The Effective Coverage of Maternal and Child Primary Health-Care-Services and its Relationship with Health-Expenditures: An Analysis at Sub-National-Level in Iran
An Analysis at Sub-National-Level in Iran
Abstract
Introduction: The primary health care (PHC) approach is widely acknowledged as a fundamental element in achieving universal health coverage (UHC) goals. Consequently, numerous countries have undertaken efforts to restructure their health systems based on PHC principles. This study aims to evaluate geographic disparities in essential maternal and child indicators provided at the PHC level, focusing on both crude and effective coverage. Additionally, it seeks to explore the association between effective coverage and health expenditures within the national and sub-national contexts of Iran.
Methods: This research employed a secondary analysis approach to investigate the spatial distribution of maternal and child health (MCH) indicators in Iran's provinces, utilizing the latest available data from the 2010 Demographic Health Survey (DHS). To provide a comprehensive understanding of MCH indicators, the study calculated composite indicators, crude, and effective coverage. The provinces' situations were compared using the median cut-off method. Additionally, the study examined the association between coverage indicators and total health expenditure per-capita.
Results: At the national level, the crude and the effective composite coverage were 89.56% and 77.22%, respectively. Also, the medians of composite crude and effective service coverage in the provinces were 90.25% and 77.62%, respectively. There was no significant difference between urban and rural areas.
Conclusion: This study has revealed a notable difference between the crude and effective service coverage of the selected MCH indicators. While the coverage of maternal services was generally higher than that of child services, there were significant geographic disparities in the coverage of key indicators of MCH services across provinces. Despite the provision of free services in rural areas, their coverage was not higher than that of urban areas. These findings suggest that PHC services in Iran are still far from achieving the desired coverage and UHC goals. Policymakers and stakeholders need to focus on addressing the gaps in effective coverage and geographic disparities to improve access to essential maternal and child health services and achieve UHC in Iran.
2. World Health Organization (WHO). Primary health care on the road to universal health coverage: 2019 monitoring report: Executive summary: World Health Organization, 2019.
3. UNICEF. Declaration of Astana. Global Conference on Primary Health Care: from Alma-Ata towards universal health coverage and the Sustainable Development Goals. Astana, Kazakhstan. 2018.
4. Malekafzali H. Primary health care in the rural area of the Islamic Republic of Iran. Iran J Public Health 2009; 38(Suppl 1): 69- 70.
5. Keshvari M, Mohammadi E, Boroujeni AZ, Farajzadegan Z. Burnout: interpreting the perception of Iranian primary rural health care providers from working and organizational conditions. International journal of preventive medicine 2012; 3(Suppl1): S79.
6. Bahadori M. Medical care and education in Iran. JAMA 1975; 232(9): 2.
7. Tabrizi JS, Pourasghar F, Nikjoo RG. Status of Iran’s primary health care system in terms of health systems control knobs: a review article. Iranian journal of public health 2017; 46(9): 1156.
8. Takian A, Rashidian A, Kabir MJ. Expediency and coincidence in re-engineering a health system: an interpretive approach to formation of family medicine in Iran. Health policy and planning 2011; 26(2): 163-73.
9. Abdi Z, Majdzadeh R, Ahmadnezhad E. Developing a framework for the monitoring and evaluation of the Health Transformation Plan in the Islamic Republic of Iran: lessons learned. Eastern Mediterranean Health Journal 2019; 25(6).
10. Mirzaei H, Zhaleh A, Ahmadnezhad E, et al. Health status in the Islamic Republic of Iran, Middle East and North Africa countries: Implications for global health. Iranian journal of public health 2020; 49(1): 86.
11. Ferede Gebremedhin A, Dawson A, Hayen A. Evaluations of effective coverage of maternal and child health services: A systematic review. Health policy and planning 2022; 37(7): 895-914.
12. Hogan DR, Stevens GA, Hosseinpoor AR, Boerma T. Monitoring universal health coverage within the Sustainable Development Goals: development and baseline data for an index of essential health services. The Lancet Global Health 2018; 6(2): e152-e68.
13. World Health Organization (WHO). Tracking universal health coverage: 2017 global monitoring report. 2017.
14. Maele NV, Xu K, Soucat A, Fleisher L, Aranguren M, Wang H. Measuring primary healthcare expenditure in low-income and lower middle-income countries. BMJ Global Health 2019; 4(1): e001497.
15. Abdalmaleki E, Abdi Z, Gohrimehr M, Alvandi R, Riazi Isfahani S, Ahmadnezhad E. Multiple Indicator Clustar Survey and Demographic and Health Survey in the Eastern Mediterranean Region: What is the Iran’s Situation in Terms of Implementation? Iranian Journal of Epidemiology 2020; 16(2): 108-21.
