An Innovative Primary Health Care System from Iran to Mississippi: The Roles of Health Houses/Community Health Workers

Transcription

1 An Innovative Primary Health Care System from Iran to Mississippi: The Roles of Health Houses/Community Health Workers Mohammad Shahbazi, PhD, MPH, MCHES Professor of Behavioral Health Promotion and Education/Public Health Jackson State University (JSU) Portland, Oregon, September 18, 2014

2 An Overview Presentation Health Disparity in Mississippi Search for a Model Why Iran? Health Houses/Community Health Workers from Iran to Mississippi Accomplishments and Challenges

3 In the News The Los Angles Times Aljazeera TV AARP The New York Time Magazine Many Local/National and International Media Have Covered 3

4 Aljazeera,

5 Per Capita Total Current Health Care Expenditures, U.S. and Selected Countries, 2009 ^OECD estimate. *Break in series. Notes: Amounts in U.S.$ Purchasing Power Parity, see includes only countries over $2,500. OECD defines Total Current Expenditures on Health as the sum of expenditures on personal health care, preventive and public health services, and health administration and health insurance; it excludes investment. Source: Organisation for Economic Co-operation and Development. OECD Health Data: Health Expenditures and Financing, OECD Health Statistics Data from internet subscription database. data accessed on 01/10/12.

6 Selected Health Outcomes by Country Country (Per Capita Spending- 2009) Infant Mortality Rate Rate per 1,000 (2012) Under-Five Mortality Rate Rate per 1,000 (2011) Life Expectancy- Female # (2009) Life Expectancy- Male # (2009) Austria ($4,045) Finland ($3,053) Spain ($2,982) United Kingdom ($5,144) United States ($7,598)

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8 Medicaid Spending Estimates in Mississippi (in millions), MS $ 1995 $1,373 $136, $1,512 $144, $1,578 $150, $1,605 $158, $1,779 $171, $2,035 $186, $2,526 $208, $2,773 $230, $2,897 $250, $3,289 $269,892 US $ 8

9 Mississippi Profile Population 2,918,785 53% live in rural areas Poverty rate highest of all US states Ranks last of all states in health outcomes Teenage pregnancy rate highest in US Delta region highest poverty rates in state 9

10 Poverty Rates in Mississippi Delta Counties Counties with highest poverty rates have highest average percentage of African- Americans - 68% Mississippi state average - 37% The U.S. Census Bureau 10

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12 Health Status in Mississippi High rates of obesity High rates of diabetes High rates of infant mortality High rates of stroke Chronic disease Poor nutrition Reduced life expectancy (healthyamericans.org) 12

13 Mississippi s Health Ranking,

14 Current Situation in Mississippi (Delta Region in particular) Hospital Adopted from Dr. Shadpour s October 2009 Presentation in Jackson, MS, USA 14

15 Search for a Model: Why Iran? 15

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18 A Brief Review of What the Iranians Have Achieved by Applying IPHC PHC Coverage Life expectancy Population growth rate Indicator Early 80s Negligible >90% >95% (male) 70 (female) 3.4% 1.4% 1.6% MMR 200< IMR 120< (male) 73.6 (female)

19 Changes in Infant Mortality Rates of Urban and Rural Areas, births IMR Urban Rural. Year

20 Health System in Iran Chancellor of University of Medical Sciences and Health Services Directorate of District Health Network BTC District Health center District Hospital SP BTC:Behvarz Training Center HP:Health Post HH:Health Houses SP:Specialized Polyclinic Urban Health Center HP HP HP WHV:Woman Health Volunteers Rural Health Center WHV HH HH HH HH HH

21 Health House Health House is the most peripheral rural health facility, covers approximately 1500 population who live in the main and satellite villages. The number of villages covered by Health House depends on population, cultural, climatic and geographical conditions Each Health House staffed by a female and a male Behvarze (Community Health Workers).

22 Duties of Community Health workers (Behvarzes) 1. Annual Census and registration of health information 2. Health Education 3. Maternal and Child Care 4. Family planning 5. Nutritional Care and Improvement 6. School Health 7. Oral Health 8. Immunization 9. Environmental and Occupational health 10. Home visit 11. Early detection/ Screening of diseases 12. Rehabilitation and assistance for mentally and physically challenged 13. Cooperation with medical universities on training and research projects

23 Key factors for CHW program success The 7 Cs: Community-based Cooperation among community actors CHWs recruited and introduced by their own community Continuing education provided Compensation is provided Careful supervision and monitoring Commitment of all actors involved

24 Strength of health network system Selection and training of local CHWs; Simple Health Information System; Supportive supervision and In-service training activities; Revised text book of CHWs based on community needs and burden of diseases; Defined coverage area for each health facility;

25 Strength of health network system (Cont.) Dynamic feature Referral and well integrated system. Community participation through training and usage of volunteers; Established community participatory research centers;

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28 Iranians Integrated Primary Health Care Model Second referral level Hospital First referral level Adopted from Dr. Shadpour s October 2009 Presentation in Jackson, MS -USA 28

29 From Iran to Mississippi Activities, Accomplishments, and Challenges in Mississippi to Date 29

30 Americans in Iran, May 2009 (The Staff of a Rural Health Center)

31 An Iranian Health Worker checking Dr. Shirley s Blood Pressure Iran, 2009

32 The Iranians in the USA, October, 2009

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35 Initial Pilot Project Insurer Medicare Medicaid Medicare/Medicaid dual eligible Private Insurance Uninsured # of Pts Total

36 Initial Pilot Outcomes Average National Hospital Readmission Rate Hospital Readmission Rate CHW Intervening 25% 4.68%

37 Global Community Health Working Program (Curriculum/Courses) HHW Cultural competency and professional ethics HHW 102 Computer applications HHW 103 Bio/Epi/Demography HHW Instruments/Field HHW 111- Administration HHW 112- Medical terminology HHW 121- Anatomy/Physiology HHW 122- Psychology/Mental Htl HHW 123- Principles of Nutrition & Food Safety HHW Pathogenic agent HHW Communicable disease HHW Non communicable/ chronic diseases HHW Health system HHW 135 Emergency preparedness/responses HHW First aid HHW Reproductive health HHW 142 Infant/child health care HHW Occupational health and Community based rehabilitation HHW Elderly health care / home nursing HHW 145 HLT Edu and promotion HHW Field work (hands on internship) 37

38 The Unique Feature of our CHW Certification Program at JSU 1) a component of an accredited public health certification program; this is, it has been approved through Jackson State University s accredited public health program and thus health house worker trainees graduating from this program will receive their certification from an accredited public health program; 2) The Global Community Health Worker Training Center has been recognized and incorporated into Pan American World Health Organization s RETS Networking the only such center in North America

39 Current Activities Pilot Project Gran by CMS: 1) To Train and Certify 3 CHW to staff 2 CHH and 1 Health Post 2) Goals: To document such intervention reduces cost and increase community satisfactions

40 The Health House Network 40

41 What is the driving force behind our team-work endeavor?

42 Iranian 13 th Century Poet, Saadi Shirazi The world honors Saadi today by gracing the entrance to the Hall of Nations in New York with a call for a humanitarian action. And that is: Human beings are member of a whole, in creation of one essence and soul. If one member is afflicted with pain, other members uneasy will remain. If you have no sympathy for human pain, the name of human you cannot retain.

43 contact information: