Effect of the Iranian Health Sector Evolution Plan Implementation Focused on the Type of Delivery on Maternal and Neonatal Health Indicators in Selected Hospitals of East Azerbaijan Province
Abstract
Background: Health systems are making reforms to ensure and promote public health. Measuring the effects of reform is one way to determine its effectiveness and consequences.
Objectives: This study was aimed at investigating the effect of the Iranian Health Sector Evolution Plan (HSEP) implementation with a focus on the type of delivery on maternal and neonatal health indicators in East-Azerbaijan Province.
Methods: This descriptive-analytical study was conducted in 2017. The data of 800 patients were randomly selected through the dataset of eight hospitals equally in the two time periods of before and after the HSEP implementation. A researcher-made checklist was used for data extraction. Data were analyzed by SPSS version 22 using descriptive statistics, t-test, and chi-square.
Results: The mean age of the mothers in both periods was 27 years. Most of the participants did not have a previous delivery and had a diploma or a lower level of education. The rate of natural childbirth increased from 34.5% (before the HSEP) to 44.2% (after the HSEP) (P <0.05). Maternal and neonatal mortality rates decreased from 0.3 and 0.8% to 0.0 and 0.5%, respectively. Maternal and neonatal mortality and stillbirth rates were not significantly different based on the study period and type of delivery (P > 0.05).
Conclusions: The findings indicated a significant increase in the rate of natural childbirth after the HSEP implementation. Maternal and neonatal mortality rates had also decreased. These results can guide policymakers in deciding whether to continue or review the reform.
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26. Bragg F, Cromwell DA, Edozien LC, Gurol-Urganci I, Mahmood TA, Templeton A, et al. Variation in rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study. BMJ. 2010;341:c5065. doi:10.1136/bmj. c5065. [PubMed:20926490]. [PubMed Central:PMC2950923].
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29. Festin MR, Laopaiboon M, Pattanittum P, Ewens MR, Henderson-Smart DJ, Crowther CA, et al. Caesarean section in four South East Asian countries: Reasons for, rates, associated care practices and health outcomes. BMC Pregnancy Childbirth. 2009;9:17. doi:10.1186/1471-2393-9-17. [PubMed:19426513]. [PubMed Central:PMC2695422].
30. Torloni MR, Daher S, Betran AP, Widmer M, Montilla P, Souza JP, et al. Portrayal of caesarean section in Brazilian women’s magazines: 20 year review. BMJ. 2011;342:d276. doi:10.1136/bmj.d276. [PubMed:21266421]. [PubMed Central:PMC3026601].
31. Policy Council of Ministry of Health and Medical Education. [Book of abstracts National Conference on Criticism of the 11th Government Performance in the Field of Health]. Tehran, Iran: National Institute of Health Researches of Iran; 2015.
32. Barati O, Maleki M, Gohari M, Kabir M, Amiresmaili M, Abdi Z. [The impact of family physician program on health indicators in Iran (2003-2007)]. Payesh. 2012;11(3):361-3.
33. Vora KS, Mavalankar DV, Ramani KV, Upadhyaya M, Sharma B, Iyengar S, et al. Maternal health situation in India: A case study. J Health Popul Nutr. 2009;27(2):184-201. doi:10.3329/jhpn.v27i2.3363. [PubMed:19489415]. [PubMed Central:PMC2761784].
34. Haghdoost AA, Mehrolhassani MH, Khajehkazemi R, Fallah MS, Dehnavieh R. [Monitoring indicators of Iranian health system reform plan]. Hakim Research Journal. 2013;16(3):171-81.
35. Fernandes QF, Wagenaar BH, Anselmi L, Pfeiffer J, Gloyd S, Sherr K. Effects of health-system strengthening on under-5, infant, and neonatal mortality: 11-year provincial-level time-series analyses in Mozambique. Lancet Glob Health. 2014;2(8):e468-77. doi:10.1016/S2214-109X(14)70276-1. [PubMed:25103520]. [PubMed Central:PMC4158849].
36. Isfahan University of Medical Sciences. Book of abstracts international conference on sustainable reform in health system: Approaches and challenges. Isfahan, Iran: Isfahan University of Medical Sciences; 2015.
37. Bastani P, Lotfi F, Moradi M, Ahmadzadeh MS. [The performance analysis of teaching hospitals affiliated with Shiraz University of Medical Sciences before and after health system reform plan using pabon lasso model]. J Rafsanjan Univ Med Sci. 2016;15(8):781-92.
2. Frenk J, Gonzalez-Pier E, Gomez-Dantes O, Lezana MA, Knaul FM. Comprehensive reform to improve health system performance in Mexico. Lancet. 2006;368(9546):1524-34. doi:10.1016/S0140- 6736(06)69564-0. [PubMed:17071286].
