The Effective Coverage of Maternal and Child Primary Health Care Services and its Relationship with Health Expenditures: An Analysis at Sub-National Level in Iran

BackgroundsMeasuring the effective coverage of essential health services is necessary for monitoring progress towards Universal Health Coverage (UHC). So, this study aimed to assess the geographic variations in key maternal and child indicators (as essential health services) provided at the primary health care (PHC) level in terms of their crude and effective coverage, and also to investigate the relationship between the effective coverage and health expenditures in the national and sub-national level of Iran. MethodsThis study was a secondary analysis, which analyzed the spatial distribution of six key maternal and child health indicators using the latest available data of Demographic Health Survey-DHS (2010) across 31 provinces of Iran. Moreover, two composite indicators, the crude, and the effective coverage were calculated. The median cut-off was used to compare provinces situations. Furthermore, the relationship between coverage indicators and total health expenditure per capita was evaluated. ResultsAt the national level, the crude and the effective composite coverage were 89.56 and 77.22%, respectively. Also, the medians of composite crude and effective service coverage in the provinces were 90.25 and 77.62%, respectively. There was no significant difference between urban and rural areas. Conclusionsin this study, we found that there is a significant gap between crude and effective service coverage of the selected indicators. Overall, coverage indicators of maternal services were higher compared to those of children. In addition, geographic variations in key Indicators of maternal and child health services coverage among provinces were almost high. Although the services are free of charge in the rural areas, they did not have higher coverage than those of urban areas. PHC services in Iran are far away from reaching the desired coverage and achieving UHC. O_TEXTBOXWhat is already known?O_LIIn Iran, primary health coverage(PHC) has a long history, even years before the adoption of Alma-ata declaration in1979. C_LIO_LIIran is committed to implementing PHC programs in line with the Astana Declaration to accelerate access to universal health coverage. C_LI What are the new findings?O_LIthere is a significant gap between crude and effective coverage of maternal and child services, with high geographic variations among provenances. C_LIO_LIHealth expenditures have no statistical relationship between coverage indicators; however, in low-coverage provinces, per capita health expenditure was lower C_LI What do the new findings imply?O_LIThe concept of the effective coverage of interventions has not received enough attention from health policy-makers in Iran, so it has not been incorporated into health system performance, yet. C_LIO_LIDespite the long history of PHC in Iran, these services are still far away from reaching the appropriate targeted coverage; therefore, it is necessary to formulate and implement appropriate interventions in the provinces, based on their health needs and priorities. C_LI C_TEXTBOX