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School Health in Iran: School Health in Iran: evidence for success and evidence for success and future challenges future challenges Nastaran Keshavarz Nastaran Keshavarz Mohammadi Mohammadi Fereshteh Bakhshalian Fereshteh Bakhshalian Minoo Sadat Mahmud Minoo Sadat Mahmud Arabi Arabi

School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

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Page 1: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

School Health in Iran: evidence for School Health in Iran: evidence for success and future challengessuccess and future challenges

Nastaran Keshavarz MohammadiNastaran Keshavarz Mohammadi Fereshteh BakhshalianFereshteh Bakhshalian

Minoo Sadat Mahmud ArabiMinoo Sadat Mahmud Arabi

Page 2: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

AcknowledgementAcknowledgement Professor Don NutbeamProfessor Don Nutbeam Dr K.C TangDr K.C Tang Dr Jaafar JokhadarDr Jaafar Jokhadar Dr Said ArnaoutDr Said Arnaout Co-authorsCo-authors Joint Consortium for School Health Joint Consortium for School Health

Page 3: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

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

Knowledge gap in school health research:Knowledge gap in school health research:

Inadequate diversity of perspectives (Nutbeam, 2000Rowling, Inadequate diversity of perspectives (Nutbeam, 2000Rowling, 1997 ;St Leger,2000) such as educational or parent’s perspective1997 ;St Leger,2000) such as educational or parent’s perspective

Inadequate knowledge about schools as organisations /systems Inadequate knowledge about schools as organisations /systems (Baric,1994)(Baric,1994)

Inadequate knowledge about school health in Non-English Inadequate knowledge about school health in Non-English speaking and /or low income countries speaking and /or low income countries

Limitations of defining “evidence", excludes valuable Limitations of defining “evidence", excludes valuable knowledge and experiences (Green,2000)knowledge and experiences (Green,2000)

Page 4: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

Geographical location of IranGeographical location of Iran

Page 5: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

Geo-political context of IranGeo-political context of Iran

1979: Evolution 1979: Evolution 1981: Invasion of Iran by Saddam Hussein 1981: Invasion of Iran by Saddam Hussein

followed by 8 yearsfollowed by 8 years Increasing economic sanction up to presentIncreasing economic sanction up to present Change in life style due to globalizations and Change in life style due to globalizations and

local events, advancement in science and local events, advancement in science and communication technologycommunication technology

Increasing un-employment and financial Increasing un-employment and financial constraints on familiesconstraints on families

Page 6: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

Socio-demographic contextSocio-demographic context

Above 70 millions populationAbove 70 millions population Among the youngest nations in the worldAmong the youngest nations in the world Increasing Literacy rate specially for girlsIncreasing Literacy rate specially for girls Increasing secondary and tertiary Increasing secondary and tertiary

education for girls (Currently about 60% of education for girls (Currently about 60% of University students are female)University students are female)

Page 7: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

The Education context of IranThe Education context of Iran99,500 school (IRAN Ministry of Education ,2007)99,500 school (IRAN Ministry of Education ,2007)

15, 000, 000 at school age15, 000, 000 at school age

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1978 2007

Primary school

Middle school

High school

Table.1 The coverage of primary school education in Iran (1978-2007)Table.1 The coverage of primary school education in Iran (1978-2007)

Page 8: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

Health system in Iran: Health system in Iran: PHC NetworksPHC Networks

Ministry of Health services and Medical EducationMinistry of Health services and Medical Education

The Universities of medical sciences and health servicesThe Universities of medical sciences and health services

(at least one per each province)(at least one per each province)

Deputy of Health services Deputy of Health services

Metropolitan PHC Network Districts PHC NetworkMetropolitan PHC Network Districts PHC Network

Urban Health Centers Rural Health CentersUrban Health Centers Rural Health Centers

(Local Health centers) (Village Health houses)(Local Health centers) (Village Health houses)

Page 9: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

Mortality and MorbidityMortality and Morbidity

Main causes of Mortality (Ghasemi, 2002)Main causes of Mortality (Ghasemi, 2002)

the cardiovascular and cerebrovascular diseases considered the the cardiovascular and cerebrovascular diseases considered the causes of half of mortality ratescauses of half of mortality rates

Accidents.Accidents.

