Volume 23, Issue 91 (2-2024)
refahj 2024, 23(91): 253-278 |
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Ethics code: IR.USWR.REC.1400.270
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Gohari T, Mohaqeqi Kamal S H, Frouzan A S, Ahmadi S, Araban M. (2024). Health System Responsiveness Status: Study of Slum Areas of Ahvaz. refahj. 23(91), : 7 doi:10.32598/refahj.23.91.1369.6
URL: http://refahj.uswr.ac.ir/article-1-4224-en.html
URL: http://refahj.uswr.ac.ir/article-1-4224-en.html
Tahere Gohari 
, Seyed Hossein Mohaqeqi Kamal * , Ameneh Setare Frouzan , Sina Ahmadi , Marzieh Araban
, Seyed Hossein Mohaqeqi Kamal * , Ameneh Setare Frouzan , Sina Ahmadi , Marzieh Araban
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Extended abstract
Introduction
The World Health Organisation (WHO) considered responsiveness, fair financing, and equity as essential aims of health systems. Nevertheless, of these goals, responsiveness received notabtly less attention (WHO, 2000). Responsiveness is how well the health system meets the just expectations of the people for the non-health incresing features of the health system. Responsiveness has been operationalized taking account of eight dimensios as respect for human dignity; autonomy to participate in health-related decisions; confidentiality; prompt attention; adequate quality of care; communication; access to social support networks; and choice of health care providers (Fathi, 2019).
In the 2000 global report of WHO, the ranking of the health systems of 191 countries in terms of responsiveness was determined. Iran has been ranked 100 in this report (WHO, 2000). Iran’s ranking was relatively low in the responsiveness of the health system, while currently this goal of WHO is one of the important issues of every health system and one of the components desired by policy makers and health system managers all over the world (Piroozi, 2016).
On the other hand, nowadays people’s awareness and consequently their understanding of the health system has increased and they no longer consider the health system as the mere act of meeting their medical needs (Fazaeli, 2014). Investigating the health responsiveness system status of slum areas as emerging communities and one of the social determinants of health is necessary to achieve a system of proper service delivery. The aim of this study was to evaluate the responsiveness of the health system in the slum areas of Ahvaz.
Method
This cross-sectional study was conducted in 2022 in the slum areas of Ahvaz, Iran. The study population was outpatients and inpatients referring to health centers and hospitals in the slum areas of Ahvaz. The sample size consisted of 385 people using Cochran’s formula. After determining the sample size, the research participants were selected by multi-stage sampling method; first, among the 14 slum areas of Ahvaz city, seven areas of Al-Safi, Manba-e- Ab, Kot-e-Abdullah, Koi Ramezan, Ain Do, Hasir Abad, and Kian Abad were selected by random sampling. Then, sampling was done in the service centers in each region, according to the size (population) of the region and by the available sampling method among the people who refer to the centers. Each region had a health care center, but only two hospitals, Allameh Karami and Sinai Hospital were located in these regions. Due to the fact that most of the patients referring to health care centers to receive outpatient services did not have a history of hospitalization in the last 6 months, in order to better reach samples with a history of hospitalization, data were gathered from the aforementioned hospitals.
Outpatients in the waiting room of health care centers and emergency departments of hospitals, after the visit and also hospitalized patients in the room where they were hospitalized, completed the questionnaires, and the purpose of the study was explained to them as well. In the case of hospitalized patients, it was considered that at least 24 hours had passed since the patient’s hospitalization in order to achieve a relative knowledge of the environment and health care providers. In cases where the patient was not able to answer for any reasons, the questions were asked from his companion or the questionnaire was completed by the researcher according to a structured interview (interview based on questionnaire questions).
To collect data related to the measurement of responsiveness from the questionnaire of WHO regarding the measurement of the responsiveness of the health system, which includes demographic-social questions and questions related to the measurement of responsiveness, and in the study of Askari et al. (2016), it was localized and validated by experts and the experts reviewed and its reliability was confirmed with Cronbach’s alpha of 0.92 and 0.94 respectively for outpatient and inpatient services.
