School Health in Iran: evidence for success and future challenges

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School Health in Iran evidence for success and
future challenges

• Nastaran Keshavarz Mohammadi
• Fereshteh Bakhshalian
• Minoo Sadat Mahmud Arabi

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Acknowledgement

• Professor Don Nutbeam
• Dr K.C Tang
• Dr Jaafar Jokhadar
• Dr Said Arnaout
• Co-authors
• Joint Consortium for School Health

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How dose this case study fits into the school
health literature?

• Knowledge gap in school health research
• Inadequate diversity of perspectives (Nutbeam,
  2000Rowling, 1997 St Leger,2000) such as
  educational or parents perspective
• Inadequate knowledge about schools as
  organisations /systems (Baric,1994)
• Inadequate knowledge about school health in
  Non-English speaking and /or low income countries
  
• Limitations of defining evidence", excludes
  valuable knowledge and experiences (Green,2000)

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Geographical location of Iran
1.648.000 Km2 1/2 of India
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Geo-political context of Iran

• 1979 Evolution
• 1981 Invasion of Iran by Saddam Hussein followed
  by 8 years
• Increasing economic sanction up to present
• Change in life style due to globalizations and
  local events, advancement in science and
  communication technology
• Increasing un-employment and financial
  constraints on families

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Socio-demographic context

• Above 70 millions population
• Among the youngest nations in the world
• Increasing Literacy rate specially for girls
• Increasing secondary and tertiary education for
  girls (Currently about 60 of University students
  are female)

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The Education context of Iran99,500 school (IRAN
Ministry of Education ,2007)15, 000, 000 at
school age
Table.1 The coverage of primary school education
in Iran (1978-2007)
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Health system in Iran PHC Networks

• Ministry of Health services and Medical
  Education
• The Universities of medical sciences
  and health services
• (at least one per each
  province)
• Deputy of Health
  services
• Metropolitan PHC Network
  Districts PHC Network
• Urban Health Centers
  Rural Health Centers
• (Local Health centers)
  (Village Health houses)

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Mortality and Morbidity

• Main causes of Mortality (Ghasemi, 2002)
• the cardiovascular and cerebrovascular diseases
  considered the causes of half of mortality rates
• Accidents.
• Main cause of Morbidity
• Malnutrition
• 1. Iron anemia deficiency,
• 2. Insufficient consumption of calcium
• 3.Increasing obesity and below 3 percentile

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History of school health in Iran

• 1935 Establishment of Department for school
  health in Ministry of Education
• 1971 Establishing special colleges to train
  school health technicians in all provinces
• In 1979 Post evolution re-structuring followed
  by transferring school health departments and its
  staff (including school health technicians) to
  Ministry of Health
• 1989 Transferring back the school health
  technicians from health sector to education
  sector
• 2001 Re-Establishment of department of health
  and sport in Ministry of Education
• 2006Passing Supportive legislation for school
  health, and highlighting school health in
  national development plan

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Current practice of school health in Iran A
collaborative effort

• Targets all 6 -18 years old children with higher
  priority for disadvantaged children in rural
  areas
• Main focus of nutrition and reproductive health

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Current school health promotion

• Health education (healthy eating, Reproductive
  health, HIV/AIDS)
• Health services
• Regular screening examinations and issuing health
  ID for 2,000,000 students (100 coverage in rural
  area and 10in urban Areas)
• milk and Iron table supply (For 9o girls in high
  schools and middle schools)
• Free meal
• Immunization ( reminder dt for 3,000,000 high
  school girls that is about 82/27)
• Environmental health
• Students and parents participation (3,000,000
  students as school health promoter, 30,000
  parents volunteer to examine students)

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Summary of school health achievements in a
quarter of century in Iran

• 1. Significant increase in coverage of primary
  education with focus on equity
• 2. Strengthening infrastructure for school health
  by re-establishing school health unit in
  Department of Health and employing more school
  health technicians
• 3. Passing supportive legislation for school
  health promotion
• 4. Integration of school health in primary health
  care system
• 5. Joint collaboration of education and health
  sector for better health and education for all,
  with more focus on disadvantaged students

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Achievements Continue

• 6. Delivering free meals Iron supplements and
  free milk are delivered to 90 of girls in
  intermediate and high schools (Iron tablets for a
  period of 6 months)
• 7. Special national protocols have been designed
  and used.
• 8. Collaboration of public Medias regarding
  school health such as TV, newspapers, radios etc
• 9. Availability of target group because of good
  collaboration between three responsible bodies in
  two MOE and MOHME ministries (school health
  office MOHME, office for students with
  disabilities MOE and deputy of health and
  sports MOE

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Future challenges

• Co-ordination of school health practice and
  research
• More effective management of the current data
• Inadequate resources
• Impact of political conflicts and economic
  sanctions on school health

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Thanks!