Department of Industrial Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran.
Department of Healthcare Systems Engineering, Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran.
J Prev Med Public Health. 2022 Jan;55(1):49-59. doi: 10.3961/jpmph.21.401. Epub 2021 Dec 28.
Access to maternal and neonatal care services (MNCS) is an important goal of health policy in developing countries. In this study, we proposed a 3-level hierarchical location-allocation model to maximize the coverage of MNCS providers in Iran.
First, the necessary criteria for designing an MNCS network were explored. Birth data, including gestational age and birth weight, were collected from the data bank of the Iranian Maternal and Neonatal Network national registry based on 3 service levels (I, II, and III). Vehicular travel times between the points of demand and MNCS providers were considered. Alternative MNCS were mapped in some cities to reduce access difficulties.
It was found that 130, 121, and 86 MNCS providers were needed to respond to level I, II, and III demands, respectively, in 373 cities. Service level III was not available in 39 cities within the determined travel time, which led to an increased average travel time of 173 minutes to the nearest MNCS provider.
This study revealed inequalities in the distribution of MNCS providers. Management of the distribution of MNCS providers can be used to enhance spatial access to health services and reduce the risk of neonatal mortality and morbidity. This method may provide a sustainable healthcare solution at the policy and decision-making level for regional, or even universal, healthcare networks.
获得孕产妇和新生儿保健服务（MNCS）是发展中国家卫生政策的一个重要目标。在这项研究中，我们提出了一个 3 级层次定位分配模型，以最大限度地扩大伊朗 MNCS 提供者的覆盖范围。
首先，探讨了设计 MNCS 网络的必要标准。根据 3 个服务级别（I、II 和 III），从伊朗母婴网络国家注册处的数据银行中收集了包括胎龄和出生体重在内的出生数据。考虑了需求点和 MNCS 提供者之间的车辆行驶时间。在一些城市规划了替代 MNCS，以减少准入困难。
在 373 个城市中，发现分别需要 130、121 和 86 个 MNCS 提供者来满足 I、II 和 III 级需求。在确定的行驶时间内，有 39 个城市没有提供 III 级服务，这导致到最近的 MNCS 提供者的平均行驶时间增加了 173 分钟。
本研究揭示了 MNCS 提供者分布的不平等。MNCS 提供者分布的管理可用于改善卫生服务的空间获取，并降低新生儿死亡和发病的风险。这种方法可以为区域甚至全球卫生保健网络的政策和决策制定层面提供可持续的医疗保健解决方案。
