UNITED NATIONS NATIONS UNlES
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WORLD H E A L T H O R G A N I Z A T I O N
REGIONAL OFFICE FOR THE EASTERN MEDITERRANEAN
REZIONILL COMNITTEE FOR THE
=TERN MEDITEIBUW S i x t h Session
TECHNICAL DISCUSSIONS
ORGANISATION MONDIALE DE LA
SANTE
HEALTH EDUCATION I N IRiiN
Submitted by t h e Demrtment of Public Health Ministry of Health, I r a n
I
G r ~ a n i e a t i o n and Develoument of Public Health Education Services.
m s t o r yThere has been a d i v i s i o n of propaganda i n t h e Ministry of Health since 1930 but a public health education programe t o give continuity t o educational a c t i v i t i e s emphasizing t h e needs of t h e people was established i n t h e then-organized Department of Public Ifealth of t h e Kinistry of Health.
The d a i l y problems of this department were the c o n t r o l of malaria and a few other cormnuuicable diseases; t h e health education s e c t i o n a s s i s t e d various divisions within t h e department i n r
1. Preparation of plans f o r teaching a u x i l i a r y and professional workers i n h e a l t h questions that needed m e d i a t e attention.
2. Health education of the public. For t h i s purpose, a group of six h e a l t h workers were given a six-week introductory course i n h e a l t h education with p a r t i c u l a r emphasis on malaria control and education with audio-visual means.
These h e a l t h workers were s e n t t o areas where malaria c o n t r o l groups were planning t o spray. Their a c t i v i t y proved t o be highly e f f e c t i v e i n encouraging people t o copperate i n t h e c o n t r o l of nntlaria.
3. Jn 1952, a health education programme was s t a r t e d i n t h e Health Division of t h e U.S. Operations Mission i n I r a n with a wider scope:
(a) Assisting i n t r a i n i n g of auxiliary public h e a l t h personnel including a s s i s t a n t o r a u s i l i a r y home-visitors, s a n i t a r i a n s , teachers i n rural schools, etc. ;
(b) preparing o r a s s i s t i n g i n t h e preparation of health education materials such a s *ado-scripts, posters, panphlets, etc.;
(c) A s s i s t i n g t h e p r o v i n c i a l publlc health personnel i n t h e i r educational a c t i v i t i e s ;
(d) planning and conducting a country-wide programme i n public h e a l t h education t
(e) a s t h e need f o r h e a l t h education s e r v i c e s grew, there was a n increased need f o r professionzl public h e a l t h educators. TMs was met by first, t r a i n i n g a group of t e n h ~ a l t h educators a d then, a year l a t e r , when requests f o r more h t a l t h educators were received from p r w i n c e s , another group of sixteen. The t r a i n i n g of an emergency character consisted of stx-months' condensed t h e o r e t i c a l and f i e l d t r a i n i n g on graduate level. The t r c i n e e s were a l l college graduates i n one of t h e follow- i n g f i e l d s : education, sociology, pharmacy, agriculture,.economice o r n a t u r a l science. I n t h i s t r a i n i n g , t h e emphasis wns based on M a - mental a c t i v i t i e s , community organization and techniques of communica- tion. The philosophy of public h e a l t h education a s w e l l a s some basic infohnation abcrut public.health was a l s o included. Various divisions of t h c U S ~ I , the Ministry of Health, t h e T f i O advisory group i n I r a n end s e v e r a l other agencies o r competent individuals assisked i n this t r a i r d n g ,
B. Present S i t u a t i o n
1 A p r i l 1953, t h e Department of Public Health of the H n i s t r y of Health end t h e Health Division of t h e USOWI were p a r t i a l l y i n t e g r a t e d and thus established t h e Public Iiealth Cooperative Organization of t h e Ministry of Health, an agency somewhat s i m i l a r t o t h e s e r v i c e s i n Latin America. The Cooperative was financed and s t a f f e d by Iranians and Americans and a t the present time i s the nucleus of a l l preventive a d , h e a l t h propagarda a c t i v i t i e s i n t h e country.
On 2 1 &rch 1956, t h e beginning of the I r a n i a n New Year, t h e Public Health Cooperative Organization was completely i n t e g r a t e d within the Ministry of Health, resuming its previous t i t l e , the Department of Public Health of the Ministry of Health.
The Public Health Education Division w i l l continue t o function under t h i s department.