Findings
The age range of the participants was 18 to 97 years with an average of (42.84±16.56). 66.2% (255 people) used government health service providers. Based on the data obtained, 66% (254 people) of the research population were women, 26% (100 people) were illiterate and 4.4% (17 people) had university education, and 47% (181 people) used outpatient services and 53% (204 people) used inpatient services.
The mean value of the domains of responsiveness were generally better in the inpatient department than that of the outpatient department, except for the dimension of communication. The mean scores of the dimensions of responsiveness in the outpatient department were different from maintaining dignity (4.07) to choice of health care providers (3.03). In the inpatient services, the dimension (4.18) had the highest mean and the choice (3.07) had the lowest mean. In the outpatient services, the mean of dignity dimension (4.07) was evaluated as good and the average of other dimensions as moderate. In the inpatient services, the average dimensions of dignity, confidentiality, independence, attention, and immediate care were evaluated as good, and the average dimensions of communication, quality of facilities, social support, and choice were evaluated as average.
There was no significant relationship between occupation, gender, educational status, and household income level with the responsiveness of the health system. But there was a significant relationship between having supplementary insurance and the dimensions of informed choice (p=0.03), independence (p=0.03) and confidentiality of information (p=0.004). Also, there was a significant relationship between the type of service provided (outpatient/inpatient) and the dimension of communicating with the service recipient (p=0.001). In addition, this type of service provider organization had a significant relationship with all dimensions of responsiveness and total responsiveness (p<0.05) as well.
Discussion
In general, the findings of this research showed that the state of overall responsiveness in the slum areas of Ahvaz is at an average level, and therefore there is not a big gap between the goal of health departments to reach the desired level of responsiveness and the result of the study. The average level of responsiveness in the slum areas of Ahvaz, despite the implementation of the health system reform plan with the specific aim of improving responsiveness and providing healthcare services to the slum areas, shows that this plan is not good enough to make the health system accountable, and there is a need for simultaneous measures to improve and promote social support, informed choice, and communication should be measured. Especially the dimensions of communication and informed choice, which were faced with a low level of response in most of the internal studies.
Ethical considerations
Contribution of authors
All authors contributed to this article.
Financial Resources No direct or indirect financial support has been received from any organization for the publication of this article.
Conflict of interest
According to the authors, there is no conflict of interest in this article.
Following Principles of Research Ethics
All procedures performed in studies involving human participants were in accordance
with the ethical standards of the Committee of Ethics in Research of the University of Social Welfare and
Rehabilitation Sciences, Tehran (ethical code IR.USWR.REC.1400.270).
Introduction
The World Health Organisation (WHO) considered responsiveness, fair financing, and equity as essential aims of health systems. Nevertheless, of these goals, responsiveness received notabtly less attention (WHO, 2000). Responsiveness is how well the health system meets the just expectations of the people for the non-health incresing features of the health system. Responsiveness has been operationalized taking account of eight dimensios as respect for human dignity; autonomy to participate in health-related decisions; confidentiality; prompt attention; adequate quality of care; communication; access to social support networks; and choice of health care providers (Fathi, 2019).
In the 2000 global report of WHO, the ranking of the health systems of 191 countries in terms of responsiveness was determined. Iran has been ranked 100 in this report (WHO, 2000). Iran’s ranking was relatively low in the responsiveness of the health system, while currently this goal of WHO is one of the important issues of every health system and one of the components desired by policy makers and health system managers all over the world (Piroozi, 2016).
On the other hand, nowadays people’s awareness and consequently their understanding of the health system has increased and they no longer consider the health system as the mere act of meeting their medical needs (Fazaeli, 2014). Investigating the health responsiveness system status of slum areas as emerging communities and one of the social determinants of health is necessary to achieve a system of proper service delivery. The aim of this study was to evaluate the responsiveness of the health system in the slum areas of Ahvaz.