Main cause of Morbidity: Main cause of Morbidity:

MalnutritionMalnutrition 1. 1. Iron anemia deficiency,Iron anemia deficiency, 2. Insufficient consumption of calcium2. Insufficient consumption of calcium 3.Increasing obesity and below 3% percentile3.Increasing obesity and below 3% percentile

Page 10: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

History of school health in IranHistory of school health in Iran 1935 :Establishment of Department for school health in Ministry of 1935 :Establishment of Department for school health in Ministry of

Education Education

1971 :Establishing special colleges to train school health 1971 :Establishing special colleges to train school health technicians in all provincestechnicians in all provinces

In 1979In 1979 : : Post evolutionPost evolution re-structuring followed by transferring re-structuring followed by transferring school health departments and its staff (including school health school health departments and its staff (including school health technicians) to Ministry of Health technicians) to Ministry of Health

1989 : Transferring back the school health technicians from health 1989 : Transferring back the school health technicians from health sector to education sectorsector to education sector

2001 : Re-Establishment of department of health and sport in 2001 : Re-Establishment of department of health and sport in Ministry of EducationMinistry of Education

2006:Passing Supportive legislation for school health, and 2006:Passing Supportive legislation for school health, and highlighting school health in national development planhighlighting school health in national development plan

Page 11: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

Current practice of school health in Current practice of school health in Iran: A collaborative effortIran: A collaborative effort

Targets all 6 -18 years old children with Targets all 6 -18 years old children with higher priority for disadvantaged children higher priority for disadvantaged children in rural areasin rural areas

Main focus of nutrition and reproductive Main focus of nutrition and reproductive healthhealth

Page 12: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

Current school health promotionCurrent school health promotion Health education (Health education (healthy eating, Reproductive health, HIV/AIDShealthy eating, Reproductive health, HIV/AIDS)) Health services:Health services: Regular screening examinations and issuing health ID for 2,000,000 Regular screening examinations and issuing health ID for 2,000,000

students (students (100% coverage in rural area and 10%in urban Areas100% coverage in rural area and 10%in urban Areas) ) milk and Iron table supply (Fmilk and Iron table supply (For 9o% girls in high schools and middle or 9o% girls in high schools and middle

schools) schools) Free meal Free meal Immunization ( Immunization ( reminder dt for 3,000,000 high school girls that is about reminder dt for 3,000,000 high school girls that is about

82/27%)82/27%)

Environmental healthEnvironmental health

Students and parents participation (3,000,000 students as school Students and parents participation (3,000,000 students as school health promoter, 30,000 parents volunteer to examine students)health promoter, 30,000 parents volunteer to examine students)

Page 13: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

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

1. Significant increase in coverage of primary education 1. Significant increase in coverage of primary education with focus on equitywith focus on equity

2. Strengthening infrastructure for school health by re-2. Strengthening infrastructure for school health by re-establishing school health unit in Department of Health establishing school health unit in Department of Health and employing more school health techniciansand employing more school health technicians

3. Passing supportive legislation for school health 3. Passing supportive legislation for school health promotionpromotion

4. Integration of school health in primary health care 4. Integration of school health in primary health care systemsystem

5. Joint collaboration of education and health sector for 5. Joint collaboration of education and health sector for better health and education for all, with more focus on better health and education for all, with more focus on disadvantaged studentsdisadvantaged students

Page 14: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

Achievements :ContinueAchievements :Continue

6. Delivering free meals; Iron supplements and free milk 6. Delivering free meals; Iron supplements and free milk are delivered to 90% of girls in intermediate and high are delivered to 90% of girls in intermediate and high schools (Iron tablets for a period of 6 months)schools (Iron tablets for a period of 6 months)

7. Special national protocols have been designed and 7. Special national protocols have been designed and used.used.

8. Collaboration of public Medias regarding school health 8. Collaboration of public Medias regarding school health such as TV, newspapers, radios etcsuch as TV, newspapers, radios etc

9. Availability of target group because of good 9. Availability of target group because of good collaboration between three responsible bodies in two collaboration between three responsible bodies in two MOE and MOHME ministries (school health office MOE and MOHME ministries (school health office [MOHME], office for students with disabilities [MOE] and [MOHME], office for students with disabilities [MOE] and deputy of health and sports [MOE]deputy of health and sports [MOE]

Page 15: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

Future challengesFuture challenges

Co-ordination of school health practice Co-ordination of school health practice and research and research

More effective management of the current More effective management of the current datadata

Inadequate resourcesInadequate resources Impact of political conflicts and economic Impact of political conflicts and economic

sanctions on school healthsanctions on school health

Page 16: School Health in Iran: evidence for success and future challenges Nastaran Keshavarz Mohammadi Nastaran Keshavarz Mohammadi Fereshteh Bakhshalian Fereshteh

Thanks!Thanks!