived daily by immigrant doctors driving taxis. A retired nurse in the same province points to a 2002 advisory committee that issued 51 recommendations to avert a nursing exodus; instead, understaffing and mandatory overtime drove burnout, and today emergency physicians report patients lying in their own excrement for hours.

Across these geographies, a common thread emerges: funding increases are blunted by internal inefficiencies. In Iran, a cardiologist notes that over-prescription of antibiotics, unnecessary imaging, and the absence of an electronic health record and referral system waste scarce foreign exchange and accelerate equipment depreciation. Brazilian sanitarian José Gomes Temporão argues that tax subsidies for private health plans should be capped or eliminated to redirect resources to the public system. The next concrete milestone in Tehran is the inspection agency’s review of how the $28,500 rial exchange allocation was spent, a process that will either expose diversion or confirm that even protected currency cannot compensate for structural fragmentation.