Geographic distribution of need and access to health care in rural population: an ecological study in Iran.

Aliasghar Ahmad Kiadaliri,Behzad Najafi,Hassan Haghparast-Bidgoli

doi:10.1186/1475-9276-10-39

Abstract

IntroductionEquity in access to and utilization of health services is a common goal of policy-makers in most countries. The current study aimed to evaluate the distribution of need and access to health care services among Iran's rural population between 2006 and 2009.MethodsCensus data on population's characteristics in each province were obtained from the Statistical Centre of Iran and National Organization for civil registration. Data about the Rural Health Houses (RHHs) were obtained from the Ministry of Health. The Health Houses-to-rural population ratio (RHP), crude birth rate (CBR) and crude mortality rate (CMR) in rural population were calculated in order to compare their distribution among the provinces. Lorenz curves of RHHs, CMR and CBR were plotted and their decile ratio, Gini Index and Index of Dissimilarity were calculated. Moreover, Spearman rank-order correlation was used to examine the relation between RHHs and CMR and CBR.ResultsThere were substantial differences in RHHs, CMR and CBR across the provinces. CMR and CBR experienced changes toward more equal distributions between 2006 and 2009, while inverse trend was seen for RHHs. Excluding three provinces with markedly changes in data between 2006 and 2009 as outliers, did not change observed trends. Moreover; there was a significant positive relationship between CMR and RHP in 2009 and a significant negative association between CBR and RHP in 2006 and 2009. When three provinces with outliers were excluded, these significant associations were disappeared.ConclusionResults showed that there were significant variations in the distribution of RHHs, CMR and CBR across the country. Moreover, the distribution of RHHs did not reflect the needs for health care in terms of CMR and CBR in the study period.

Highlights

Equity in access to and utilization of health services is a common goal of policy-makers in most countries
The distribution of Rural Health Houses (RHHs) did not reflect the needs for health care in terms of crude mortality rate (CMR) and crude birth rate (CBR) in the study period
This study focuses on the following research questions: How were RHHs, crude mortality rate (CMR) and crude birth rate (CBR) distributed between different provinces in years 2006 and 2009? How has changed the inequality measures between 2006 and 2009? Did the distribution of RHHs reflect CMR and CBR in the rural population of the provinces?

Summary

Introduction

Equity in access to and utilization of health services is a common goal of policy-makers in most countries. The current study aimed to evaluate the distribution of need and access to health care services among Iran’s rural population between 2006 and 2009. RHHs act as the first level of contact to the basic PHC in Iran’s rural areas. Two trained local residents, who are known as Behvarz (one male and one female), work as health workers in each RHH and provide PHC services including maternal and child health care, family planning, vaccinations and environmental health promotion to the rural population. They are responsible for referring patients who need further care to the level of care.

Methods

Results

Discussion

Conclusion