Method
This cross-sectional study was conducted in 2022 in the slum areas of Ahvaz, Iran. The study population was outpatients and inpatients referring to health centers and hospitals in the slum areas of Ahvaz. The sample size consisted of 385 people using Cochran’s formula. After determining the sample size, the research participants were selected by multi-stage sampling method; first, among the 14 slum areas of Ahvaz city, seven areas of Al-Safi, Manba-e- Ab, Kot-e-Abdullah, Koi Ramezan, Ain Do, Hasir Abad, and Kian Abad were selected by random sampling. Then, sampling was done in the service centers in each region, according to the size (population) of the region and by the available sampling method among the people who refer to the centers. Each region had a health care center, but only two hospitals, Allameh Karami and Sinai Hospital were located in these regions. Due to the fact that most of the patients referring to health care centers to receive outpatient services did not have a history of hospitalization in the last 6 months, in order to better reach samples with a history of hospitalization, data were gathered from the aforementioned hospitals.
Outpatients in the waiting room of health care centers and emergency departments of hospitals, after the visit and also hospitalized patients in the room where they were hospitalized, completed the questionnaires, and the purpose of the study was explained to them as well. In the case of hospitalized patients, it was considered that at least 24 hours had passed since the patient’s hospitalization in order to achieve a relative knowledge of the environment and health care providers. In cases where the patient was not able to answer for any reasons, the questions were asked from his companion or the questionnaire was completed by the researcher according to a structured interview (interview based on questionnaire questions).
To collect data related to the measurement of responsiveness from the questionnaire of WHO regarding the measurement of the responsiveness of the health system, which includes demographic-social questions and questions related to the measurement of responsiveness, and in the study of Askari et al. (2016), it was localized and validated by experts and the experts reviewed and its reliability was confirmed with Cronbach’s alpha of 0.92 and 0.94 respectively for outpatient and inpatient services.
Findings
The age range of the participants was 18 to 97 years with an average of (42.84±16.56). 66.2% (255 people) used government health service providers. Based on the data obtained, 66% (254 people) of the research population were women, 26% (100 people) were illiterate and 4.4% (17 people) had university education, and 47% (181 people) used outpatient services and 53% (204 people) used inpatient services.
The mean value of the domains of responsiveness were generally better in the inpatient department than that of the outpatient department, except for the dimension of communication. The mean scores of the dimensions of responsiveness in the outpatient department were different from maintaining dignity (4.07) to choice of health care providers (3.03). In the inpatient services, the dimension (4.18) had the highest mean and the choice (3.07) had the lowest mean. In the outpatient services, the mean of dignity dimension (4.07) was evaluated as good and the average of other dimensions as moderate. In the inpatient services, the average dimensions of dignity, confidentiality, independence, attention, and immediate care were evaluated as good, and the average dimensions of communication, quality of facilities, social support, and choice were evaluated as average.
There was no significant relationship between occupation, gender, educational status, and household income level with the responsiveness of the health system. But there was a significant relationship between having supplementary insurance and the dimensions of informed choice (p=0.03), independence (p=0.03) and confidentiality of information (p=0.004). Also, there was a significant relationship between the type of service provided (outpatient/inpatient) and the dimension of communicating with the service recipient (p=0.001). In addition, this type of service provider organization had a significant relationship with all dimensions of responsiveness and total responsiveness (p<0.05) as well.
Discussion
In general, the findings of this research showed that the state of overall responsiveness in the slum areas of Ahvaz is at an average level, and therefore there is not a big gap between the goal of health departments to reach the desired level of responsiveness and the result of the study. The average level of responsiveness in the slum areas of Ahvaz, despite the implementation of the health system reform plan with the specific aim of improving responsiveness and providing healthcare services to the slum areas, shows that this plan is not good enough to make the health system accountable, and there is a need for simultaneous measures to improve and promote social support, informed choice, and communication should be measured. Especially the dimensions of communication and informed choice, which were faced with a low level of response in most of the internal studies.
Ethical considerations
Contribution of authors
All authors contributed to this article.
Financial Resources No direct or indirect financial support has been received from any organization for the publication of this article.
Conflict of interest
According to the authors, there is no conflict of interest in this article.
Following Principles of Research Ethics
All procedures performed in studies involving human participants were in accordance
with the ethical standards of the Committee of Ethics in Research of the University of Social Welfare and
Rehabilitation Sciences, Tehran (ethical code IR.USWR.REC.1400.270).
Type of Study: orginal |
Received: 2023/06/21 | Accepted: 2023/10/21 | Published: 2024/02/14
Received: 2023/06/21 | Accepted: 2023/10/21 | Published: 2024/02/14
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