Promoting the Efficient Use of Human Resources in Reproductive Health Services in Iran: A Cost-Service Analysis

Effective use of human resources is considered as a key factor in the efficiency of health systems. Accessibility to affordable services for individuals according to their needs is also regarded as a sign of equitable health care system. Providing health services, particularly reproductive health, for women as a vulnerable population is one of the main priorities for health policy makers. Gynecologists and midwives are well-trained and have some common skills to provide women with reproductive health services. The aim of this study was to undertake a cost-service analysis of these services from efficiency perspective. This study was performed in three phases. The educational curricula of midwifery and gynecology were first reviewed and compared. Then, a 20-item questionnaire was designed and its validity and reliability were confirmed. Finally, the questionnaire was used to collect data from 261 randomly selected women in reproductive age who were visited by gynecologists or midwives in their offices. The collected data was analyzed by SPSS. Overall, 14 common services which could be provided by both gynecologists and midwives were identified. Mean age of patients was 28 years and 65% of them were covered by health insurance services. Genital infection and pregnancy care were the most common causes why women referred to gynecologists or midwives. While the most common reason for choosing gynecologists was their confidence in their skills, it was the affordable fee for selecting midwifes. Midwifery patients had shorter waiting time, longer visit length and lower payment rates in all 14 services. The results of this study showed that spending specialist's time for common cases with longer waiting time and higher payment rate could be considered as an important source of inefficiency in reproductive health services. Therefore, development of an effective referral system from midwives to gynecologists and providing insurance coverage for midwifery services could improve the efficiency of reproductive health services and save more than 250 million dollars annually for the country.