“Isfahan Healthy Heart Program”: A Practical Model of Implementation in a Developing Country

There are few models that describe the experience of implementing multisectoral community-based programs of noncommunicable diseases prevention in developing countries. We describe the barriers and facilitators in implementing the “Isfahan Healthy Heart Program” (IHHP) interventions. The IHHP was conducted from 2000 to 2007 in Iran. The program consisted of 10 multidisciplinary intervention projects using both population and high risk approaches. Multiple organizations contributed to the implementation of the different interventions, including health centers, schools, worksites, food industries, academic institutes, nongovernmental organizations, and the media. To consider how to scale up this project for possible national implementation, we conducted a qualitative study that included interviewing all project managers about the facilitators and barriers they experienced. Factors that facilitated IHHP implementation included ownership and leadership, political will, existing capacity and infrastructure, good managerial relations, dedicated human resources, community empowerment, provider and user acceptance and cooperation, external collaboration, and flexibility of the interventions. Barriers included nonsupportive and unstable policies and environments, absence of universal health insurance coverage for noncommunicable disease primary prevention, “best buys” that were not applicable in different situations or cultures, failure in communication, sociopolitical and economic factors, and lack of connection between researchers and knowledge users. More intersectoral collaboration and adaptation to the continuous dynamic changes and interactions between and among the different components of interventions could overcome some of the barriers experienced. Identifying the barriers and facilitators of implementing community-based program can provide critically important information for large-scale implementation and development of new programs