Iranian health houses open the door to primary care

Abstract

They have been described as an incredible masterpiece. Iranian health houses, conceived and introduced during the 1980-1988 war with Iraq, have been at the centre of a so-called master plan to bring health care to every district. Devised in 1981, the plan was informed by a health-care development programme from the Western Azerbaijan province that had focused strongly on what we now recognize to be primary health care. It emphasized community participation and intersectoral cooperation to serve the needs of the thinly distributed and rapidly swelling population. Locally sourced health workers or behvarzan from the Farsi words beh (good) and varz (skill) were originally trained to meet the basic health-care needs of people living in rural areas. female behvarz was responsible for, among other things, child and maternal health; a male behvarz for sanitation and environmental projects. Both worked out-of the health house, a rural medical post and the most basic unit of service delivery in the country's healthcare plan. health houses refer patients to rural health centres, which cover about 6000 to 10 000 people, and have up to two physicians and several health technicians. These centres are responsible for elective and emergency case management, supporting the health houses, and supervising both the health technicians and the behvarzan or community health workers. Dr Sirous Pileroudi, a retired former senior official with the Ministry of Health and one of the founders of the Iranian health-care system, describes the health houses as an incredible masterpiece. At the beginning, we could never imagine such a breakthrough, he says. We were at war and the country was in a miserable condition. There was strong opposition at the time of its inception from health experts who thought the infrastructure too ambitious and the scheme a regression in health care owing to the limited education of the behvarzan. Despite this opposition and the debilitating eight-year war with its neighbouring country, Iraq, the master plan to bring health to every district has been largely successful. According to Dr Mohammad Esmael Motlaq, the director of the Centre for Healthcare Promotion affiliated with the Ministry of Health, more than 90% of the Islamic Republic of Iran's 23 million rural population enjoys healthcare services through the health houses staffed by these community health workers. People enjoy primary health care services free of charge, Motlaq says. The health workers are well familiar with the culture and traditions and that is a big advantage. [ILLUSTRATION OMITTED] There are now about 17 000 health houses in the Islamic Republic of Iran, according to the most recent Ministry of Health statistics. Almost 30 000 community health workers are working in these health houses, more than 16 000 of them women. On average, each health house serves 1500 people in its village and surrounding settlements. Community health workers are often from the village they serve, their appointment confirmed by the local rural council. Their efforts have not gone unnoticed. In a speech made in September 2007 at a ceremony to pay tribute to their work, the health minister, Dr Kamran Baqeri Lankarani, said that these community workers had made a significant contribution to the sharp decline in mortality rates in the past three decades, helping to reduce deaths among infants and pregnant women, and curbing contagious diseases. Motlaq concurs, saying the behvarzan are the axis of the village. A community health worker is from the people and has their approval. These workers regularly supervise people's health. Indeed, community health workers often have an impressive knowledge of their patients' case histories. Log books on each household are kept at the health house. These contain the name, gender and age of all family members, sanitation conditions of the household, history of pregnancies, details of care for those aged under-five and dental-care records. …