A t present, t h i s Division has four main branches a t Headquarters, as U O W ~ I (see a l s o Chart
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Annex I )1. F i e l d Services Brancb
(a) To a s s i s t p r o v i n c i a l p u b l i c h e a l t h educators with t h e i r problems;
(b) t o coordinate t h e various Droarammes i n t h e orovinces:
(c) t o give s e r v i c e i n areas where t h e r e a r e no h e a l t h educators;
(d) t o evaluate programmes and prepare plans f o r new ones;
(e) t o plan and conduct research a c t i v i t i e s i n t h e f i e l d of public h e a l t h education.
2. Information Branc
(a) To supply t h e press, radio, and i n t e r e s t e d persons with t h e news of t h e a c t i v i t i e s of t h e Cooperative,;
(b) t o i s s u e publications, of which t h e r e a r e two, ( i ) IfIiife and Health1'
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a non-technical magazine with a wide c i r c u l a t i o n aimed a t people with low l i t e r a c y , a d ( i i ) "Health f o r Everyonelf
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a -tprepared f o r educated groups t o teach them new and u s e f u l approaches t o h e a l t h problems;
(c) t o prepare and d i s t r i b u t e p i c t u r e s f o r t h e information and education of t h e public.
3. Audio-visual Aids Branch
To prepare audio-visual material such a s posters, pamphlets, radio- s c r i p t s , etc. f o r nation-wide public h e a l t h education programmes.
4.
Training Branch(a) T O a s s i s t with,or conduct, t h e i + s e r v i c e o r pre-service h e a l t h t r a i n i n g of t h e p r o f e s s i o n a l or auxiliary personnel i n public h e a l t h o r r e l a t e d f i e l d s such as a g r i c u l t u r e , teaching, etc;
(b) t o provide t e c h n i c a l advice and consultation on t h e production of motion p i c t u r e s r e l a t e d t o h e a l t h (15 have been prepared s o f a r ) ;
(c) t o operate t h e PHCO l i b r a r y .
NOfE:
A t present, i n nine out of t h e t e n provinces of the country,p r o f e s s i o n a l public h e a l t h educators a r e working a s members o f t h e public h e a l t h team.
C A c t i v i t i e s 1. Treining
I n t h e f i e l d of t r a i n i n g , i n a d d i t i o n t o t h e t r a i n i n g of public h e a l t h educators, and on-the-job t r a i n i n g of some other personnel, t h e following cornon a c t i v i t i e s were c a r r i e d out with other agenciea:
(a) Training teachers f o r r u r a l areas
Id t h i s case, with t h t cooperation of the ?+inistry of Education, more t h a n 2,060 teachers from various p r t s of the country p a r t i c i p a t e d i n four summer s h o r t courses organized i n s e v e r a l p a r t s of t h e country.
(b) Training a g r i c u l t u r a l extension workers
With a s s i s t a n c e of t h e Ministry of Agriculture, i n two provinces, a g r i c u l t u r a l extension workers were, given a course i n n u t r i t i o n and health.
( c ) Training crown land s u ~ e r v i s o r s
C r o w n land supervisors were 'given i n s t r u c t i o n i n s a n i t a t i o n and o t h e r h e a l t h m a t t e r s on s e v e r a l d r f f e r e n t occasions.
(dl Assistance i n t r a i n i n c a u x i l i a m s a n i t a r i a n s .
T h i s -was sponsored j o i n t l y by t h e Public Health Cooperative Organiza- t i o n and the Near East Foundation,
2, Public Health m u c a t i o n
(a) Public h e a l t h education programmes a r e being c a r r i e d out i n nine provinces. h c t i v i t i e s include :
(i) Direct contacts with pcople, encouraging thein t o u t i l i v e a v a i l a b l e h e a l t h service;
( k t ) use of audi+visual materials such a s films, posters, pamphlets and others;
@li) g u i d b g o r s t i m u l a t i n g people i n organiaing study groups, clubs, e t c , t o study o r t a k e a c t i o n i n health;
( i v)' health i n s t r u c t i o n i n schools ;
(v) a s s i s t a n c e t o other s e l e c t e d group9 i n carrying out h e a l t h education p r o g r a m s ;
( v i ) p r e p a r a t i o n of h e a l t h materials when requests a r c received o r t h e need i s f e l t J
( v i i : a s s i s t i n g other d i v i s i o n s i n t h e Cooperative in the*-educational a c t i v i ~ l e s .