16. Rashidian A, Karimi-Shahanjarini A, Khosravi A, et al. Iran's multiple indicator demographic and health survey-2010: Study protocol. International journal of preventive medicine 2014; 5(5): 632.
17. World Health Organization (WHO). 2018 Global reference list of 100 core health indicators (plus health-related SDGs): World Health Organization, 2018.
18. Wehrmeister FC, Restrepo-Mendez M-C, Franca GV, Victora CG, Barros AJ. Summary indices for monitoring universal coverage in maternal and child health care. Bulletin of the World Health Organization 2016; 94(12): 903.
19. YAZDI FV, Mehrolhassani M, Haghdoost A, Bahrampour M. The trend of impoverishing effects of out-of-pocket health expenditure in Iranian provinces in 2008- 2014. 2017.
20. Zhaleh A, Rezvaneh A, Bahar H, et al. Measuring progress toward Universal Health Coverage in Iran: two years after the implementation of the Health Transformation Plan. Journal of Biostatistics and Epidemiology 2022; 8(2).
21. Greco S, Ishizaka A, Tasiou M, Torrisi G. On the methodological framework of composite indices: A review of the issues of weighting, aggregation, and robustness. Social indicators research 2019; 141(1): 61- 94.
22. Lozano R, Soliz P, Gakidou E, et al. Benchmarking of performance of Mexican states with effective coverage. Lancet 2006; 368(9548): 1729-41.
23. Rahman MS, Rahman MM, Gilmour S, Swe KT, Abe SK, Shibuya K. Trends in, and projections of, indicators of universal health coverage in Bangladesh, 1995–2030: a Bayesian analysis of population-based household data. The Lancet Global Health 2018; 6(1): e84-e94.
24. Biranvandzadeh M, Heshmati Jadid M, Sorkhkamal K. Assessment of development level of Sistan and Baluchistan province compared to other Iran’s provinces. International Journal of Architecture and Urban Development 2015; 5(1): 69-76.
25. Rezapour R, Khosravi A, Farahbakhsh M, Ahmadnezhad E, Azami-Aghdash S, Tabrizi JS. Developing Iranian sub-national primary health care measurement framework: a mixed-method study. Archives of Public Health 2023; 81(1): 98.
26. Rezapour R, Khosravi A, Farahbakhsh M, Ahmadnezhad E, Azami-Aghdash S, Tabrizi JS. Developing Iranian sub- national Primary Health Care Measurement Framework: a study protocol. Primary Health Care Research & Development 2022; 23: e62.
27. Primary health care. 2021. http:// www.emro.who.int/health-topics/primary- health-care/.
28. Khatooni E, Akbarzadeh I, Abdalmaleki E, Abdi Z, Ahmadnezhad E. Evaluating maternal and child health indicators for the Sustainable Development Goals in 2018: what is Iran’s position? Epidemiology and health 2019; 41.
29. Moradi-Lakeh M, Esteghamati A. National Immunization Program in Iran: whys and why nots. Human vaccines & immunotherapeutics 2013; 9(1): 112-4.
30. Razavi SM, Mardani M, Salamati P. Eradication of Polio in the World; Iran is at Risk for Reemerging of Polio: A Review of the Literature. Archives of Clinical Infectious Diseases 2016; 11(4).
31. Iran Receives Polio-Free Certificate From WHO. https://financialtribune.com/ articles/people/60095/iran-receives-polio- free-certificate-from-who (accessed February 21, 2017.
32. Namaki S, Gouya MM, Zahraei SM, Khalili N, Sobhani H, Akbari ME. The elimination of measles in Iran. The Lancet Global Health 2020; 8(2): e173-e4.
33. Karami M, Khazaei S, Babaei A, Yaghini FA, Gouya MM, Zahraei SM. Accuracy and quality of immunization data in Iran: findings from data quality self- assessment survey in 2017. BMC health services research 2019; 19(1): 1-9.
34. Chaman R, Alami A, Emamian MH, et al. Important Risk Factors of Mortality Among Children Aged 1-59 Months in Rural Areas of Shahroud, Iran: A Community-based Nested Case-Control Study. International journal of preventive medicine 2012; 3(12): 875-9.
36. national health accounts Statistical Center of Iran. https://www.amar.org.ir.
37. Xu K, Soucat A, Kutzin J, Brindley C, Vande M, Touré H. Public spending on health: a closer look at global trends. 2018. EMEA–EMNES Studies/April 2020.
| Files | ||
| Issue | Vol 9 No 2 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jbe.v9i2.14622 | |
| Keywords | ||
| Universal health coverage Effective coverage Primary health care Total health expenditure Evidence-informed policy making Health policy and systems research | ||
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