The Effective Coverage of Maternal and Child Primary Health-Care-Services and its Relationship with Health-Expenditures: An Analysis at Sub-National-Level in Iran

Introduction: The primary health care (PHC) approach is widely acknowledged as a fundamental element in achieving universal health coverage (UHC) goals. Consequently, numerous countries have undertaken efforts to restructure their health systems based on PHC principles. This study aims to evaluate geographic disparities in essential maternal and child indicators provided at the PHC level, focusing on both crude and effective coverage. Additionally, it seeks to explore the association between effective coverage and health expenditures within the national and sub-national contexts of Iran. Methods: This research employed a secondary analysis approach to investigate the spatial distribution of maternal and child health (MCH) indicators in Iran's provinces, utilizing the latest available data from the 2010 Demographic Health Survey (DHS). To provide a comprehensive understanding of MCH indicators, the study calculated composite indicators, crude, and effective coverage. The provinces' situations were compared using the median cut-off method. Additionally, the study examined the association between coverage indicators and total health expenditure per-capita. Results: At the national level, the crude and the effective composite coverage were 89.56% and 77.22%, respectively. Also, the medians of composite crude and effective service coverage in the provinces were 90.25% and 77.62%, respectively. There was no significant difference between urban and rural areas. Conclusion: This study has revealed a notable difference between the crude and effective service coverage of the selected MCH indicators. While the coverage of maternal services was generally higher than that of child services, there were significant geographic disparities in the coverage of key indicators of MCH services across provinces. Despite the provision of free services in rural areas, their coverage was not higher than that of urban areas. These findings suggest that PHC services in Iran are still far from achieving the desired coverage and UHC goals. Policymakers and stakeholders need to focus on addressing the gaps in effective coverage and geographic disparities to improve access to essential maternal and child health services and achieve UHC in Iran.