(b) In terms of s t a t i s t i c s , t h e a c t i v i t i e s o;f t h e division.f+om'l April 1953 t o 1 January 1956, were a s follows:
(i) Fiim r e e l s shown approximately 8,560
( 5 ) numbers of people i n attendance; II 1,500,000
cii)
number of h e a l t h programmes; 11 2 , m( i v ) number of people present; II 500,000
(v) materials d i s t r i b u t e d ; n 300,000
( v i ) 2 x b ~ i of c l a s s e s held f o r various
groups; n 1.250
( v i l ) p a r t i c i p a n t s i n classes; 11
40,
D Objectives
The p b j e c t i v e s o r
tne
u i v r s i o n a r e a s follows:1. Promotion of the h e a l t h of t h e p u b l i c through education;
2. informing t h e public of t h e h e a l t h s e r v i c e s a v a i l a b l e t o then;
3. guiding t h e public t o understand t h e i r own h e a l t h problems3
4.
n o t i v a t i s g t h e people t o work toward a more h e a l t h f u l l i f e ;5.
b u i l d i n g amoag t h e people a d e s i r e t o acquire h e a ' l t h f u l ~ h b i t s ; 6. encouraging peopls t o organize study and a c t i v i t y groups t o improvet h e i r h e a l t h conditions;
7. in-service t r a i n i n g of publlc h e a l t h s t a f f and teachers;
8. formal a d informal t r a i n i n g of c e r t a i n s e l e c t e d p r o f e s s i o n a l groups;
9. informing h e a l t h a u t h o r i t i e s of t h e h e a l t h needs of people, E P r i o r i t i e s and-problems
I n I r a n due t 9 t h e prevalence of c e r t a i n comunicable diseases, h e a l t h ducation i s r e q g r e d t o emphasize t h e following subjects8
1 . .
Need for a kealthy environment (a) Water s a n i t a t i o n ;(b) e x c r e t a disposal;
(c) focd s a n i t a t i o n ;
b)
i n s e c t and v e c t o r control.2 . C e r t a i n c o r d i t i o n s t h a t a c t i v a t e o r cause. d i s e a s e (a) P a l n u t r i t i o n ;
(b) Xmpropr housing I (c) improper r e c r e a t i o n ;
3 Need of c o n t r o l of ccnnnunicable diseases other than those d i r e c t &
due t o Lnsanitsry conditions, ( a ) smallpox (vaccination) ; (b) trachoma ;
(c) t u b e r c u l o s i s ; (d) Venereal diseases f
4.
.%term1 and Child HealthThe high r a t e of i n f a n t m o r t a l i t y and a l s o c e r t a i n mental and s o c i a l d i s o r d e r s i n a d u l t s t h a t might have originated i n childhood c a l l f o r s p e c i a l e t t e n t i o n t o t h e h e a l t h conditions of children. The following i t e m s h o u l d , t h e r e fore, be given proper emphasis i n h e a l t h education:
(a) I n f a n t mortality; causes ond prevention:
(b) k a l t h i n s t r u c t i o n i n schools;
( c ) m?ntal hygiene of t h e i n f a n t and school children;
(d) ohildrenls d i s c s s e s ;
( e ) u n t e n a t a l and p o s t n a t a l cares.
I1 S t a f f i w
The minimum requirement f o r public h e a l t h educators i n I r a n i s s a t i s f a c t o r y completion of c o l l e g t plus six months t r a i n i n g nnd f i e l d work i n p u b l i c h e a l t h education.
A t present thero a r t 19 h e a l t h educators working in I r a n and two a r e receiving f u r t h e r education a t t h e Lumerican University of Beirut. Of t h e t o t a l of 21, 19 have taken t h e course i n public h e a l t h education conducted by t h e Cooperative. The two others had t h e i r t r a i n i n & i n t h e accredited schools of Public Health of t h e
USA.
Furthermore, of t h e l o c a l l y t r a i n e d personnel, one received f u r t h e r t r a i n i n g a t the United S t a t e s and t h r e e a t t h e A.U.B.
I n addition, t h e r e a r e other professional and administrative personnel i n t h e d i v i s i o n such as: o r t i s t , audio-visual supervisor, l i b r a r i a n , w r i t e r , education a s s i s t a n t , photographer, s e c r e t a r i e s , clerk, etc.
On t h e p r o v i n c i a l l e v e l , t h e number of s t a f f depends on t h e l o c a l budgetary
: i t u a t i o n . Usually i n t h e absence of q u a l i f i e d public h e a l t h educators, t h e p r o v i n c i a l i e a l t n educators u t i l i z e t h e s e r v i c e s of s a n i t a r i a n a s s i s t a n t s o r a s s i s t a n t home-
r i s i t o r s , f o r e d u c a t i ~ n a l purposes.
