Iranian journal of health sciences 2013;1(3):35-42 http://jhs.mazums.ac.ir Original Article Evidence for Policy Making: Health Services Access and Regional Disparities in Kerman Mina Anjomshoa1 Seyyed Meysam Mousavi2 *Hesam Seyedin3 Aidin Ariankhesal3 Jamil Sadeghifar4 Nasrin Shaarbafchi-Zadeh3 1-MSc Student in Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, I.R. Iran. 2-PhD Student in Health Policy, Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Students’ Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, I.R. Iran. 3- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, I.R. Iran. 4-PhD Student in Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, I.R. Iran. *[email protected] Abstract Background and purpose: Health indices, regarding to their role in the development of a society, are one of the most important indices at national level. Success of national development programs is largely dependent on the establishment of appropriate goals at the health sector, among which access to healthcare facilities is an essential requirement. The aim of this study was to examine the disparities in health services access across the Kerman province. Materials and Methods: This was a cross-sectional study. Study sample consisted of the cities in Kerman province, ranked based on 15 health indices. Data was collected from statistical yearbook. The indices were weighted using Shannon entropy, then using the TOPSIS technique and the result were classified into three categories in terms of the level of development across towns. Results: The findings showed distinct regional disparities in health services across Kerman province and the significant difference was observed between the cities in terms of development. Shannon entropy introduced the number of pharmacologist per 10 thousand people as the most important indicator and the number of rural active health center per 1000 people as the less important indicator. According to TOPSIS, Kerman (0.719) and Fahraj (0.1151) ranked the first and last in terms of access to health services respectively. Conclusion: There are significant differences between cities of Kerman province in terms of access to health care facilities and services. Therefore, it is recommended that officials and policy-makers determine resource allocation priorities according to the degree of development for a balanced and equitable distribution of health care facilities. [Anjomshoa M. Mousavi M. *Seyedin H. Ariankhesal A. Sadeghifar J. Shaarbafchi-Zadeh N. Evidence for Policy Making: Health Services Access & Regional Disparities in Kerman. IJHS 2013;1(3):35-42] http://jhs.mazums.ac.ir Key words: Policy Making, Health Services Access, Regional Disparities IJHS 2013;1(3): 35 Evidence for Policy Making: Health Services Access and Regional Disparities M. Anjomshoa et al. 1.Introduction important indicators of development) in the cities of Iran is heterogeneous and Recognizing the existing situation using disproportionate (10). Iran's geographical appropriate indicators and reducing conditions has led to the diversity and disparities is essential. The aim of socio- unbalanced development (11). Similar to economic development programs after the other developing countries, some areas Iranian revolution is reduction of inequality compare to small areas are responsible for in order to create social and economic the majority of production and national justice in all provinces (1). Regional studies income. This means their income is at a reveals that some areas have better higher level and as a result, they enjoy more performance than the other ones and enjoy public service (12).Therefore, it is necessary more facilities and development to define the term access to health services level(2).GDP(Gross domestic product) and and then develop a comprehensive program GDP per capita were the main indicators to to fix this problem. This study was assess development level. These indicators conducted using TOPSIS technique do not consider fairness in the distribution (The Technique for Order of Preference by of health services and other social services Similarity to Ideal Solution) to assess the (3). Health and development are closely health services access across the Kerman linked to each other and can affect province. Due to the multiplicity of criteria interchangeably (4). Health sector as an for comparison subjects, the use of other important social part of any country plays a techniques will lead to problems in decisive role in the well-being of people decision-making. However, these things do (5).Access to health care is crucial and is a not occur in the TOPSIS technique. TOPSIS multi-dimensional concept; physical access technique as a family member in a multi- and financial access. Physical access is criteria decision making techniques are used defined as geographical access to health to rank the different concepts of science, facilities which can effect on health