The Problem

In its simplest terms, the problem is to develop a strategy of providing a comprehensive health service for small rural communities scattered over an area of more than half a million square miles. To accomplish this, doctors have to be found and sent out to the rural areas. In all parts of the world, this has proved a major problem. In a developing country it can seem almost insurmountable.

Even with the best will in the world, there is a serious shortage of qualified physicians. The Ministry of Health and other interested organizations had mounted various programs. But such programs, while providing valuable services, proved to be small outposts in huge areas of need.

What was required was a massive program of rural institutional change and reconstruction in which health care would be one aspect of wider goals pursued with revolutionary élan. To amplify this problem within the Iranian context, some 15 million people, or 65 percent of the Iranian population, live in about 50,000 isolated villages. These villages are widely scattered over a land area of 628,000 square miles.

A vast, rugged country, Iran is rich in mountains but short on water. In most of the land, agriculture is possible only through the engineering of subterranean conduits or "qanats", which lead water from the mountains to a level area below. Around the outlet of one or more qanats the village is built. The location of the village is primarily dependent upon the possibility of providing a permanent supply of irrigation water rather than on other economic factors such as proximity to market. Thus, the villages typically tend to be scattered over a wide area, to be small, and to be as self-sufficient as possible.

Further, due to the need to construct and continually maintain the qanat, which involves some considerable organization and expense, the system led to landlordism and the growing of one or more cash crops on a sharecropping basis for the landlord. The system, which in a feudal age was a workable adaptation to Iranian conditions, soon proved ill adaptable to modern Iranian life.

Although the rural areas generated a value of some 2 billion dollars, little of this value remained in the villages. Life expectancy of the farmer was low due to unsanitary conditions and insufficient health facilities. Agricultural production was low and the share retained by the villagers still lower. Literacy was low. Living standards were low.

The Revolution from the Throne aimed to change all this. Among the innovations would be rural democracy, education and health care. Through village councils, programs of self-help would be established. An important part of the village self-help program would be the building of a school to be staffed by a Literacy Corps teacher, and the construction of a better access road over which other help could enter. Among the people to travel that road would be a qualified physician. Soon village self-help efforts would be directed towards a village clinic.

The only practical source of qualified physicians was the graduating classes of the medical schools. They turned out some 600 physicians per year. They would not be enough to provide care for 50,000 villages, but how effective could such a number prove to be? Obviously they would have to be highly mobile, operating from fully equipped rural bases. But how many villages could they visit in the course of a day? 

This was resolved as a maximum of two villages: one in the morning, the other in the afternoon, and to provide an effective service, these visits should be at least once per week. Thus, in a six-day workweek, with a day at the base, a doctor could take on a maximum of 12 villages. Further mobility could be provided if the operations were conducted so that the villages chosen for the visits were central to other villages in the vicinity. Thus, one village might serve as the collecting point for the sick of several neighboring villages. A radius of ten kilometers from the village was considered a maximum distance.

Ideally, therefore, a doctor visiting twelve villages in a week might place every inhabitant of an area within a maximum of 10 kilometers of medical attention at least once in the week. Something more would be desirable, but the capacity for curative treatment could not realistically be stretched any further. 

Preventive medicine, however, would be another question. In every village in the area, a program to build a more sanitary environment and mount a preventive medicine campaign could be put into effect. Thus, a qualified physician, supported by a trained team, could take on two major functions in a specified area. He could both treat patients and further a national program of preventive measures.

It was with this problem, the limited resources, and the Iranian conditions in mind, that the Shah of Iran conceived of the Health Corps as a possible and practical means of providing health care and medical facilities for the rural communities of Iran.