Global learning process for scaling up poverty reduction shanghai conference may 25 27 2004
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Global learning process for scaling up poverty reduction shanghai conference may 25 27 2004

Global Learning Process for Scaling Up Poverty Reduction: Shanghai Conference May 25-27, 2004


Primary Health Care and the Rural Poor in the Islamic Republic of IranAmir Mehryar & Shirin Ahmad-niaCenter for Population Studies & ResearchMinistry of Science, Research & Technology, Tehran, IranApril 22, 2004


Outline and objectives of presentation
Outline and Objectives of Presentation Republic of Iran

  • Brief description of Iranian Primary Health Care System

  • Evidence of Improvements in Health Status of Rural Population

  • The Role of Primary Health Care System

  • Factors Underlying the Success of Iranian PHC

  • Lessons Learned


Rural population of iran
Rural Population of Iran Republic of Iran

  • Iran has experienced a high rate of urbanization over the past 50 years.

  • Currently about one-third of Iran’s population, around 24 million, live in rural settlements.

  • Rural settlements are defined by population size (less than 5000) and/or absence of an officially recognized municipal administration.

  • In 1996 about 64000 rural settlements were identified.


Relative deprivation of rural population in terms of
Relative Deprivation of Rural Republic of Iran Population in Terms of:

  • Government investment, including most of the subsidized goods

  • Private income/expenditure

  • Access to social services:

    • Education

    • Health

    • Social Insurance

  • Poverty levels


Organization structure of iranian health network the phc system
Organization & Structure of Iranian Health Network & the PHC System

  • Nationally

  • In Urban Areas

  • In Rural Areas


Components of phc system in rural areas
Components of PHC System in Rural Areas System

  • Rural Health House

    • Based in a village

    • Staffed by 2 or more Behvarz

    • Covering a population of 1,500 individuals

  • Rural Health Center

    • Based in a large village

    • Supervising/supporting 5 health houses

    • Staffed by at least one GP & several health workers

    • Offering outpatient care,oral health, basic environmental sanitation, maternity facilities

  • District Health Center

    • Supervising and supporting several Health Centers

    • Medical trained personnel, laboratories, Behvarz Training Centers

    • Referral to District Hospitals & higher levels of care


Basic features of iran s rural phc system
Basic Features of Iran’s Rural PHC System System

  • Community participation

  • Recruitment of locally acceptable providers (Behvarz)

  • Careful training/retraining of health workers

  • Continuous monitoring/supervision/motivation

  • Emphasis on appropriate technologies

  • Simple but well integrated health information system


The behvarz
The Behvarz System

  • Criteria for Selection

  • Responsibilities

  • Training


The health information system
The Health Information System System

  • Household file

  • Vital horoscope

  • Statistical wheel

  • Monthly report forms


Impact on health outcomes
Impact on Health Outcomes System

  • Impressive improvements in health indicators of rural population since 1980s in terms of:

    • Health of children

      • Infant and child mortality

      • Preventive health/medical care

    • Health of mothers

      • Mortality

      • Antenatal care

      • Postnatal care

      • Reproductive health & family planning

    • Environmental hygiene

  • Considerable narrowing of urban-rural disparities in health outcomes







Factors underlying the success of iranian phc system
Factors Underlying the Success of Iranian PHC System 2000.

  • Learning and Experimentation

    Concept of Behvarz tried in two pilot projects:

    • Kavar rural district (Shiraz University)

    • West Azarbijan (World Health Organization)

  • Leadership Commitment to Change

    • Political commitment to provide basic health care services to poor population

    • Reallocation of government health budget towards preventive and public health care

  • Institutional Innovation

    • Decentralization

    • Selection and training of Behvarz


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