TEHRAN - Jafar Sadeq Tabrizi, the director of health network department at the Ministry of Health, has said the health network has been playing a key role in fighting the coronavirus pandemic mostly through holding seminars, equipping medical centers, and implementing screening tests and family physician programs across the country.

“At the time China announced the outbreak of coronavirus, we started holding training courses for all the healthcare providers in rural and urban areas, based on the health protocols of the World Health Organization (WHO),” he said in an exclusive interview with the Tehran Times on Saturday.

He went on to say that “some national and provincial conferences were held to make all the officials and the health network aware of the pandemic and its consequences, adding, in the third step, some 1,900 health houses and posts were assigned to COVID-19 patients.

We have provided the necessary equipment for the virus diagnosis and treatment to the health houses and health posts, and after a while, the COVID-19 self-assessment system was set up and introduced to the people; which was for informational purposes, not a medical diagnosis.

However, some 14.5 million people registered in the system, 4.5 million of whom showed COVID-19 symptoms.

During 10 days, 78 million people were contacted through phone conversation and had been checked.”

As a result of the first phase of the screening program, 31,000 people were hospitalized, he further stated.

Through the second phase, 30 million people were diagnosed, with a priority of people at a higher risk of COVID-19, including, older people (that is people over 60 years old); and those with underlying medical conditions (such as cardiovascular disease, diabetes, chronic respiratory disease, and cancer). 

The screening was also conducted on 1.2 million nomads in the country, 442 of whom were infected and referred to the hospitals, while there have so far been no mortalities among the nomads, he noted, adding, all received self-protective equipment and disinfectants free of charge.

Highlighting that refugees also have undergone screening tests, he said that 3.7 million refugees were registered in the Salamat system, 2.7 million of whom were diagnosed, and those infected with the virus received free medicine.

How PHC system established in Iran?

In 1971, a research project was carried out in the northwestern city of Urmia that came up with an idea of setting up a comprehensive healthcare network in both rural and urban areas of the country, similar projects were piloted in the provinces of West Azarbaijan, Shiraz, Tehran, Fars and Lorestan from 1973 to 2020, However, Iran’s health care network was launched in 1981-1983. 

He went on to note that over six years (1984 to 1990), the PHC system was fully developed throughout the country.

The country’s PHC system is formed of several sections working in harmony to offer primary care to different groups of people in rural and urban areas; in rural areas, Health Houses are established in villages with over 300 residents, which are under the supervision of a rural comprehensive health center.

Each health center takes control of five Health Houses.

Two healthcare providers (called Behvarz) are providing primary care in each health house; including, preventive care, health promotion, screening, and basic medical services for the predefined conditions, to an approximate population of 1,100 people.

While complicated cases or those with more severe symptoms are sent to the comprehensive health center, and emergency patients are referred to the provincial hospitals.

Currently, 31,400 Health Houses and 7,400 health centers are providing services to over 20 million villagers nationwide, with 630 healthcare providers, he highlighted, adding, therefore, 97 percent of the country’s rural population is covered by the PHC system.

A similar system is providing primary care in urban and suburban areas called Health Posts with community-based health care workers (called “Moragheb-e-Salamat”), each of whom is tasked with offering services to about 2,500 people.

There is also an urban comprehensive health center that supervises three Health Posts, he noted, adding, some 5,500 health posts and 2,723 health centers are active across the country, with 24,000 healthcare practitioners.

Pointing out that 93 percent of the urban residents are covered by the health networks in the country, he said that 3,987 physicians and 12,032 health care providers (dentists, nurses, midwives, and health professionals in the fields of environmental health, nutrition, mental health, etc.) provide services to 54 million people,” he also explained.

He went on to say that patients who need more specialized services are referred to the provincial hospitals and medical clinics; each health networks in 31 provinces of the country, operates under the supervision of the province's medical universities.

Family Physician program expansion a must

In 2005, Family Physician (FP) program was started, which targeted almost 25,000,000 citizens residing in rural areas, and piloted in two provinces of Fars and Mazandaran. 

Based on the program, a physician and a midwife offer services in rural areas, every 3,300 villagers have a physician and there is a midwife per 5,200 people in villages.

The plan helped reduce treatment costs and public spending on healthcare services, as the physician is aware of the person’s health background, so that it prevents many unnecessary diagnostic processes, like scans.

A longstanding challenge, however, remains to be a barrier to the expansion of the FP program into urban settings, where the PHC is undeveloped and fragile as well as the powerful private sector is resistant.

It is of great importance to expanding the plan across the country, and the government must support to implement the FP program in all the provinces, which leads to a considerable reduction in treatment costs, he emphasized. 

PHC system, a key element to COVID-19 vaccination

Pointing to the COVID-19 vaccine production, he said that currently, 20 projects are running for vaccine production in the country, which will soon start human trials, as animal testing has been made successfully.

Whenever a vaccine is ready to mass-produce, the health network will be the key to its nationwide distribution and injection, he noted, emphasizing that by the time the vaccine is introduced to the national or international market, we will plan to vaccinate the whole population without a doubt.

He further warned of a hard winter due to the influenza strike, which may make the current situation more complicated, stating that last year we have purchased 1.4 million dosage of flu vaccine for the public and private sector, however, this year, we offered nearly 7 million dosages to vaccinate people against influenza.

Iranian health network model implemented in the U.S.

As WHO have several times praised Iran’s PHC system, many countries expressed eagerness to use Iran’s experience in their countries and strengthen their healthcare system.

So far numerous conferences and meetings held to exchange ideas for different countries in the region, as Iran has the most unique PHC system, he noted, stating that Mississippi state in the United States has run the same system after using Iran’s experiences.

The most unique electronic health record (EHR) system

In 2016, we have also established a national electronic health record (EHR) system in which every citizen is registered with the national ID number, he highlighted, adding, which provides us with comprehensive health data on different fields. 

Moreover, we have assigned a person to follow up on people's complaints in each province and determine the people’s satisfaction with the received services, he added.

Challenges facing PHC network 

Elsewhere in his remarks, he pointed to the challenges and barriers to the health network expansion and empowerment, noting that we are currently grappling with a lack of workforce, as more healthcare providers are needed to cover the whole villages.

As long as our budget is dropping year by year, we need more sustainable funds, he said, calling on officials to think of a solution for budget allocation and speed up the health network development.

Another barrier to the expansion of health networks is the lack of vehicles for providing primary health care services to remote areas, impassable villages, in addition to the provision of motorcycles for Behvarz that should cover their surrounding villages that have no health houses.

FB/MG