CII ;
ME.eds
1. Personnel
Lack of adequate numbers of p r o f e s s i o n a l Q t r a i n e d public h e a l t h educators;
;he programme has n o t grown enough t o enable one t o s p e c u l a t e on t h e numbef O f public;
l e a l t h educators needed t o meet t h e t o t a l h e a l t h s i t u a t i o n of t h e country.
Moreover, t h e r a t i o of health.educators i n a population accepted i n other :ountries may o r my n o t apply h t r e due t o ecological difference, A t any r a t e , one
? a c t i s c e r t a i n
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%ny more p r o f e s s i o n a l workers a r e needed i n t h e field. of public ieolth education,To remedy t h i s :
(a) ir l a r g e r budget i s necessary t o e s t a b l i s h a continuing t r a i n i n g progranme
.;
(b) more fellowships a r e urgently nee6ed t o t r a i n q u a l i f i e d personnel abroad;
( c ) a s a long-term p r o j e c t , a plan should be .nade f o r t h ~ c r e a t i o n of a school o r department of public h e a l t h i n t h e University t o t r a i n t h e necessary workers.
2, Evaluation
The h e a l t h education progranme i n I r a n i s four years old. There a r e reasons t o be confident of t h e e f f i c a c y of t h e progmme. But a more c a r e f u l evaluation seems necessary t o show whether t h e programme has:
(a) Given people aclequate knowledge necessary f o r a h e a l t h i e r l i v i n g ;
(b) provided adequate motivation in people t o change p a t t e r n s of l i f e which a r e not healthy;
(c) encouraged people t o cooperate with t h e e d s t i n g h e a l t h agencies;
( d ) stimulated people t o i n i t i a t e health a c t i v i t i e s . 3. Eauirvnent
(a) Expansion of t h e present l i b r a r y ;
(b) more foreign-made audio-visual materials such a s mobile film u n i t s a r e necessary
(c) adequate budget f o r l o c a l production of films and f i l m s t r i p s .
I V Immediate Future Plana
(a) Evaluation on t h e I x s i s mentioned above:
(b) continuation of t h e present programme ; ( c ) scnool neaLtn :
(1)
Educational a c t i v i t i e s with t h e e x i s t i n g parent-teacher organizations6 (2) Continuation of teacher t r a i n i n g ;( 3 ) Provision of teaching o r supplementary m a t e r i e l s in health;
( d ) In-service t r a i n i x g of present public h e a l t h educators i n a r e f r e s h e r 'course
in group dynamics;
( e l trainimg 15 new public h e a l t h educators.
V Community Development
Health education i n I r a n , having b ~ e n carried out on an emergency b a s i s , has not permitted long-term planning i n c o m u n i t y development, Development has taken place mostly i n t h e u t i l i z a t i o n of h e a l t h s c r v i c c s a v a i l a b l e t o people. They have been,
f o r instance, guided t o a s s i s t in malaria eradication, use of the s a n i t a r y t o i l e t , vaccination, etc.
During t h e r e c e n t m d l p a a m s - v a c c i n a t i o n i n Tehran, f o r t h e first time, about 1,200,000 people were vaccinated. T h i s shows e f f e c t i v e n e s s of h e a l t h education progra:tmcs as w e l l a s the p o s i t i v e response of people t o education.
I n some a r e a s communal work through education has s t a r t e d . People have collected money t o Aig s a n i t a r y wells, have given t h e i r time a d labour f o r malaria e r a d i c a t i o n
o r have encouraged t h e i r pregnant neighbours t o go t o well-baby c l i n i c s , ctc.
& more comprehensive h e a l t h education programme d t h more t r a i n e d s t a f f s e e m very necessary f o r c o m u n i t y organization in h e a l t h work.
W R C ~ / T ~ C ~ . D ~ S C
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I CHIEF I
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Div. Publlc Health Eklnca.I
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& s t . Chief I~ -~ --.:
Training E a x h
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k t e r i a li I Preparation
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/ I Sracch
1, Film Section !
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I2, i d e m i c e i 1 1,
Art
Training
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Section 1F i e l d
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1 Services
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InformationI Services W n c h
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h d u c t i o n 2. News Release
Section
? + L i b r a r j I I I ' I
S e c t i o n I I
' 3.
PhotographyI 1
S e c t i o nI I
