Iranian national thalassaemia screening programme

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Abstract
Iran's experience shows that genetic screening can be successful in lower resource countries and also provides some lessons for high resource nations Progress in controlling communicable diseases increases the relative importance of non-communicable diseases, including genetic disorders.1 In Iran, the development of primary health care over the past 20 years has greatly reduced infant mortality and crude birth rate. Accordingly, in 1991 prevention of non-communicable diseases was added to the primary healthcare programme, and a department for the control of non-communicable disease, including a genetics office, was established within the Ministry of Health and Medical Education. β Thalassaemia, which is an important health problem in Iran,2 was chosen to test the feasibility of preventing non-communicable disease in primary care. We describe how the programme has been implemented. Iran has a five level primary healthcare network covering the entire population of 60 million, in 28 provinces (figure).3 Responsibility for health and medical education are merged throughout the system. Each medical university has a vice chancellor responsible for primary health care. There were 14 826 rural health houses at the start of the thalassaemia project. These are staffed by trained health workers (behvarz) supported by a system of continuing education. As well as premarital health education and blood tests, the responsibilities of primary care staff include an annual census of the population covered, health education, family health (prenatal and postnatal care, children, family planning, immunisation), disease control (tuberculosis, malaria, leprosy, etc), simple treatments, environmental health, and collection, recording, and storage of health information. Organisation of the Iranian primary healthcare system Continuing education for primary care workers is particularly important in developing countries, where the rapid evolution of health priorities requires a flexible response. In Iran, when a new programme is developed, provincial health workers attend an initial meeting …