Jackson Medical Mall Founder Patterns Statewide Outreach Program after Iran’s Health House System

An innovative and successful universal healthcare program initiated during the 1980s Iran-Iraq War under the Islamic Republic of Iran is being duplicated by leaders at Jackson Medical Mall and Jackson State University for implementation in Mississippi, beginning with the rural Delta.

“We saw it could be done in a country with a fraction of the resources that we have,” said Aaron Shirley, MD, founder and board chairman of the Jackson Medical Mall Foundation. “They simply had the determination.”

Iran’s master plan to provide healthcare at no charge to residents in every district encountered difficult financial, environmental, and industry challenges. For example, a latrine building program wasn’t initiated until 1975 to create a better environment. Health experts believed the infrastructure proposition was too ambitious and the limited education requirement of community health workers would weaken an already ineffective healthcare delivery system. The nine-year Iran-Iraq War drained financial resources.

“At the beginning, we could never imagine such a breakthrough,” said Sirous Pileroudi, MD, a retired senior official with the Ministry of Health and co-founder of the Iranian healthcare system. “We were at war and the country was in a miserable condition.”

Despite strong opposition, Pileroudi and others initiated the grass roots program in the Western Azerbaijan province, where pockets of the rural population were rapidly swelling. Emphasizing community participation and regional collaboration, health houses were designed to meet the needs as the first level of public healthcare. Rural health centers that cover 6,000 to 10,000 people with one or two physicians and several health technicians represent the second level. Hospitals are charted as the third level of care.

Now, 17,000 modest rural medical posts serve more than 90 percent of the Islamic Republic’s 23 million rural residents. Since it was established in 1981, mortality rates have sharply declined, particularly among infants (from 200 to 26 per 1,000 births) and pregnant women. Contagious diseases have been significantly curtailed, and continuous improvements are being made with chronic diseases such as diabetes and hypertension. Health houses have also improved nutrition and fluoride treatment, and helped control iodine disorders and iron-deficiency anemia.

Here’s how it works: Local rural councils approve community health workers, known as behvarzan, who have gender-specific roles. A female behvarzan, eligible for the job at the age of 16, is responsible for child and maternal health, vaccination, administering medicine, and registration. A male Behvarzan—minimum age of 20—is responsible for outdoor activities, such as follow-up visits to patients, sanitation and environmental projects. Minimum job requirements include 11 years of regular education plus two years of theoretical and practical training before applicants are awarded a certificate to practice.

“The health workers are well familiar with the culture and traditions and that’s a big advantage,” said Mohammad Esmael Motlaq, MD, director of the Centre for Healthcare Promotion affiliated with the Ministry of Health.

For example, Maryam Alaini, a 25-year-old high school graduate, has been working for two years in the health house in the village of Afjeh, on the outskirts of the capital, Tehran. Her health house covers 1,215 Iranian and 67 Afghan-born villagers. A typical weekday involves seeing 15 people for general consultations, blood pressure checks, diabetes treatment, and minor ailments, such as the common cold.

The number doubles on Saturday, when a physician visits. Along with her male counterpart, Alaini visits local schools on a regular basis to teach preventive care to schoolchildren. She maintains log books—circular charts known as “vital horoscopes”—on each household, containing the name, gender and age of all family members, sanitation conditions of the household, history of pregnancies, details of care for preschool-aged children and dental-care records.

“I was impressed with both the simplicity and effectiveness of that system to the point where … over a short period of time, we were able to build a formal relationship through a memorandum of understanding between Jackson State University, Jackson Medical Mall and Shiraz University of Medical Sciences in Iran,” said Shirley, who was among a small delegation from the United States to travel to the Islamic Republic late last year to see first-hand how the program works. “From that first visit, the relationship has evolved to the point where Jackson State, in working with the Iranians, has been able to create what we refer to as the Global Center for Training and Certification of Community Health Workers joint venture between all three institutions.”

Even though state and federal healthcare funding agencies are disinclined to fund the program in Mississippi, Shirley and others are moving forward with the Mississippi Health House Network.

“It’s a work in progress,” said Shirley, who organized a second trip to Iran for program leaders to begin formalizing the relationship and to bring back the core faculty to staff two health houses in Hinds County. “We’ve identified six communities in the Mississippi Delta—Greenwood, Hollandale, Mound Bayou, Belzoni, Leland and Clarksdale—for the first phase … to duplicate the concept and link to the network. The ultimate goal is to establish health house networks in 15 communities throughout the Mississippi Delta.”

The typical community health house network structure will become the first level of healthcare. Primary care clinics and existing practices will comprise the second level; community hospitals will represent the third level.

“If they could do it there with almost no resources, we should be able to do it here with the vast resources we have,” Shirley pointed out. “Nobody’s doing anything like it in the U.S.”

For more information on the Mississippi Health House Network, visit www.hchaweb.com.

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