تبيين نابرابري فضايي سطح سلامت با استفاده از مدل تصميم گيري الكتره (مطالعه‌ موردي: شهرستان هاي استان خراسان رضوي)

Explaining Spatial Inequalities in Health Care Using Decision Electre Model (Case study: Townships of Khorasan Razavi Province)

اهداف: تعادل فضايي سلامت، يكي از اصول زمينه ساز تحقق عدالت و پايداري اجتماعي است و در اين راستا، شناخت فضايي نسبت به نابرابري سلامت، در سطح استان، كمك شاياني به برنامه‌ريزان، جهت تصميم‌گيري براي كاهش شكاف‌، فراهم مي كند؛بنابراين در تحقيق حاضر با هدف تبيين نابرابري فضايي سلامت، به سنجش سطح سلامت شهروندان در شهرستان‌هاي استان خراسان رضوي پرداخته مي شود. روش: روش تحقيق توصيفي- تحليلي است و براي تحليل وضعيت سلامت در استان و رتبه بندي شهرستان ها، از تكنيك الكتره استفاده مي شود. ازجمله ورودي مدل الكتره، وزن معيار ها است كه در تحقيق با مدل ANP و نرم افزارSuper Decision با تكيه بر نظر ?? نفر از خبرگان به دست آمده است. روش جمع‌آوري اطلاعات، كتابخانه‌اي و بر پايه داده‌هاي خام سرشماري عمومي و سالنامه‌هاي آماري استان، در سال هاي ???? تا ???? است. يافته ها/ نتايج: نتايج نشان مي‌دهد نابرابري فضايي سلامت، در سطح استان، بالا بوده است، به طوري كه نوزده شهرستان استان در يازده طبقه قرار گرفته‌اند. دو شهرستان سبزوار و كاشمر با رتبه يك و شهرستان مشهد با رتبه دو، از وضعيت سلامت مطلوبي برخوردارند. دو شهرستان خليل آباد و مه ولات با رتبه يازدهم، در پايين‌ترين سطح قرار دارند. نتيجه گيري: وجود نابرابري فضايي سلامت بين شهرستان هاي استان، بيانگر آن است كه در استان سياست‌ها و برنامه‌هاي بهداشتي- درماني، به دور از عدالت اجتماعي بوده است؛ بنابراين لازم است به توزيع عادلانه منابع، خدمات مراقبت‌هاي بهداشتي و ديگر عوامل بهداشتي موثر، در سطح سلامت، توجه شود.

1. INTRODUCTION Spatial balance in healthcare is one of the underlying principles of social justice. In this regard, spatial recognition of health inequalities at provincial level helps planners make decisions with the aim of bridging the health gap between different regions. Therefore, this article with the aim of explaining the spatial inequality in health care, seeks to assess and analyze the health of citizens in Khorasan Razavi province. 2. THEORETICAL FRAMEWORK Sustainable development is one of the most important models of intellectual development in the twenty-first century that addresses all areas of human life such as economics, politics, culture, environment, security, education, health and ethics with an emphasis on human and society health. Today, health planning has been established by urban and regional planners to link the community environment with the physical and mental health of communities. The outcome of such effort is the development of a healthy society as a public health issue. It is noteworthy that in all descriptive patterns of a healthy society, humans, health and quality of life are at the center, with the community health being a variable of human health. Despite the expanded scope of the concept of health, still social and individual health builds the foundation of health concept. Also, in policy assessments of United Nations Development Program, the health security or health factor is one of the requirements of evaluating the nature of administrative and planning policies and an instrument for evaluating the status of countries in development process. 3. METHODOLOGY The research method is descriptive and analytical. To analyze the health condition in the province and rank townships, ELECTRE method (Elimination Et Choice Translating Reality) was used. The study included 27 indicators in six subgroups of reproductive health, human health resources and physical health resources. Library method was used for data collection based on statistical data derived from Census of Population and Housing, Statistical Yearbooks and the Health and Medical Sciences Organization of Khorasan in the years 2005- 2008. Criteria weight is also one of the inputs of Electre model, which was determined by Analytic Network Process (ANP) model and Super Decision Software in this paper based on the opinions of 13 experts in this field. 4. RESULT & DISCUSSION The results show that there is a high spatial gap in health at the provincial level, so that nineteen townships of Khorasan province could be classified in eleven categories. Sabzevar and Kashmar with rank 1 and Mashhad with rank 2 had the most favorable health status whereas Khalilabad and Mahvelat with rank 11 had the lowest health level. Almost all main and large cities such as Mashhad and Sabzevar and their nearby cities such as Kashmar, Fariman and Bardaskan had acceptable health status whereas border cities such as Gonabad, Khaf, Sarakhs and Dargaz had poor health facilities and undesirable health status. 5. CONCLUSIONS & SUGGESTIONS The spatial inequalities in health care between central and border cities of the province indicate that policies, plans and measures of health care have not been in line with social justice, resulting to regional health inequalities in the province. Therefore, to achieve improved health equity and reduce health inequalities in Khorasan Razavi province, the equitable allocation and distribution of resources, capitals, and health care services to citizens and other factors affecting health should be reconsidered. In particular, aspects of the health physical resource capacity and health human resource capacity should be further noted because despite their importance, they have been distributed unequally in the province.