Iran’s Excellent Primary Health Care System

In the past three decades, the Islamic Republic of Iran has adopted a policy aimed at more strongly addressing the needs of its population, and substantial progress has been achieved both in the social and economic sectors. Since the revolution of 1979, a Primary Health Care network has been established throughout the country. In rural areas, each village or group of villages contains a Health House, staffed by trained “Behvarz” or community health workers – in total, more than 17,000, or one for every 1,200 inhabitants. These Health Houses, which constitute the basic building blocks for Iran’s health network, are the health system’s first point of contact with the community in rural areas.

In addition, Rural Health Centers were put in place. They include a physician, a health technician and an administrator, and deal with more complex health problems. On average, there is one Rural Health Center per 7,000 inhabitants. In urban areas, similarly distributed urban health posts and Health Centers have been established. The whole network is managed and administered through District Health Centers, answerable to the Ministry of Health and Medical Education. The universities of medical sciences, of which one exists in each province, play an important role in medical education and in the provision of health services. The Chancellor of the university as executive director of the provincial health services is also in charge of all district health centers and hospitals.

Significant health indicators

Iran has fairly good health indicators. More than 85 per cent of the population in rural and deprived regions, for instance, has access to primary health care services. The infant mortality rate is 28.6 per 1,000 live births; under-five mortality rate is 34 per 1,000 and maternal mortality rate is 25 per 100,000 live births. Poliomyelitis has been reduced to the point of near-eradication and the coverage of immunization for children and pregnant women is very extensive. Access to safe drinking water has been provided for over 90 per cent of Iran’s rural and urban population. More than 80 per cent of the population has access to sanitary facilities.

Despite having a proper and elaborate system in place, Iran, however, has not been able to keep pace with the rapidly changing demographic developments. Rural areas in some parts of the country are not fully covered and health centers are inadequately equipped to meet community needs.

No Iodine Deficiency Disorders

The support of UNICEF contributed to Iran having achieved its “IDD free status”. Iodine Deficiency Disorders were prevalent in Iran before 1989 and less than 50 per cent of Iranian households in rural areas consumed iodized salt by 1994. A law for the mandatory production of iodized salt for households was passed in 1994. In a recent study conducted by the Endocrine Research Center and Institute of Nutrition, urinary iodine excretion was considered adequate in school children. Taking into account the percentage or Iranian households consuming iodized salt and the standards established by the IDD program, the Islamic Republic of Iran has reached a sustainable control program for iodine deficiency.

Malnutrition and childcare feeding practices

Malnutrition has been somewhat neglected in Iran, both as a result of its multiple etiologies and because many of its aspects are still unknown. Malnutrition and childcare feeding practices remain a challenge in the country, especially at community level, in disparity provinces where there is a high prevalence of underweight, wasting and stunting, and micronutrient deficiencies among children and women are high.

Iran’s capacity to address malnutrition needs to be strengthened at all levels. According to the Anthropometrics Nutrition Indicator Survey (ANIS 2), conducted by Iran’s Ministry of Health and Medical Education, 11 per cent of children below the age of five from Kerman province are underweight. In Sistan and Baluchestan, this figure increases to 16 per cent. Only about 23 per cent of all children are exclusively breastfed until their sixth month, and more than half of Iran’s children are weaned before the age of four months.

The knowledge and research based on nutrition increased through a series of studies on micronutrients, complementary food, regional availability of foods, implement to growth and referral system. UNICEF Iran’s advocacy led to the introduction of a child-care card, facilitating health workers and care-givers to provide children with the necessary care for development. Based on previous experience, a community-based nutrition project was launched in four districts of Sistan and Baluchestan last year, with the cooperation of the Ministry of Health and medical science universities. In West Azerbaijan, the project has begun in two disparity districts, and it is planned to develop the initiative also soon in Hormozgan province.

Community Based Nutrition Initiative

UNICEF Iran has developed a model for community-based nutrition involving Nutritional Counseling Centres. These centers provide training, facilities and educational materials for mothers, health workers, and volunteers. With the establishment of 160 additional Nutritional Counseling Centres in four districts of Sistan and Baluchestan, where malnutrition is a major problem, this initiative has exceeded all expectations. This is a result of the positive response by the Iranian government to UNICEF Iran’s pilot project, and the rapid expansion of the Nutritional Counseling Centres in 2006 was a significant step forward, reflecting an important success for UNICEF Iran’s programme.

by Seyed Enayatollah Asaei, UNICEF Iran's specialist for early childhood development