School Health in Iran: evidence for success and future challenges

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

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

3. 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 parent’s 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)

4. Geographical location of Iran 1.648.000 Km2 1/2 of India

5. 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

6. 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)

7. 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)

8. 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)

9. 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

10. 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 • 2006:Passing Supportive legislation for school health, and highlighting school health in national development plan

11. 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

12. 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 10%in 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)

13. 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

14. 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]

15. 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

16. Thanks!