Evaluating Physical Access to Primary Health Care Services: A Case Study of Mashhad City

Behzad  Kiani; Fatemeh  Kokabi-Saghi; Jamshid  Jamali; Azam  Movahedian; Hamidreza  Shabanikiya

doi:10.18502/jimc.v8i3.18802

Behzad Kiani School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
Fatemeh Kokabi-Saghi Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
Jamshid Jamali Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
Azam Movahedian Student Research Committee, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
Hamidreza Shabanikiya Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

DOI: https://doi.org/10.18502/jimc.v8i3.18802

Keywords: Economic status, Primary health care, Health services accessibility, Workforce, Spatial analysis

Abstract

Background: Ensuring equitable access to health services is a primary objective of health systems. This study aimed to evaluate the physical accessibility of Primary Health Care (PHC) facilities in Mashhad city, Iran, in 2022.

Methods: This cross-sectional study utilized geo-spatial analysis, specifically the Two-step Floating Catchment Area (2SFCA) method. The population within a 4 km radius of each of the 83 PHC facilities was calculated using ArcMap software. A checklist for weighting the components of service production in the facility was designed that included three main components (manpower, materials, equipment and space) and 17 sub-components. The differences between geographical areas of the studied city in terms of Accessibility Index were determined using cluster analysis.

Results: All areas of the city were covered by the 4 km buffer zones of PHC facilities and there was no area out of the 4 km buffer zones. In addition, the eastern regions of the studied city, which had lower socio-economic status, enjoyed higher capacity density and access indices. Considering capacity and access indices, physical access to PHC facility across the areas of the city was not equal. In areas with lower socio-economic status, there was better access to services than areas with higher status.

Conclusion: Totally, at least in some areas covered by a PHC system contrary to the popular idea, having good financial situation may prevent a person from accessing some PHC and cause the creation of areas we called them “deprived affluent areas” in this study.