Iran engages local communities in health research

Abstract

Iran has been promoting community-based participation in health research for the past 5 years. Here the public are not just the subject of study but also active partners in setting research agendas, designing studies, and acting on results. Kristin Elisabeth Solberg reports. For years, people in the ancient oasis city of Kashan, about 150 miles south of the Iranian capital Tehran, were alarmed by the high number of motorcycle accidents on their roads. They therefore embraced a recent opportunity to study the problem under the guidance of professional researchers. The community designed a study to identify the causes of the accidents, and, on the basis of research results, launched an action plan to make their city a safer place to live in. In this way, the Kashan community helped itself—as a partner in rather than the subject of research. Iranian authorities regard the Kashan project as a successful example of the country's 5-year-old programme of community-based participatory research in health. “Iran's main health challenges are very much related to community actions and behaviours”, says Hossein Malekafzali, chief architect of the programme and director of the Public Health Research Institute at Tehran Medical University. “Therefore, the community should be involved in combating the problems.” That is exactly what community-based participatory research is all about. The topic of inquiry is identified by the community itself, and the community is mobilised to do the study in partnership with professional researchers. The research results should benefit the local population, but the process can also be seen as an end in itself. Community empowerment and capacity building are important goals, and social change is a part of the entire process. “It's a matter of empowering people to be active participants in their own health development”, comments Ulysses Panisset, a scientist in the Research Policy & Cooperation department at WHO. Community participation in health research in Iran, now an integral part of the country's health system, dates far back. Shortly after the 1979 Islamic Revolution, the new government introduced a system of community health workers, as part of a larger plan to provide primary health care in rural areas. These so-called behvarzan—from the Farsi words beh (good) and varz (skill)—were recruited from local communities and given training to meet the basic medical needs of the rural population. One of their main tasks was to collect health data for research and statistics. To extend the success of the behvarzan programme to urban areas, in 1994 the Iranian Government introduced a Women Health Volunteers programme. The volunteers, who are recruited from well respected members of the local population, today act as bridges between the public health-care system and the communities. The introduction of the nationwide community-based participatory research programme in 2003, was therefore merely a natural extension of civil society participation in health in the Islamic Republic. Today, there are 18 Population Research Centres across the country, providing the necessary infrastructure for community participation. There have been dozens of studies and interventions in the past 5 years, ranging from projects aiming to reduce rates of depression and tobacco consumption, to programmes promoting physical activity and good nutrition. There has still been no assessment of the programme outside Iran, but according to Hossein Malekafzali, community participation in health has been a success in his country. “I think the experience of Iran is unique because we have empowered the community to be real managers of research, and act on the basis of research results”, he says. Iran has successfully integrated community participation into their health system, notes Panisset at WHO. “It's part of the way they do business”, he says, adding that WHO hopes to see civil society play a greater part in health research and policy formulation in the future. “We are all committed to improving the health of populations through research for health. It makes sense that the people who are the end users, also participate in that process.” But there are still a few obstacles that have to be tackled before communities are seen as equal partners in the research process. “The challenge is how to do this in an effective way that also maintains high standards in research”, Panisset says. “In this, we still have a long way to go.”