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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
  • 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
  • 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 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
  • 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
  • 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
  • Criteria for Selection
  • Responsibilities
  • Training
the health information system
The Health Information System
  • Household file
  • Vital horoscope
  • Statistical wheel
  • Monthly report forms
impact on health outcomes
Impact on Health Outcomes
  • 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
  • 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