Mississippi's Delta Region: Borrowing a Novel Rural-Based Health Houses System

INTRODUCTIONIran has been very successful in providing healthcare to millions of its citizens after the political revolution of over three decades ago. Praising the state of post-1979 Iranian healthcare, in 2006, the World Health Organization (WHO) reported that Iran's "health indicators.. .show a consistent improvement and are now near those for developed countries" as they relate to education and healthcare access (World Health Organization, 2006). To appreciate the significance of the WHO report, it is important to consider that before the revolution of 1979, when Iran was transformed from monarchy to an Islamic Republic, there were tremendous disparities between care received in cities, where the healthcare system was primarily based, and in the rest of the country. The established preventative healthcare system was limited, particularly in rural areas; even in urban areas, healthcare access was limited to just a few large cities. The number of practicing physicians for its population of over 30 million inhabitants in the 1970s was a mere 14,000 - the majority of whom practiced only within a small circumference of the nation's larger cities. As a result, poor individuals living in rural areas, including nearly 65,000 villages, were forced either to travel long distances to find effective care, or to seek care from healthcare providers in a different part of the multi-lingual country, who may not have spoken their native local language (Marandi, 2009).As the WHO statement demonstrates, Iran's healthcare has improved vastly since 1979, and the disparity has been greatly reduced. Given Iran's success in improving the healthcare of those living in its 65,000 villages, it is not unrealistic to assume that those in charge of designing Iran's rural-based healthcare system have not been unfamiliar with the Kissick Iron Triangle model of cost, quality, and access, or the Donabedian SPO model which emphasizes structure of healthcare organizations (Donabedian, 1998; Kissick, 1994).In addition, the complexity of the rural health houses system suggests it was designed with healthcare management theory including concepts such as SWOT analysis in mind. But why and how has Iran's healthcare system been so successful - particularly in providing care to approximately 65,000 rural villages? As suggested by Aghajanian, Mehryar, Ahmadnia, and Kazemipour (2007), the Iranian government initiated a "strong push" in the 1980s to develop an inexpensive community-based primary healthcare (PHC), and foster the expansion of this system throughout the 1990s, for several reasons. First, according to Mehrdad (2009), the government of Iran sought to uphold Article 29 of the Constitution of the Islamic Republic of Iran, which concretely states that every Iranian has the right to enjoy the best possible health. Next, Mehrdad (2009) points to the country's Ministry of Health and Medical Education stated mandate of "designing and implementing a rational level health policy" as a motivation to invest in a novel community-wide healthcare model.As a result of Iran's success in improving the health of rural villagers that policymakers and other healthcare stakeholders in the delta region of Mississippi turned to the healthcare delivery model implemented in Iran - Health Houses Network - as a means of solving the shortfalls of its healthcare system (Martin, 2012). This paper demonstrates the successful changes in Iran's rural-based healthcare system since 1979. Next, it discusses why health leaders in Mississippi have found Iran's Health Houses Network appropriate for rural Mississippi and how the implementation of this system has impacted the current state of healthcare in the rural Mississippi Delta region.HEALTHCARE IN PRE-1979 IRANBefore the 1979 revolution, Iran had developed a relatively successful curative healthcare system. However, that healthcare system was restricted to Tehran and other major cities, and was absent in small towns and in particular, in 65,000 or so small villages. …