Healthy cities experience in Iran; A national evaluation study

Introduction: In 1991 the Healthy City concept was introduced in Iran and then expanded in 1996 with the establishment of the National Coordination Council for Health Cities Project (NCCHCP). A group of experts from different sectors implemented a systematic evaluation study in 2005-6, the main findings of which will be discussed here.

Methods: Two of the HCPs in Saveh and Yazd were evaluated. Data collection methods included document review at national, provincial and district/city levels; 29 interviews with members of NCCHCP, program managers, provincial/ district/ sub-district governors, and other stakeholders; and 14 focus group discussions with intersectoral teams, NGOs and beneficiaries.

Results: A series of Healthy City initiatives were launched which focused on environment, water and sanitation, and healthy settings, although some local initiatives focused on issues such as addictions, nutrition, health promotion and injury prevention. Programs were launched and managed in collaboration with local councils and were frequently initiated by a comprehensive community needs assessment to guide local priority-setting. Strong political commitment, linkage with national development plans, acceptability of the program among community members and program staff as well as success in capacity building were found as the strengths of HCPs. City health plan and city health profile were very limited. Limitations in supervision, monitoring, evaluation and project documentation were observed. Changes in key positions like governors or HCP coordinators and raised expectations were found as major threats to project sustainability.

Recommendations: Establishment of a national HCP designation process and creating a national network of healthy cities will vitalize HCPs. Community participation needs to be strengthened by involving NGOs, city councils and particularly council assistants. Issues like Health Impact Assessment and Disaster Preparedness Plans could be added to HCPs. A national web site and a regular newsletter will help to share knowledge and experience between all stakeholders.