Sakineh Majidi’s home on the outskirts of Tehran, the Iranian capital, was shaking from the tremors generated by a powerful earthquake rocking Kermanshah, a city over 400 kilometers away.
But it was her speeding heart that worried her most.
“My walls were moving, and my pulse was racing. It was very stressful,” says 63-year-old Sakineh, who suffers from hypertension and pre-diabetes, caused by a diet high in salt, trans fats and sugar. “But we knew what to do. My son came and took me to my doctor.”
The health centre in her district of Shahriar is one of thousands of facilities across Iran benefiting from the government’s drive, backed by the World Health Organization, to deliver health services to all residents.
“Every activity in the health sector is based on the philosophy of universal health coverage,” explains Dr Afshin Ostovar, director of the Department of Noncommunicable Diseases of the Ministry of Health and Medical Education.
Every activity in the health sector is based on the philosophy of universal health coverage.
One key pillar of universal health coverage is to ensure people are protected financially when it comes to receiving health services. More than 90% of Iranians are covered predominantly by government health insurance plans, with people paying out of pocket for on average about 10% of their medical costs.
Another pillar is to cover people with the quality health services they need.
Sakineh’s physician, Dr Bahamin Jahanian, is among thousands of Iranian health professionals trained to meet her country’s most pressing health needs – noncommunicable diseases. Heart and lung conditions, cancers and diabetes, are all on the rise. “We have stepped up health services for people with risk factors like high blood pressure, exposure to tobacco smoke, unhealthy diets and physical inactivity,” she says.
This has not been easy since Iran has a large, scattered rural population. The government has established over 17 000 “health houses” staffed by 32 000 community health workers, called behvarz, trained to deliver essential health services. A referral system links these “health houses” to higher levels of care, including health centres close to where people live, district hospitals and university teaching hospitals.
Universities play a major role not just in training cardiologists, nurses and other health workers, but also in delivering health services. In addition, these higher educational institutions are the custodians of all government healthcare funding and they channel resources to Iran’s many health facilities.
WHO developed a package of essential interventions to prevent and control noncommunicable diseases. Iran followed suit with its own customized package, piloting it in four selected cities in 2016 before starting expansion of it to every rural health care facility in the country a year later.
“We have tried to make a link between people’s health needs and medical education for health workers,” says Dr Mohammad Shariati, director of the Primary Health Care Network at the Ministry of Health and Medical Education. “If the needs of the community change, the capacities of human resources change, too.”
We have tried to make a link between people’s health needs and medical education for health workers. If the needs of the community change, the capacities of human resources change, too.
Thanks to Dr Jahanian’s specialized training to detect and treat noncommunicable diseases, Sakineh received the health care she needs. “From the mosque to the neighbourhood, everyone is singing Dr Jahanian’s praises,” says Sakineh. “My whole family visits her routinely because we know we are in the best of hands.”
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