services due to the transparent nature, mathematical usage(6). This issue has been the concern of logic and do not have any operational issues community and health policy makers (7, 8). (13). Kerman located in southeastern Iran is Regional studies in many countries reveal considered as one of important and that specific areas have better performance historical provinces. Kerman is regarded as and have enjoyed the modern the most important reference to the facilities(2).After the Islamic Revolution industrial, cultural, political, agricultural, special attention has been paid to the health academic and scientific, religious and other sector. Iran's Constitution has defied the factors within the South-East region of Iran. provision of basic needs in health care as The aim of this study was to provide a clear the responsibility of the government to vision from the status of Kerman cities in mobilize its resources to meet the nation's terms of access to health services. health (9). The geographical distribution of health indicators (as one of the most IJHS 2013;1(3): 36 Evidence for Policy Making: Health Services Access and Regional Disparities M. Anjomshoa et al. 2. Materials and Methods This was a cross-sectional study. The Shannon entropy method included the sample included all 16 towns of Kerman following steps (14): province which were ranked based on 15 First, the raw data matrix was normalized health indices. The health indices were according to the formula: 푟푖푗 selected based on their availability at 2011 푃 = 푖푗 푚 푟 National Statistics Center's annual report 푖=1 푖푗 that included some indicators of availability "Pij" is the normalized value of the index "j" in the "i-th"rank; "r " is the initial index of healthcare human and physical resources ij value; and "m" is the number of options as follows: available to the ranking. Then "Ej"(entropy a) Number of laboratories per 1000 people, per index) of "Pij", for each index was b) Number of rural active health house calculated: 1 workers per1000 people, c) Number of 퐸 = −퐾 푚 푃 × 퐿푛푃 K = 푗 푖=1 푖푗 푖푗 퐿푛 푛×푚 general practitioners per 1000 people, d) "n"is the number of variables and "m" the Number of specialists per 1000 people, e) number of places which are compared with. Number of paramedics per 1000 people, f) Accordingly, the degree of uncertainty or Number of active inpatient beds per 1000 standard deviation (dj) for each of the people, g) Number of rural active health indices is obtained: houses per 1000 people, h) Number of 푑푗 = 1 − 퐸푗 pharmacies to 1000 people, i) Number of Finally, the weight of each indicator (Wj) is pharmacologist per 10 thousand people, j) calculated as follows: Number of dentists per 1000 people, k) 푑푗 푊푗 = 푛 Number of rural active health centers per 푗 =1 푑푗 1000 people, l) Number of urban health TOPSIS is done in the following steps (22): + − centers per 1000 people, m) Number of First, the maximum (푥푗 ) and minimum (푥푗 ) radiology centers per 1000 people, n) values of each index are identified. Then, Number of rehabilitation centers to 1000 using the following equation, normalization people, o) Number of active treatment takes place.If the positive and negative centers per 1000 people. indices are intended to be combined Data were collected by a data collection reversing the negative aspects into positive form made by the researcher from the aspects should be done as follows: − above-mentioned source. These indices x푖푗 푥푗 r푖푗 = + 푥푖푗 > 0r푖푗 = 푥푖푗 < 0 were weighted using Shannon entropy, then 푥푗 푥푖푗 using the TOPSIS technique, according to The standard weighted matrix based on the which each town was evaluated in terms of following equation is obtained: its access to health services and finally the 푣푖푗 = 푟푖푗 × 푤푗 towns were classified into three categories The positive ideal and negative ideal in terms of the level of development. solutions for each of the indices are determined by the following procedure: IJHS 2013;1(3): 37 Evidence for Policy Making: Health Services Access and Regional Disparities M. Anjomshoa et al. + + + + + − 퐴 = 푣1 , 푣2 , … , 푣푗 , … 푣푛 퐴 The ranking is done based on the decreasing − − − − + + = 푣1 , 푣2 , … , 푣푗 , … 푣푛 values of 퐶푖 ,means that the highest 퐶푖 is The positive ideal index is equal to its considered as the most developed, and the + maximum, and the negative ideal in every lowest 퐶푖 as most undeveloped. index, the index is equal to the minimum. Distance of each option compared with 3. Results ideals of positive and negative, are as Encompassing more than 11 percent of + − follows (푆푖 ,푆푖 ): Iran's area, Kerman is the largest province Distance option i from the positive ideal: of Iran. The objective of this study was to 푛 푛 + + + use TOPSIS technique for appraising health 푆푖 = 푣푖푗 − 푣푗 = 퐷푖푗 푗 =1 푗 =1 services access in cities of Kerman province Distance option i from the negative ideal: and to aware the policy maker in order to 푛 푛 − − − reduce differences in the cities.