Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2011

Open Access 01-12-2011 | Research

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

Authors: Aliasghar Ahmad Kiadaliri, Behzad Najafi, Hassan Haghparast-Bidgoli

Published in: International Journal for Equity in Health | Issue 1/2011

Login to get access

Abstract

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.

Methods

Census 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.

Results

There 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.

Conclusion

Results 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.
Appendix
Available only for authorised users
Literature
1.
2.
The World Health Report: Primary health care, now more than even. 2008, Geneva World Health Organization
3.
4.
Hanson K, Ranson K, Oliveira-Cruz V, Mills A: Expanding access to priority health interventions: a framework for understanding the constraints to scaling-up. J Int Dev. 2003, 15: 1-14. 10.1002/jid.963.CrossRef
5.
Taylor DH, Ricketts TC, Kolimaga JT: Defining under-service and physician shortage areas in historical and future context. North Carolina Rural Health Research Program, University of North Carolina, Working Paper No.30. 1994
6.
CSDH: Closing the gap in a generation: Health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. 2008, Geneva, World Health Organization
7.
Abasolo I, Manning R, Jones AM: Equity in utilization of and access to public sector GPs in Spain. Applied Economics. 2001, 33: 349-364.CrossRef
8.
Isfahani DS, Shavazi MJA, Chavoshi MH: Family planning and fertility decline in rural Iran: the impact of rural health clinics. Health Economics. 2010, 19: 159-180. 10.1002/hec.1613.CrossRef
9.
Aghajanian A, Mehryar AH, Ahmadnia S, Kazemipour S: Impact of rural health development programme in the Islamic Republic of Iran on rural-urban disparities in health indicators. Eastern Mediterranean Health Journal. 2007, 13 (6): 1466-75.PubMed
10.
11.
Office for Family Health and Population: Undersecretary for Health. Iran Population Data Report. 2003, Tehran, MOHME
12.
13.
14.
Wilkinson D: Inequitable distribution of general practitioners in Australia: analysis by state and territory using census data. Aust J Rural Health. 2000, 8: 87-93. 10.1046/j.1440-1584.2000.00255.x.CrossRefPubMed
15.
Gravelle H, Sutton M: Inequality in the geographical distribution of general practitioners in England and Wales 1974-1995. J Health Serv Res Policy. 2001, 6: 6-13. 10.1258/1355819011927143.CrossRefPubMed
16.
Gravelle H, Sutton M: Trends in geographical inequalities in provision of general practitioners in England and Wales. Lancet. 1998, 352: 1910-10.1016/S0140-6736(05)60402-3.CrossRefPubMed
17.
Chang RKR, Halfon N: Geographic Distribution of Pediatricians in the United States: An Analysis of the Fifty States and Washington, DC. Pediatrics. 1997, 100: 172-179. 10.1542/peds.100.2.172.CrossRefPubMed
18.
Theodorakis PN, Mantzavinis GD, Rrumbullaku L, Lionis C, Trell E: Measuring health inequalities in Albania: a focus on the distribution of general practitioners. Human Resources for Health. 2006, 4: 5-10.1186/1478-4491-4-5.PubMedCentralCrossRefPubMed
19.
Bidgoli HH, Bogg L, Hasselberg M: Pre-hospital trauma care resources for road traffic injuries in a middle-income country- A province based study on need and access in Iran. Injury. 2010
20.
Brown MC: Using Gini-style indices to evaluate the spatial patterns of health practitioners: theoretical considerations and an application based on Alberta data. Soc Sci Med. 1994, 38: 1243-1256. 10.1016/0277-9536(94)90189-9.CrossRefPubMed
21.
22.
Buck D, Smith K: The distribution of community psychiatric nurses in England: are they where they should be?. Journal of Advanced Nursing. 1998, 28 (3): 508-516. 10.1046/j.1365-2648.1998.00699.x.CrossRefPubMed
23.
Theodorakis PN, Mantzavinis GD: Inequalities in the distribution of rural primary health care physicians in two remote neighboring prefectures of Greece and Albania. Rural and Remote Health. 2005, 5: 457-PubMed
24.
Fordyce MA, Chen FM, Doescher MP, Hart LG: 2005 Physician Supply and Distribution in Rural Areas of the United States. Rural Health Research Center. 2007, University of Washington, Report No.116
25.
Khosravi A, Taylor R, Naghavi M, Lopez AD: Mortality in the Islamic Republic of Iran, 1964-2004. Bull World Health Organ. 2007, 85 (8): 607-14. 10.2471/BLT.06.038802.PubMedCentralCrossRefPubMed
Metadata
Title
Geographic distribution of need and access to health care in rural population: an ecological study in Iran
Authors
Aliasghar Ahmad Kiadaliri
Behzad Najafi
Hassan Haghparast-Bidgoli
Publication date
01-12-2011
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2011
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/1475-9276-10-39

Other articles of this Issue 1/2011

International Journal for Equity in Health 1/2011 Go to the issue

Research

Wealth inequality and utilization of reproductive health services in the Republic of Vanuatu: insights from the multiple indicator cluster survey, 2007

Research

Equity implications of coverage and use of insecticide treated nets distributed for free or with co-payment in two districts in Tanzania: A cross-sectional comparative household survey

Research

Factors associated with female genital mutilation in Burkina Faso and its policy implications

Research

Reduction of social inequalities in life expectancy in a city of Southeastern Brazil

Research

Social support needs for equity in health and social care: a thematic analysis of experiences of people with chronic fatigue syndrome/myalgic encephalomyelitis

Research

Challenges and opportunities for policy decisions to address health equity in developing health systems: case study of the policy processes in the Indian state of Orissa