Maternity and child health care services delivered by public health centers compared to health cooperatives: Iran's experience

Abstract

Reform programs in some developing countries are focused in transferring these services to nongovernmental organizations or groups. In this WHO grant study our aim was to implement and evaluate the efficacy of a new model for transferring state service delivery governance to nongovernmental groups and studying if they can be efficient in field of child and maternity health services compared to public health centers. In this comparative study a total of 1000 households were selected systematically from the population covered by 9 health centers transferred to cooperatives and 18 current public health centers. Data were collected during a three months long study period and analyzed by SPSS 10 statistical package. Chi-Square and t-tests were used to analyze data. Overall health care coverage was higher for either cooperative or public health centers compared to private sector physicians (p = 0.005). Around 88.8% of under 6 years aged children were under coverage of health services provided by health centers in both groups and no difference was found. There was no statistically significant difference in quality of child health care services in declaring the date of health care visit and follow up in due time. There was no difference between the groups in perfect filling child growth cards but the ability of mothers in interpreting child growth cards was statistically higher for the population covered by cooperative health centers (p = 0.02). Growth status of children based on growth percentiles were relatively similar in two groups. Some health indices of target groups covered by public and cooperative health centers such as family planning, child health cares, perinatal cares, and the numbers of households covered by health volunteers were studied. The results showed that in all of these fields cooperative health centers had better rates. Observed differences were statistically significant (family planning: p = 0.03, infant health care: p = 0.03, 1-6 years old children cares: p = 0.009). The proportion of those women owning a vaccination record (card) was higher in population covered by cooperative health centers (p = 0.004). The rate for performing a cervical smear examination during the national program for cervical cancer screening was higher for the women covered by cooperative health centers (p = 0.01). No difference was found between the knowledge level of women covered by cooperative health centers about the importance of cervical examination when compared with public health centers. We conclude that in the field of target group children's health care and maternity health services, cooperatives sector not only acts as well as public sector meeting the standards of the program, but also has got a better function in some areas. This can be assumed as an achievement for the policy of transferring the health services to cooperative health centers along with ongoing governmental supervision.