Objective: To assess equity in the distribution of hospital beds in northern Iran. Methods: In this cross-sectional study, we investigated the degree of equity by using 2016 census data from 16 cities in Guilan province. The hospital beds include burns, intensive care unit, coronary care unit and neonatal intensive care unit beds. We analysed the general status and explored its distribution equity by using the Theil index. Findings: We found that Rezvanshahr and Masal had no hospital beds. The utilisation gap was positive only in Rasht, as capital of the province. Neonatal intensive care unit beds were only found in Rasht and Lahijan. Rasht was shown to have a positive gap in using burns, intensive care unit and coronary care unit beds, with a negative gap of 14.68 in coronary care unit beds. The other 15 cities did not have such hospital beds. For intensive care unit, coronary care unit and neonatal intensive care unit beds, nearly 8%, 2% and 14% of cities were deprived of being equipped with these hospital beds, respectively. The highest positive gap and the lowest negative gap were attributed to coronary care unit beds. In the province, there were 0.057 burns beds, 0.137 intensive care unit beds, 0.381 coronary care unit beds and 0.72 neonatal intensive care unit beds per 10,000 population (neonatal intensive care unit beds, per 1000 neonates). In 11 out of 16 cities, the number of coronary care unit beds per 10,000 population was higher than the provincial average. The highest inequality in distribution was shown to be for burns beds (0.8), neonatal intensive care unit beds (0.75), intensive care unit beds (0.55) and coronary care unit beds (0.21), respectively. Conclusion: This study revealed high inequalities in the distribution of hospital beds in northern Iran. The local and national policy-makers should design and implement a comprehensive monitoring and evaluation system for tracking and allocating healthcare resources, both qualitatively and quantitatively, which appears to be very necessary to increase the equity in access to healthcare services.

Background Inequitable distribution of human resources in healthcare is one of the main obstacles to improve any health system. This study aimed to evaluate inequalities in the distribution of human resources in healthcare in South Khorasan Province, Iran. Methods We have investigated three types of health staff (i.e. nurses, general practitioners, and specialists) from 2013 to 2018. Data were collected from the annual reports of the Statistical Centre of Iran. The Gini coefficient and time trend regression were applied to measure the inequality. Results The distribution of specialists and general practitioners were the highest and lowest inequality, respectively. Inequalities in the distribution of nurses and specialists have decreased from 2013 to 2018, while the Gini coefficients of the general practitioners have increased from 0.31 to 0.38. According to the regression analysis, inequality in the distribution of nurses and specialists was decreasing over the time; however, the decline was only significant for specialists. While the coefficient B for general practitioners is positive, this indicates raised inequality, but the observed increase was not significant. Conclusions This study revealed that Iran, similar to several other low- and middle-income countries, is with faced the challenge of inequitable distribution of human resources in healthcare, which in turn indicates the necessity of reforms at national and regional levels to address inequalities in the distribution of healthcare human resources, particularly in South Khorasan Province. Hence, the main policy recommendation is to focus on continuous monitoring and evaluation of resource allocation in South Khorasan Province to reduce inequalities.