3. Specialized Committee for Health and Life Sciences. [Universal map of healt scientific]. Tehran, Iran: Supreme Council of the Cultural Revolution; 2010.
4. Shariati M, editor. [health system reform why? And what?]. 6th Iranian Congress of Epidemology; 2010; Shahroud, Iran. Journal of Knowledge & Health in Basic Medical Sciences.
5. Luce BR, Elixhauser A. Standards for the socioeconomic evaluation of health care services. Berlin, Germany: Springer Science & Business Media; 2012.
6. Bateman A, Fonagy P. Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care. Am J Psychiatry. 2003;160(1):169-71. doi:10.1176/appi. ajp.160.1.169. [PubMed:12505818].
7. Day C, Groenewald P, Laubscher R, Chaudhry S, Van Schaik N, Bradshaw D. Monitoring of non-communicable diseases such as hypertension in South Africa: Challenges for the post-2015 global development agenda. S Afr Med J. 2014;104(10):680-7. doi:10.7196/samj.7868. [PubMed:25363054].
8. de-Graft Aikins A, Kushitor M, Koram K, Gyamfi S, Ogedegbe G. Chronic non-communicable diseases and the challenge of universal health coverage: insights from community-based cardiovascular disease research in urban poor communities in Accra, Ghana. BMC Public Health. 2014;14 Suppl 2:S3. doi:10.1186/1471-2458-14-S2-S3. [PubMed:25082497]. [PubMed Central:PMC4120153].
9. Atun R, Jaffar S, Nishtar S, Knaul FM, Barreto ML, Nyirenda M, etal. Improving responsiveness of health systems to non-communicable diseases. Lancet. 2013;381(9867):690-7. doi:10.1016/S0140-6736(13)60063-X. [PubMed:23410609].
10. Vlassoff M, Musange SF, Kalisa IR, Ngabo F, Sayinzoga F, Singh S,et al. The health system cost of post-abortion care in Rwanda. Health Policy Plan. 2015;30(2):223-33. doi:10.1093/heapol/czu006. [PubMed:24548846]. [PubMed Central:PMC4325535].
11. Keckley PH, Coughlin S. Deloitte 2012 survey of US health care consumers: The performance of the health care system and health care reform. Washington, USA: Deloitte Center for Health Solutions; 2012.
12. Squires DA. Explaining high health care spending in the United States: An international comparison of supply, utilization, prices, and quality. Issue Brief (Commonw Fund). 2012;10:1-14.[PubMed:22582452].
13. Akinci F, Mollahaliloglu S, Gursoz H, Ogucu F. Assessment of the Turkish health care system reforms: A stakeholder analysis. Health Policy. 2012;107(1):21-30. doi:10.1016/j.healthpol.2012.05.002. [PubMed:22652336].
14. Balabanova D, Roberts B, Richardson E, Haerpfer C, McKee M. Health care reform in the former Soviet Union: Beyond the transition. Health Serv Res. 2012;47(2):840-64. doi:10.1111/ j.1475-6773.2011.01323.x. [PubMed:22092004]. [PubMed
Central:PMC3419892].
15. Leggat SG, Bartram T, Stanton P. High performance work systems: The gap between policy and practice in health care reform. J Health Organ Manag. 2011;25(3):281-97. doi:10.1108/14777261111143536. [PubMed:21845983].
16. Rosoff AJ. The role of clinical practice guidelines in healthcare reform: An update. Annals Health L. 2012;21(1):21-33.
17. Sharghi A, Kamran A, Sharifirad G. [Factors influencing delivery method selection in primiparous pregnant women referred to health centers in ardabil, Iran]. Journal of Health System Research. 2011;7(3):364-72.
18. Ghasemi F. Investigating the abundance of saesarean section and its reason in Yazd in 2009. SSU Journals. 2012;20(2):229-36.
19. Nasri K, Rafiei M, Pishgahi Z. [The relationship between fetal sex and complications of labor which end in cesarean delivery at Taleghani Hospital of Arak in 2009]. Arak Med Univ J. 2011;14(55):81-7.
20. Mohammadpourasl A, Asgharian P, Rostami F, Azizi A, Akbari H. [Investigating the choice of delivery method type and its related factors in pregnant women in Maragheh]. Knowledge and Health. 2009;4(1):36-9.
21. Pirdehghan A, Farajzadegan Z, Maraci M, Mehrabian F. [Predictive factors of selection caesarean in women referred to hospitals in Isfahan: 2009]. Iran J Obstet Gynecol Infertil. 2012;15(11):1-6.
22. Shadpour K. [Health sector reform in Islamic Republic of Iran]. Journal of Inflammatory Disease. 2006;10(3):7-20.
23. Mehrolhasani MH, Abolhalaj M, Barouni M, Jafari J, Dehnavish R, Emami M. Identifying barriers and challenges of establishing accrual accounting system in iran health system short Title: chal-lenges of accrual accounting system. Pensee. 2014;76(3).
