Country Stories

Innovative approaches for tackling NCDs and mental health disorders in Iran: Lessons from the COVID-19 pandemic

The Islamic Republic of Iran has acted on a wide range of noncommunicable disease (NCD) issues with innovative strategies that can be replicated by other countries. Alongside creating strong multi-stakeholder and cross-sectoral collaborations, the Ministry of Health and Medical Education has leveraged the country’s strong primary health care system, skilled general practitioners and community health workers to take major steps on their journey to 2030.

In 2014, Islamic Republic of Iran formed the Iranian Non-Communicable Diseases Committee. It comprised members of different governmental bodies, and the aim was to accelerate the control and prevention of NCDs. The Committee developed a national action plan in collaboration with WHO, setting national targets for NCDs which are fully supported by the President and achieved through multisectoral dialogue, cross-ministry cooperation and NCD surveillance and monitoring systems.
The Iranian High Council of Health and Food Security has been reducing malnutrition and ensuring nutrition security by institutionalizing management, policy- making, evaluation and coordination since 2004.
Ban on radio and television advertising of soft drinks to protect children and adolescents, as well as bans on unhealthy food in school canteens and vendors near schools.
2016 – mandatory traffic light labelling on the front of food packaging to help people make healthier choices. Includes calories, sugars, total fat, trans fat and salt.
Nationwide tobacco free initiative from 2020. This focuses on the WHO MPOWER strategy, which helps countries to reduce the demand for tobacco products.
Ban on waterpipe use in public places, reinforced with fines or the closure of premises. Launch of health awareness campaigns to counteract misinformation from the tobacco industry.
2020 – Qom becomes Islamic Republic of Iran’s first tobacco-free city after collaboration with local and religious leaders. The five-year plan will make 63 cities and 63 villages in Islamic Republic of Iran tobacco free.
SHINE – Islamic Republic of Iran is one of four countries collaborating on this project researching the challenges of scaling up mental health services in schools. See Pakistan for details.

Delivering mental health and psychosocial support services (MHPSS) and ensuring continuity

The COVID-19 pandemic has affected every aspect of life – even the act of burying and mourning loved ones. The Ministry of Health and Medical Education developed measures to help people suffering with grief by collaborating its internal Department for Mental Health And Substance Abuse and with the Iranian Psychiatric Association and Iran University of Medical Sciences. Measures included:
  • Guidance on safe ways to commemorate loved ones
  • Training hospital staff to deliver bad news
  • Guidelines on balancing safe burial practices with mourners’ needs 
  • Training mental health staff at Islamic Republic of Iran’s 63 medical universities to give structured psychological counselling to help people cope better with loss
  • Face-to-face or telephone counselling for families of COVID-19 victims, with referral pathways for those needing psychiatric care
This strategy helped people to navigate their grief, identified families in need of social and financial support, and detected cases of domestic violence and psychiatric or substance abuse problems.
Since 2003, Islamic Republic of Iran has integrated a child abuse prevention programme into the public health care system. The National Parenting Skills Training Programme works to improve communication between parents and children, which is recognized as one of the preventive measures that mitigates child abuse. Goals include:
  • Improving the mental health literacy of parents with children aged between 2 and 17 years
  • Improving child-parent interactions
  •  Preventing child maltreatment
  • Preventing mental health problems, specifically behavioural problems in children and adolescents
This programme, which is still ongoing, trained over 2 million parents in group sessions between March 2018 and March 2019. It has drawn on the knowledge and support of multiple partners including the Ministry of Youth Affairs and Sports, WHO and UNICEF. This breadth of experience is one of the reasons for its lasting success.
Set up in 2007, the National Suicide Prevention Programme is an example of Islamic Republic of Iran’s long-term commitment to tackling mental health issues. National and international experts recently assessed and revised the programme in order to:
  • Improve the accuracy of statistics on suicide and suicide attempts
  • Reduce stigma associated with suicide
  • Increase access to and provision of mental health and psychiatric services
  • Engage the media to improve the reporting of suicidal behaviour
  • Reduce access to frequently-used methods of suicide
  • Upscale research to understand the epidemiology and risk factors of suicide
In the pilot study, carried out in the Iranian city of Khorramabad before the Suicide Prevention Programme was rolled out nationwide, suicide mortality fell from 12.5 to 5.3 per 100 000 people in one year. The current, revised programme is ongoing and includes treatment, care and aftercare services such as psychosocial intervention and telephone follow-ups.

