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 Iran
Amir Mehryar
&
Shirin Ahmad-nia
Center for Population Studies & Research
Ministry of Science, Research & Technology, Tehran, Iran
April 22, 2004
2
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
3
Rural Population of Iran
1. Iran has experienced a high rate of urbanization
over the past 50 years.
2. Currently about one-third of Iran’s population,
around 24 million, live in rural settlements.
3. Rural settlements are defined by population size
(less than 5000) and/or absence of an officially
recognized municipal administration.
4. In 1996 about 64000 rural settlements were
identified.
4
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
5
Organization & Structure of Iranian
Health Network & the PHC System
 Nationally
 In Urban Areas
 In Rural Areas
6
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
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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
8
The Behvarz
 Criteria for Selection
 Responsibilities
 Training
9
The Health Information System
 Household file
 Vital horoscope
 Statistical wheel
 Monthly report forms
10
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
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Changes in Maternal Mortality Ratios of Urban and
Rural Areas, 1974-1996.
Urban
.
Rural
.
12
births
)
IMR
(per
Changes in Infant Mortality Rates of Urban and Rural
Areas, 1974-1996.
Urban
.
Rural
.
Year
13
Changes in Under 5 Mortality Rates (per 1000) of Urban
& Rural Areas, 1988-2000.
Urban
Rural
.
.
.
14
Urban-Rural Differences in Antenatal Care Visits, 2000.
Urban
Rural
% Receiving
.
.
Mean Number
.
.
Total
.
15
Urban-Rural Difference in Using Different
Contraceptives, 2000.
Pill
IUD
Inject
Tubect Condom Vasect
Withdra
wal
Urban
.
.
.
.
.
.
.
Rural
.
.
.
.
.
.
.
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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
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