24. Deputy of Health and Treatment, Ministry of Labor Cooperation and Social Welfare. [Protocol of family physician planing and referral system in urban area]. 2nd ed. Tehran, Iran: Ministry of Health and Medical Education; 2011.
25. Sharifizad M, Khodakaram N, Jannesari S, Akbarzadeh A. [The outcomes of natural childbirth and C-section on the mother and infant’s health in selected hospitals in Tehran]. The Horizon of Medical Sciences. 2012;18(1):5-11.
26. Bragg F, Cromwell DA, Edozien LC, Gurol-Urganci I, Mahmood TA, Templeton A, et al. Variation in rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study. BMJ. 2010;341:c5065. doi:10.1136/bmj. c5065. [PubMed:20926490]. [PubMed Central:PMC2950923].
27. Bogg L, Huang K, Long Q, Shen Y, Hemminki E. Dramatic increase of Cesarean deliveries in the midst of health reforms in rural China. Soc Sci Med. 2010;70(10):1544-9. doi:10.1016/j.socscimed.2010.01.026. [PubMed:20219278].
28. Kealy MA, Small RE, Liamputtong P. Recovery after caesarean birth: A qualitative study of women’s accounts in Victoria, Australia. BMC Pregnancy Childbirth. 2010;10:47. doi:10.1186/1471-2393-10-47. [PubMed:20718966]. [PubMed Central:PMC2939528].
29. Festin MR, Laopaiboon M, Pattanittum P, Ewens MR, Henderson-Smart DJ, Crowther CA, et al. Caesarean section in four South East Asian countries: Reasons for, rates, associated care practices and health outcomes. BMC Pregnancy Childbirth. 2009;9:17. doi:10.1186/1471-2393-9-17. [PubMed:19426513]. [PubMed Central:PMC2695422].
30. Torloni MR, Daher S, Betran AP, Widmer M, Montilla P, Souza JP, et al. Portrayal of caesarean section in Brazilian women’s magazines: 20 year review. BMJ. 2011;342:d276. doi:10.1136/bmj.d276. [PubMed:21266421]. [PubMed Central:PMC3026601].
31. Policy Council of Ministry of Health and Medical Education. [Book of abstracts National Conference on Criticism of the 11th Government Performance in the Field of Health]. Tehran, Iran: National Institute of Health Researches of Iran; 2015.
32. Barati O, Maleki M, Gohari M, Kabir M, Amiresmaili M, Abdi Z. [The impact of family physician program on health indicators in Iran (2003-2007)]. Payesh. 2012;11(3):361-3.
33. Vora KS, Mavalankar DV, Ramani KV, Upadhyaya M, Sharma B, Iyengar S, et al. Maternal health situation in India: A case study. J Health Popul Nutr. 2009;27(2):184-201. doi:10.3329/jhpn.v27i2.3363. [PubMed:19489415]. [PubMed Central:PMC2761784].
34. Haghdoost AA, Mehrolhassani MH, Khajehkazemi R, Fallah MS, Dehnavieh R. [Monitoring indicators of Iranian health system reform plan]. Hakim Research Journal. 2013;16(3):171-81.
35. Fernandes QF, Wagenaar BH, Anselmi L, Pfeiffer J, Gloyd S, Sherr K. Effects of health-system strengthening on under-5, infant, and neonatal mortality: 11-year provincial-level time-series analyses in Mozambique. Lancet Glob Health. 2014;2(8):e468-77. doi:10.1016/S2214-109X(14)70276-1. [PubMed:25103520]. [PubMed Central:PMC4158849].
36. Isfahan University of Medical Sciences. Book of abstracts international conference on sustainable reform in health system: Approaches and challenges. Isfahan, Iran: Isfahan University of Medical Sciences; 2015.
37. Bastani P, Lotfi F, Moradi M, Ahmadzadeh MS. [The performance analysis of teaching hospitals affiliated with Shiraz University of Medical Sciences before and after health system reform plan using pabon lasso model]. J Rafsanjan Univ Med Sci. 2016;15(8):781-92.
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| Issue | Vol 5, No 1 (2021) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/htaa.v5i1.7382 | |
| Keywords | ||
| Health System Evolution Plan Maternal and Neonatal Health Iran | ||
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How to Cite
1.
Jabbari Bayrami H, Sokhanvar M, Navvabi E, Asadi S. Effect of the Iranian Health Sector Evolution Plan Implementation Focused on the Type of Delivery on Maternal and Neonatal Health Indicators in Selected Hospitals of East Azerbaijan Province. Health Tech Ass Act. 2021;5(1).
