Public health improvement in Iran—lessons from the last 20 years

doi:10.1016/j.puhe.2004.05.011

Public Health

Volume 118, Issue 6, September 2004, Pages 395-402

https://doi.org/10.1016/j.puhe.2004.05.011 Get rights and content

Summary

Introduction. Health services are historically based on providers's and policy makers's understanding of population health status. This does not necessarily reflect the real needs of a population. Health needs assessment (HNA) should improve individual or population health and optimize the way that limited resources are utilized.

Objectives. To review health needs literature and to describe Iranian primary healthcare (PHC) achievements in developing a needs-driven health system.

Findings. The Iranian PHC system was established to meet healthcare needs identified through population health status surveys. Since 1984, the PHC system has become highly organized and efficient, resulting in a dramatic decrease in infant, maternal and neonatal mortality rates, population growth, increasing life span and a marked shift towards non-communicable diseases.

Through an organized partnership of the general population, volunteers, health workers and health professionals, a needs-oriented healthcare system became central to health policy in Iran. Several information sources were utilized to establish need. Improving death certification was an immediate and important part of this process.

Comment. Improved knowledge about personal rights, community and environmental health policies, and involvement of the media led to an increased range and depth of needs. Moving towards quality improvement and a needs-driven healthcare system requires continuous needs assessment. Novel methods of HNA, such as postal and telephone surveys, group discussions, surrogates for need such as quality-of-life measurement (commonly used in developed countries) or other locally designed methods such as the basic development needs approach, may be relevant to the Iranian PHC network.

Introduction

Historically, health services in the Western world are based on providers and policy makers understanding of the population health status. This has led to the introduction and widespread use of technological solutions to health problems. In developing countries such as Iran, however, public health issues such as rapid population growth, appalling infant and maternal mortality rates, and low vaccination rates against common infectious diseases predominated until recently, and increasing urbanization has seen the emergence of chronic illnesses including coronary heart disease. Is the Western approach to medical care, which is biased towards curative and technological solutions, appropriate for developing nations or is there an alternative?

The ideal model of care dictates that services meet the genuine health needs of the general population. ‘Need’ is difficult to define,¹ yet in modern healthcare systems, fulfilling health needs has a central role. Health needs refers to a wide range of issues related to people's health, including deprivation indices, literacy, housing and even social facilities such as a bus service to reach the health services.² Health needs assessment (HNA) recognizes the importance of people's genuine needs, and aims to ensure that health service resources are spent in the most efficient way to improve the population's health.

This paper provides an overview of the primary healthcare (PHC) system in Iran and its advantages, assesses the impact of the health needs approach on health care in Iran, and describes novel approaches to ongoing HNA.

Section snippets

Identifying health needs

‘Health’ is an all-inclusive concept, not just lack of illness³, so it is not surprising that numerous definitions have been presented for health need;¹ geographic variations, socio-economic status, and knowledge and attitude of the population may influence demand for health care, while guidelines and effectiveness of procedures may affect availability. Ideally, the provision of healthcare services should meet most of the population's needs. As these may not be constant, HNA surveys are

Approaches to HNA

Several methods have been used to assess a population's healthcare needs including utilization, deprivation and mortality.⁶ Recently, however, four practical methods have gained more attention.

Routine data collection

An exclusive data sheet or ‘vital horoscope’ (VH) forms the basis of data collection for every member of a community in rural areas. The VH is held as a spreadsheet in each HH and comprises several concentric circles in 12 equal slices (representing 1 year) to record vital events including births and deaths in the main and adjacent (satellite) villages. Data on inter-alia age-stratified demographics, environmental health, family planning, vaccine-preventable disease, amount of iodized salt

Applying HNA to solve health problems in Iran

In 1979, neonatal and maternal mortality rates in Iran were among the worst in the world (Fig. 1), and population growth rate exceeded 3.2%. Other major health problems identified in surveys included low vaccination uptake, high death rates from childhood infectious disease, high maternal mortality rate, limited access to clean drinking water in rural areas, and poor access to healthcare facilities in indigent localities (Table 3).

A contemporary review of the health status of the Iranian

The future

The PHC system in Iran was established in response to healthcare needs identified in surveys, but needs will change over time due to, for example, urbanization, increasing congestion and pollution, and chronic diseases in an ageing population.

The application of the epidemiological approach to HNA methodology was central at the beginning of the PHC network. However, as health needs have a dynamic nature and change over time, it must become the combined responsibility of all health workers,

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Public health improvement in Iran—lessons from the last 20 years

Summary

Introduction

Section snippets

Identifying health needs

Approaches to HNA

Routine data collection

Applying HNA to solve health problems in Iran

The future

Health Place

Lancet

Public Health

Public Health

Need for redefining needs

Health Qual Life Outcomes

Development and importance of health needs assessment

BMJ

Determining priorities for change in primary care: the value of practice-based needs assessment

Br J Gen Pract

Reliability of the Salford needs assessment schedule for adolescents

Psychol Med

Epidemiologically based needs assessment

Assessing health need using the life cycle framework

A survey of social services needs assessments for elderly mentally ill people in England and Wales

Age Ageing

Assessing health needs in developing countries

BMJ

Better ways of assessing health needs in primary care

BMJ

The perception of needs for care in staff and patients in community-based mental health services. The South-Verona Outcome Project 3

Acta Psychiatr Scand