An Iranian healthcare worker tests water quality in a health center in the south west of Tehran.
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WHV started in 1989 at Kianshahr's Badr Center in Shahre-Rey, a sprawling, mostly working-class suburb of Tehran, whose population is 30% Afghan. Iran Mokhtari, now 57, was one of the first recruits. Although she had only a primary-school education, she was taught the information that she needed to pass on in her community. Stopping at a home on her street, she rings a neighbor's doorbell. "Open up. I'm your health volunteer," she says, and instantly, the door is buzzed open. Inside, she tells 26-year-old Azizeh Mohammadi that she should come to the health center the next day to discuss family-planning with the resident doctor. Mohammadi agrees to go. Male contraception is equally promoted and sought by men.
What the volunteers do in Tehran's urban areas, staffs carry out at so-called health stations on the outskirts of the city. In Saloor in Eslamshahr, a poorer satellite city of about half a million outside Tehran, the three nurses in the two-room health station are busy weighing infants, giving vaccines and taking the blood pressure of the mostly elderly visitors, like Mirza Seyyed Hosseini, 75, a shoemaker who drops in on occasion for a multivitamin injection.
The 48-year-old head nurse, Masoumeh Bozorgnejad, points to what's called a vital horoscope--a record of all births, deaths, diseases, contraceptive methods and infant- and mother-mortality rates of the 3,335 people this station covers. "I know every single one of them by name," says Bozorgnejad with a proud smile and adds, "If a mother doesn't show up with her newborn for a scheduled vaccination, we ring her up. And if she can't come for whatever reason, we go pick the baby up ourselves."
The health workers also carry the responsibility of inspecting hygiene in schools and businesses such as bakeries, hair salons and grocery stores. "In high schools, we even have our younger trainees from Tehran hand out condoms to the boys," says Bozorgnejad.
A chador-clad volunteer says she talks to women wherever she finds them, while shopping for vegetables or at the bakery. Fatemeh Rezai, 38, standing in front of four large file cabinets with detailed health information on each household in her district, says she is proud of the work she does, "especially after hearing our Health Minister say that life expectancy in Iran has gone up from 57 to 73 in just a few decades."
Despite this enviable record, Tehran faces a whole new set of big-city problems that officials are trying to tackle. "This country is in an epidemiological transition, moving from developing-country problems like communicable diseases to a country that is dominated by the diseases typical of developed countries," explains the World Health Organization's Dr. Ambrogio Manenti.
The figures bear that out. The four biggest killers in Tehran today are road accidents, estimated to cost 28,000 lives every year; cardiovascular diseases tied to Tehran's polluted air and the high rate of smoking among men; depression; and drug addiction. "More than 70% of factors that affect health are social," says Dr. Mohammad Mehdi Golmakani, a municipality health adviser who is looking at the social determinants of disease.
The other big challenge Iran faces is offering universal health coverage. While primary and basic secondary health care are free, there are stark discrepancies when it comes to surgery and hospital care. Three decades into the revolution, some worry that without greater institutional commitment at the top, the initial enthusiasm that propelled the volunteer network could wane. "This engine is still thriving on its first start. It's like a car rolling down a hill with high speed," says Malek-Afzali. "Even if you stop pushing the gas pedal, it's going to roll." He is concerned that his brainchild could starve if the postrevolutionary fervor that energized it fades with the next generation of health directors. Then again, those directors would have to deal with 100,000 very determined women.