ISFAHAN CARDIOVASCULAR RESEARCH TRAINING COURSE: PASSING ON LESSONS IN CHRONIC DISEASE PREVENTION

The Isfahan Cardiovascular Research Centre (ICRC) held its 7th training course in non-communicable disease (NCD) prevention in April 2008. Designed for managers, researchers and health professionals involved in the prevention of NCD, the course was held with the auspices of the World Health Organization and the World Heart Federation. It brought over 20 professionals from Europe, Asia, the Americas and the Middle East together with ICRC staff, the Isfahan community, and other key Iranians who are helping change the factors that influence heart health.

Isfahan Healthy Heart Project: sharing science and experience

The course which was organised by Dr Nizal Sarrafzadegan, the director of the research centre, shared research findings, experiences and best practices based on the Isfahan Healthy Heart Programme (IHHP). The IHHP is a comprehensive, integrated, community-based intervention aiming to foster healthy behaviour related to diet, tobacco, physical activity and stress in a population of nearly two million people in Central Iran. Its interventions in the cities of Isfahan and Najaf have involved more than 150 government and non-government organizations.

The project has scored multiple successes, influencing policies at local and national level:

• Stopping television advertising of sausage and soft drinks
• Increasing fibre and decreasing salt content in bread
• Convincing snack producers to market new snacks for children with less trans fats and sugars
• Serving healthy foods and increasing exercise times in schools and workplaces
• Setting standards for restaurants
• Incorporating messages into TV programming
• Simplifying food labeling

Documented changes in behaviour in Isfahan include a reduction in the consumption of hydrogenated oil and junk food.

Evidence-based intervention

When the project started in 1999, the ICRC did a pre-intervention study establishing a baseline on CVD risk factor prevalence, mortality, and public knowledge, attitudes and practice related to chronic disease. Based on these findings ICRC worked with community leaders to develop 10 large-scale projects. Throughout implementation it adapted projects to the findings of thorough and regular process evaluation. 

Community buy-in: letting leaders take charge

Letting leaders in industry, the media, the government, education, politics, youth, women's and professional groups design, implement and get credit for IHHP projects has been the key to their success. "We at the ICRC are health professionals and we didn't really know how to make things happen in other sectors," said Dr Sarrafzadegan. "But we were lucky because by the time the baseline studies were finished there was no money left for the intervention, and so no temptation to try to do it ourselves." Having to depend entirely on local structures for both funding and implementation of project interventions ensured that they were tailored to local capacity and interests.

Asked how they managed to get leaders in other sectors interested in investing time and resources in health issues, Dr Sarrafzadegan explained "Most important was that we gave them information about the specific problems in their own community.  They were very impressed: they had heard about statistics from other countries but somehow they were not convinced that these really applied to them. When they knew about which problems affected their own families, friends, voters and clients, they were very motivated."  Giving visibility for their investment and its results is another approach that works. "Very often the health interventions are also innovations in their sector" she added "this gets them recognition in their field and helps them get ahead." 

Although the demonstration project will be over when the findings are finalised and published, the interventions will continue and their impact will be measured by routine health statistics. 

Sharing ideas and inspiration

Dr Hassan Ghanem came to the course from Sousse, Tunisia, where he is partnering with the Isfahan Cardiovascular Research Centre and the National Public Health Institute of Finland to develop a project as part of the Oxford Health Alliance's Community Interventions for Health programme. "Our health system has disconnected vertical programmes: the course gave me some ideas about how to transversal elements that can help overcome this weakness." Dr Khawas Abbas Kazmi, a cardiologist from the Agha Khan University in Karachi, said: "I have always dreamed of doing a project like this in Pakistan….now I know that it is possible." 

When advising others about how to start, Dr Sarrafzadegan sounds something like an ad for sporting goods: "It doesn't really matter where you start: just do it.  Start somewhere and work out from there…and evaluate, evaluate, evaluate.

Replication: bit by bit

"Already the project has stimulated policy change at national level," she says,"and after training courses like this health officials in other areas have developed some of its elements."  When project findings are fully analysed, the ICRC will invite the Iranian Ministry of Health to a course like this one, and hopes that the ministry will accept the model on the national level. However, course impact does not depend entirely on whether or not the full model is accepted, Dr Sarrafzadegan cautions: "You have to be patient; it isn't good to get too stuck on the model as a whole. Replication usually happens bit by bit: people generally do not buy the whole package, but rather take away the parts that are useful to them.

Practical and feasible

"When I started this project over eight years ago I had read a lot of studies, spoken in Congresses and had models and theories in my head," explains Dr Sarrafzadegan, "I thought I knew a lot, but I didn't. Now when we discuss a new intervention I don't think about models or theories. I think right away about who can help get it done, what it will take, and what the barriers will be…..practical, not theoretical."

Then she concludes: "When we started the programme the question was whether it is possible to implement a project like this in a developing or middle-income country. Now we know the answer: it is possible.

To read more about the Isfahan Healthy Heart Programme and the training course on non-communicable disease prevention: http://ihhp.mui.ac.ir/ihhp/topten.aspx?id=57

To read more about Oxford Health Alliance Community Interventions for Health projects: http://www.oxha.org/initiatives/cih