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Urban HEART Evaluation Report Iran

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Urban HEART Evaluation Report Iran Report on documentation and evaluation of Urban HEART pilot in Tehran, Islamic Republic of Iran 2013 Hamid Allahverdipoor, Hossein Behdjat, Nazila Tajaddini, Reza G. Vahidi, Habib Jabbari National Public Health Management Centre, Tabriz University of Medical Sciences Contents Acknowledgements .................................................................................................................. 4 1. Introduction ....................................................................................................................... 5 1.1 Background to health and health inequities in Iran ............................................................ 5 1.2 Evaluation of Iran’s experience in Urban HEART pilot in Tehran .................................... 9 2. Urban HEART pilot project in Tehran ........................................................................ 10 2.1 Overview of Urban HEART pilot project in Tehran ........................................................ 10 2.2 Islamic Republic of Iran: country profile ......................................................................... 15 2.3 Description of pilot site..................................................................................................... 16 2.4 Implementation of Urban HEART in Tehran ................................................................... 20 3. Method of documentation and evaluation .................................................................... 23 4. Documentation and evaluation results .......................................................................... 26 4.1 Pre-assessment phase ........................................................................................................ 26 4.2 Assessment phase ............................................................................................................. 30 4.3 Response phase ................................................................................................................. 32 5. Findings and recommendations ..................................................................................... 36 5.1 Summary of process.......................................................................................................... 36 5.2 Strengths and weaknesses ................................................................................................. 36 Annex A. Questionnaire to assess indicators ....................................................................... 39 Annex B. Participants in focus group discussions and interviews .................................... 42 Annex C. Members of Tehran Urban HEART team.......................................................... 43 Annex D. Samples of questionnaires .................................................................................... 44 Annex E. Matrices for indicators: Urban HEART pilot, Tehran ..................................... 62 References ............................................................................................................................... 64 Figures Figure 1. Iran population pyramids, 2005 and 2025 (projected) ............................................... 6 Figure 2. Classification of Iranian provinces by mortality and fertility .................................... 7 Figure 3. Modified classification of Iranian provinces based on socioeconomic status (GDP/capita and % literacy) ...................................................................................... 8 Figure 4. Stages in the development of Urban HEART .......................................................... 11 Figure 5. General principles of Urban HEART ....................................................................... 11 Figure 6. Key objectives of Urban HEART............................................................................. 12 Figure 7. Components of Urban HEART ................................................................................ 12 Figure 8. Urban HEART implementation process ................................................................... 14 Figure 9. Map of Iran ............................................................................................................... 15 Figure 10. Climate map of Iran ................................................................................................ 16 Figure 11. Tehran: population growth ..................................................................................... 17 Figure 12. Administrative districts of Tehran .......................................................................... 18 2 Figure 13. Tehran city borders ................................................................................................. 18 Figure 14. Urban HEART pilot locations ................................................................................ 20 Figure 15. Logic model of programme action ......................................................................... 23 Figure 16. Six steps to implement Urban HEART .................................................................. 24 Tables Table 1. Trends in urban and rural population distribution (%) ................................................ 5 Table 2. Demographic indicators by urban/rural and by sex ..................................................... 6 Table 3. Tehran municipal districts and populations ............................................................... 19 Table 4. List of indicators, Tehran Urban HEART ................................................................. 22 Table 5. Components of the evaluation of Urban HEART ...................................................... 25 Table 6. Indicators of Tehran Urban HEART ......................................................................... 29 Table 7. Components of Tehran Urban HEART questionnaires ............................................. 30 Table 8. Estimated costs of Tehran Urban HEART pilot, Brasilia conference ....................... 32 3 Acknowledgements This report is a joint work of the National Public Health Management Training Centre and the Faculty of Health and Nutrition, Tabriz University of Medical Sciences. The evaluation team gratefully acknowledges the WHO Country Office in the Islamic Republic of Iran, especially Dr Jihane Tawilah, WHO representative in Iran; Dr Ambrogio Manenti, previous WHO representative; members of Health for Sustainable Development, Iran unit; and members of several national organizations who made valuable contributions to this report through their comments and informative feedback. Special thanks go to the Tehran Urban HEART pilot project team, especially Dr Vaez Mahdavi, Dr Fagieh, Dr Malek Afzali, Dr Golmakani, Dr Raghfar, Dr Kalantari, Dr Farshad, Dr Nuorbala, Dr Montazeri, Dr Asadi Lari, Mr Haerie, and all other members of staff from different universities of medical sciences in Iran. 4 1. Introduction 1.1 Background to health and health inequities in Iran Equity in health is defined as the absence of systematic disparities in health or in the major social determinants of health amongst different social groups. Inequities in health systematically put groups of people who are already socially disadvantaged (for example poor people, females and members of ethnic or religious groups) in an even worse position with respect to their health (1). Differences in health that are systematic and socially induced are unfair; they are modifiable and can be regarded as inequities in health (2). Due to systematic differences in pattern of health within a society and across different socioeconomic groups, differences in health status are not distributed randomly (3). The Islamic Republic of Iran1 has a middle-income economy and is one of the most populated countries in the region, with a population of about 70 million. Iran is a multi-ethnic and multicultural country with a rich heritage in different subgroups of its population. Half of the country’s population consists of Persian-speaking Iranians, while Azerbaijanis account for at least 25%. Other major ethnic groups include Kurds, Lors, Bakhtiaris, Baluchis, Arabs and Armenians (4). The health and demographic profile of Iran is in transition (see country profile in section 2.2). However, in recent decades, the country has witnessed great progress in the development of its health sector. Following the Islamic Revolution in 1979, more investments in public health led to improved access to health services in the country. This was combined with the development of a basic but robust rural primary health care network (3). A World Bank report of 2007 showed a significant improvement in a number of health indicators, including life expectancy, infant mortality rate, under-5 mortality rate, family planning programme coverage and malnutrition rates in the Iranian population. Provision of care faces the challenge of a rapid increase in the rate of urbanization in the country in the last three decades. Less than half of the population lived in urban areas in 1980, but this has increased to around 70% (table 1). Table 1. Trends in urban and rural population distribution (%) Year Urban Rural 1980 49 51 1996 62 38 1998 63 37 2000 64 36 2002 67 33 2005 67 33 1 Henceforth referred to as “Iran”. 5 Table 2 shows data for a number of demographic indicators for urban and rural areas and for males and females. Table 2. Demographic indicators by urban/rural and by sex Indicators Urban Rural Male Female Crude birth rate 15.2 18.2 17.3 16.7 Crude death rate 5.0 5.0 5.6 4.3 Population growth
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