Human resources for health density and its associations with child and maternal mortality in the Islamic Republic of Iran

Background The Family Physician and Social Protection Scheme for Iranian rural inhabitants was launched in June 2005 to improve physician density. To our knowledge, a comprehensive study of the impact of the Scheme on mortality-related health indicators has not been conducted. Aims To investigate the effects of health workforce density on maternal, neonatal, infant and under-5 mortality rates in rural areas of the Islamic Republic of Iran between 2005 and 2011. Methods We built mixed-effects Poisson regression models including mortality measures as response variables and physician and behvarz (community-based health worker) densities as independent variables, using data from the Iranian Vital Horoscope tool, annual Households Income and Expenditure Survey, and DTARH software. We also included population sizes, age of inhabitants, rate of urbanization, years of schooling, and wealth index in each district, as well as effect of time, as covariates. Results Physician density was significantly associated with child mortality rates (1.5%, 1.1% and 63.5% decrease in neonatal, under-5 and maternal mortality with a 1-unit increase in physician density per 1000 individuals). In the model built for infant mortality rate, physician density and behvarz densities were not significantly associated with this measure. Conclusions Improving the distribution of family physicians was associated with lower child and maternal mortality. Improvements in behvarz densities were not associated with decrements in these rates, which probably calls for improvement in access to more professional health services and facilities.