Digital health and telemedicine approaches

Islamic Republic of Iran quickly switched to digital health and telemedicine formats during the COVID-19 pandemic to ensure the continuity of services for people living with NCDs. The 4030 helpline offered continuity of care, follow-ups, counselling and advice for cancer patients and people under immunosuppressive therapy. Meanwhile, community health workers supported, advised and trained patients with high blood pressure or raised blood sugar levels on how to self-manage their conditions. This remote care was a very successful approach for these vulnerable groups.
The Iranian government set up three COVID-19 helplines in September 2020. In the first phase, this initiative was delivered at primary health care (PHC) level, and over the first six months around 78 million people were screened by phone or online (self-screening). In November 2020, the initiative was extended to outpatient care. In addition, services such as extensive contact tracing were provided to identified vulnerable and high-risk groups. It was a scale up of Islamic Republic of Iran’s pre-COVID “Each Home One Health Post” initiative, which engages local communities and local stakeholders to support vulnerable households.
Tailoring the WHO PEN for NCD prevention and control to the national context
IraPEN is Islamic Republic of Iran’s adaptation of WHO’s Package of Essential NCD (PEN) Interventions for primary health care. The Ministry of Health and Medical Education launched IraPEN in 2014 as part of the National NCDs Plan. Piloted in four cities across 600 000 people, IraPEN offered screenings for three preventable cancers (cervical, breast and colorectal), screening for asthma and chronic obstructive pulmonary disease, and cardiovascular risk assessments including testing for blood sugar and cholesterol.
The IraPEN pilot was a success, with diabetic patients showing improvements in HbA1c levels and patients with hypertension reporting improved blood pressure control, among other results. This success was built on high-level political commitment, local partnerships, broad stakeholder commitment and a strong health workforce at PHC level with in-service training supported by universities.
By piloting IraPEN, authorities were able to identify any bottlenecks and gaps in the referral system that needed to be bolstered before scaling up. Through innovative thinking and collaboration, Islamic Republic of Iran has shown that countries can adapt a WHO package to suit their unique needs.
Alongside a well-established comprehensive cardiac rehabilitation (CR) programme, Islamic Republic of Iran has been pursuing innovative CR strategies since 2016, including:
  • Hybrid CR with face-to-face consultations leading to telephone follow-ups and home CR sessions
  • Home-based CR targeting moderate and low-risk patients, in the hope of empowering patients and their families with self-care plans
  • CR programmes for women
  • Encouraging patient-physician communications
  • Insurance companies agreeing to cover some CR costs
  • Patient feedback to physicians to improve referrals
These strategies are successfully addressing Islamic Republic of Iran’s high burden of cardiovascular diseases. There is strong engagement from stakeholders including the Government, doctors, patients and their families, insurers and civil society. Islamic Republic of Iran is using CR to tackle cardiovascular diseases and their consequences beyond just medical rehabilitation, with services that also focus on health promotion, education and awareness raising. Future aims include the expansion of home-based and hybrid methods of CR, developing smartphone applications for home-based CR, implementing cardiac rehabilitation in PHC, designing community-based programmes, and developing a CR network in the Eastern Mediterranean Region.

Enforcing bans on TAPs

Advertising is key to the success of the tobacco industry, but it is hard to control because of the wide variety of types, methods and channels of advertising, including cross-border. Legislation banning tobacco advertising, promotion and sponsorship (TAPS) is often not enough on its own.
Therefore, Islamic Republic of Iran’s Ministry of Health and Medical Education created the National Tobacco Control Headquarters to give national focus to the problem and bring together key authorities, ministers and relevant nongovernmental organizations. Collaboration between the National Tobacco Control Headquarters and Headquarters for Combating the Smuggling of Commodities and Foreign Exchange led to an innovative approach to effectively enforce the ban on TAPS. In June 2019, the Cabinet and the President designated all promotional tobacco products as smuggled goods.
Based on existing law, these smuggled goods would be collected from the market and destroyed, and the owners of the promotional tobacco products would be fined. This was bolstered by a 200% increase in advertising penalties. 
More than 6000 environmental health inspectors now ensure compliance with tobacco control regulations in public places as part of their regular supervisory visits, which makes monitoring cost effective. Inspectors ensure that all storage units designed to sell tobacco are covered, so that there is no advertising at point of sale. Violations in cyberspace and on the internet are reported to the cyber police to block offending sites. 
By adding all emerging tobacco products to the executive guidelines on TAPS, Islamic Republic of Iran is particularly protecting its young population from the lure of novel products. As the catalyst for intersectoral collaboration and by enforcing the ban on TAPS, the National Tobacco Control Headquarters is central to this successful strategy. Finally, by designating promotional tobacco products as smuggled goods, all related legislation is applicable to these products. This enables multiple Government departments to act together to ensure full compliance. 
From their experience of addressing the various issues surrounding tobacco, Iranian authorities have recognized that effective tobacco control must be based on reliable data. Islamic Republic of Iran has shown its commitment to reducing tobacco consumption and demonstrated that to make informed policy decisions, it is important to have a tobacco control surveillance, monitoring and evaluation system that employs a results-based management approach.
This country story is part of a series on sharing successful strategies from the Eastern Mediterranean Region mitigating noncommunicable diseases and mental health disorders during the COVID-19 pandemic and beyond. Discover additional stories and insights in the full report published by the World Health Organization Regional Office for the Eastern Mediterranean.