Primary Health care System Reform in Iran: a New Return to the Alma-Ata Declaration

The Alma-Ata Declaration of 1978, which was endorsed by the WHO and its member state, emerged as a major milestone of the twentieth century in the field of public health

Primary Health care System Reform in Iran: a New Return to the Declaration of Alma-Ata

The Alma-Ata Declaration of 1978, which was endorsed by the WHO and its member state, emerged as a major milestone of the twentieth century in the field of public health. The declaration marked a global recognition that health and access to primary health care (PHC) are fundamental human rights and it identified PHC as the key to the attainment of the goal of "Health for All by the year 2000".

In line with fulfilling the Alma-Ata vision, Islamic Republic of Iran has showed remarkable achievements toward this goal. In 1981, a PHC development program was piloted in the Western Azerbaijan province, and expanded to all other provinces in 1983, that had focused strongly on PHC. The plan emphasized on community participation and intersectoral cooperation in offering PHC services.

WHO in its World Report 2008, has stated that Iran is one of the successful example in the world for implementation of PHC. In 2016, Bloomberg News ranked Iran 30th most efficient healthcare system ahead of United States and Brazil. The significant primary healthcare advances in Iran has taken place through a multi-tiered network of health centers, starting form health houses in rural areas and health posts in urban areas, to health centers and district teaching hospitals. The Iranian public sector has provided PHC services to even its most rural populations via health houses staffed with Rural Community Healthcare Workers (Behvarz). The wide range of PHC services in Iran has been complemented with impeccably recorded data. 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 health status of Iranians has improved over the last 40 years. For instance, maternal and child mortality rates have fallen significantly, and life expectancy at birth has risen remarkably to a regionally high level of 74 years.

Despite having a proper and elaborated PHC system in place, and its relative success in providing PHC services over the past three decades, Iran, however, has not been able to keep pace with the rapidly changing demographic developments. The major challenges the PHC system in Iran facing include; the epidemiological transition and the shift in burden of diseases from communicable to non-communicable, the aging of population, and urbanization. Many cities face a triple threat: emerging and re-emerging infectious diseases which thrive when people are crowded together; chronic, non-communicable diseases including diabetes, cancers and heart disease which are on the rise with unhealthy lifestyles including tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol and urban health is often further burdened by road traffic accidents, injuries, violence and crime. Migration of people from rural areas to urban areas have resulted in a rapid increase in informal settlements in outskirts of cities and resulting marginalization and the creation of slum areas in which people do not have equal access to health care.

A revolution in PHC infrastructure

To address the new challenges in the health of the Iranian population, from May 2014, the new reforms of the health system in Iran were launched as one of the priorities of the new government. The Health System Reform plan covers all areas of the health system, including: health, treatment, drugs and education.

In terms of Public Health services, a series of modern PHC interventions, with a focus on basic preventive activities to reduce risk factors and mortality from non-communicable diseases (NCD), have been stipulated in age group specific service packages including: Infants and children, teenagers, youth, middle-aged, elderly and pregnant and lactating women. All of these services will be provided free of charge to all rural and urban people.

Service package according to age groups:
• Neonatal & children package ( up to 59 months)
• Adolescent package ( 6-17 years)
• Youth package (18-29 years)
• Adult package ( 30-59 years)
• Elderly package ( > 60 years)
• Maternal health package ( pregnant women)
• Reproductive health package ( family planning - infertile couples, child spacing )

Sistan and Baluchestan province is located in southeastern Iran, bordered by Pakistan and Afghanistan and on the Coast of Oman Sea. The population of 2,600,000 people in this province is covered by three medical universities: Zabol, Iranshahr and Zahedan. Zahedan University of Medical Sciences (ZAUMS) with a population of 1,600,000 including 8 cities. Almost half of the population covered by ZAUMS is living in rural areas.

The modern PHC services have been launched in all rural and urban areas, and more than 97% percent of the population has been registered in a national database (SIB) and so far 82% of the individuals have received modern PHC which is coupled with an active electronic health profile for each person.
More than 600 rural healthcare workers (Behvarz) from 400 health houses and 400 urban healthcare workers in 100 health posts have been delivering those PHC services.
The health system reform in public health in Iran is a dynamic process and more services will be integrated into the services packages in near future to address the major public health challenges in the country

Should you have any queries please do not hesitate to contact us on: zu.healthdeputy@gmail.com