Health Impact Assessment of the Iranian Urban Family Physician Plan in Bonab, East Azarbaijan

Abstract

Abstract Introduction: In 2015, the Iranian Urban Family Physician Program (UFPP) was implemented in urban health centers. The aim of this study was to explore the impacts of the, UFFP on the health in Bonab residents, in East Azarbaijan and, also, to recommend strategies to improve and increase the possible positive impacts of this plan on the Iranians public health. Method: In 2018, a study with a Concurrent mixed methode approach included two stages quantitative and qualitative was designed to assess the impacts of UFPP on Bonab residents’ health. Quantitative stage incluted a ten-year analizise of health indicators related to the UFPP by Interrupted Time Series (ITSA) method that the ITSA regression model was used to assess the causes between the program as an intervention and the studied outcomes. Then, a descriptive analysis was performed and linear graphs of the trend of changes in the mean of the indicators for a period of 10 years (2008-2018) were drawn descriptively. Qualitative stage included a content analysis study including Semi-structured interviews with 7 key informant and 12 services recipients. Studies were conducted simultanousely. MAXQDA10 software was used for qualitative study analysis. The data were merged in the interpretation phase. Result: in quantitative phase of the study it was found that The UFPP was found with positive impacts on some indicators including Modern Contraceptives Use, Postpartum and at least six-time care visits during pregnancy, Total fertility rate, Delivery rate in highrisk groups, Cesarean Section and Childbirth by unskilled personnel rate but it did not have impacts on the trends of some critical indicators, including MMR, NMR and IMR. The content analysis in the qualitative section resulted in emerging 4 themes with 20 categories. According to the stakeholders, the main challenges of the project included the following: changes related to health-oriented beliefs and behaviors of service recipients, quantitative and qualitative improvement of service delivery, interpersonal relationship challenges and and inefficient management. Conclution: The UFFP has led to positive effects on people's health. But some managerial factors and the challenges of interpersonal relationships such as, lack of trust in health services providers’and inappropriate behavior of the healthcare providers competencies have led to the UFFP not being able to play its role in promoting health as it should. Findings of the study showed that people's health and the improvement of health indicators in addition to the health system are largely dependent on other socio-economic factors. Therefore, it can be concluded that in addition to reviewing the UFFP, improving the living conditions of the community and trying to increase public welfare is an important step towards achieving the UFFP. Key words: Health Impact AssessmentError! Bookmark not defined., Family Physician Plan, Health Indicator, Health care system and mixed methode