Impact of rural family physician program on child mortality rates in Iran: a time-series study

Abstract

BackgroundThe rural family physician program and social protection scheme were started in Iran about 10 years ago, and no comprehensive study has been carried out to investigate the effects of this program on mortality-related health indicators yet. The present study aims to examine the impacts of implementation of the family physician program and rural insurance program, which was launched in June 2005, on neonatal (NMR), infant (IMR), and under-5-year (U5MR) mortality rates in rural areas of Iran between 1995 and 2011, using a time-series analysis.MethodsThree segmented regression models were built to evaluate the effects of the program on NMR, IMR, and U5MR, and several independent variables were entered into the models, including annual incremental effect of the program (variable of interest), time effect, behvarz density, effect of the family physician and rural insurance programs, as well as socioeconomic variables including years of schooling, wealth index, sex ratio, and logarithmic scales of rural population size in each area. Data were gathered from secondary sources and other studies. Data pertaining to the year 2007 were excluded from the final analysis due to their inaccuracy.ResultsOur results show that the incremental effect of implementing the rural family physician program is associated with significant reductions in NMR (β = − 0.341. p − value = 0.003) and IMR (β = − 0.016. p − value = 0.009). Although the association between this effect and reductions in U5MR were evident, they were not statistically significant (β = − 0.003. p − value = 0.542). Moreover, wealth status of inhabitants was associated with reductions in NMR (β = − 0.889. p − value = 0.001), IMR (β = − 0.052. p − value < 0.001), and U5MR (β = − 0.055. p − value < 0.001) in the time period of the study.ConclusionsIn this nationally representative study, we showed that implementation of the second health system reform in Iran, known as the family physician program and social protection scheme for rural inhabitants, is associated with significant reductions in NMR and IMR. However, reported reductions in U5MR were not found to be statistically associated with the launch of the program.The advantage of this study was the ability to depict a more precise picture of the outcomes of a national-level intervention.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-017-0138-0) contains supplementary material, which is available to authorized users.

Impact of Urban Family Physician Program on health indicators in Iran: an Interrupted Time Series Analysis

“…Many studies reported the decreasing trend of such indicators after implementing similar family physician programs [23,24,40,41]. Naderi et al studied the effects of rural FP program on child mortality indicators in rural areas of Iran and reported that after the initiation of program, in 2005, the NMR and IMR decreased in comparison to the previous years, but no signi cant change was observed in U5MR [6]. Chinhoyi et al also found that FP and medical o cers supply were not signi cantly associated with the incidence of under-5 mortality [42].…”

Impact of Urban Family Physician Program on health indicators in Iran: an interrupted time series analysis

“…Afterwards, it was conducted in other countries including Northern Europe, Canada and a series of developing countries, which resulted in improving the e ciency of health systems and social justice [2]. The Islamic Republic of Iran (Iran), as a developing country, has already performed two signi cant health reforms during three past decades; In the mid-1980s, Primary Health Care (PHC) Network was launched in the rural regions with less than 5,000 population [6], which was signi cantly improved rural health outcomes [7]. However, the PHC services program has not obtained predominant achievements to meet the needs of population over the decades.…”

“…Also, three important issues, including development of PHC coverage to urban and suburban areas and the PHC accessibility for care-receivers led to arising some challenges [7]. Therefore, in 2005, the FPP for rural residents was implemented [6]. In 2012, Iranian Ministry of Health and Medical Education (MoHME) also initially implemented Urban Family Physician Program (UFPP) in all provinces within the country [8].…”

“…Studies on the Taiwan Family Physician Program have also shown that the program has had a favorable effectiveness in achieving the goals like lessening the outpatient visits to clinics and hospitals, reduction in people's medical and healthcare costs, increasing the level of satisfaction among care receivers and promoting population health, disease prevention, and control bene ts [14]. In Iran, previous studies have shown that the FPP has resulted in better access to health care in rural areas [5] and reduced levels of NMR and IMR [6], but the quality of care and the proper implementation of the referral system continue to be challenging [5]. Searching the literature, a scarcity was found in studies that examined the effects of the UFPP, especially in developing countries, and thus further studies seems to be necessary.…”

Impact of rural Family Physician programme on maternal and child health indicators in Iran: an interrupted time series analysis

“…Since 2000, the promotion of maternal and child health (MCH) care through the provision of related services and recording of MCH-related indicators became a top priority for the Iranian PHC network 16 17. As of 2005, with the start of the second PHC-based reform known as Family Physician (FP) programme,18 the way each health centre (now referred to as FP team) functions within the PHC network has changed. The FP team structure was expanded to include additional staff, such as a general physician, midwives and a pharmaceutical technician 17 19–21.…”