Journal of Education and Health Promotion

Investigating the effects of human health resource changes on the basic health indicators in Iran: An econometric study

Document Type : Original Article

Authors

. Mohammad Hadian
. Pouran Raeissi 1
. Mahboobeh Shali 2
. Touraj Harati Khalilabad
. Noureddin Niknam 1

1 Department of Health Service Management, Iran University of Medical Sciences

2 Department of Critical Care Management, Tehran University of Medical Sciences, Tehran, Iran

Abstract
INTRODUCTION: In the development perspective of each country, it is important to pay attention
to the health sector and improve health indicators; therefore, planning in training and distribution of
human resources in the health sector is an important factor to achieve the health system goals. The
aim of this study was to investigate the effect of changes in health sector human resources on infant
mortality rate (IMR), maternal mortality rate (MMR), and under‑five mortality rate (U5MR) in Iran.
METHODS: This was an econometric study (data panel) that conducted retrospectively and used
data from the period 2006 to 2017 among Iranian provinces. Three regression models were used to
determine the effect of health sector human resources (physicians, nurses, and paramedical staff)
on the IMR, MMR, and U5MR. The random‑effects model was selected over the fixed‑effects model
to assess the effect of health sector human resources on health outcomes.
RESULTS: Results showed that the number of physicians in different models has a stronger impact
on these mortality rates than those of nurses and paramedics, so that a 1% increase in the number
of physicians leads to 2.1%, 3.8%, and 2.2% decrease in IMR, MMR, and U5MR, respectively.
Furthermore, per capita income has a bigger impact on these mortality rates than human health
resources.
CONCLUSION: Increasing the number of human resources in the health sector, especially the
number of physicians, by investing in these resources by providing educational facilities, plays an
important role in improving the mothers’ and infants’ health indicators.

Keywords

Health outcomes
health workforce
Iran
5. The World Health Report. The World Health Report 2006‑Working
Together for Health 2006; 2012. [cited 2019 March 20] Available
from: http://www.who.int/whr/2006/en/index.html. [Last
accessed on 2019 March 20].
6. Pando C. The influence of number of physicians on infant
mortality across nations. Lehigh Preserve 2016; 24. Available
from: http://preserve.lehigh.edu/cas‑lehighreview‑vol‑24/35.
[Last accessed on 2019 May 13].
7. World Health Organization. In: Women’s Health and Human
Rights: The Promotion and Protection of Women’s Health through
International Human Rights Law; 1994.
8. Speybroeck N, Paraje G, Prasad A, Goovaerts P, Ebener S,
Evans DB. Inequality in human resources for health: Measurement
issues. Geogr Anal 2012;44:151‑61.
9. TaatiKeley E, Meshkini A, Khorasani Zavareh D. Evaluation of
distribution of specialists in public hospitals of Iran. J Health Inf
Manage 2012;9:548‑57.
10. Noe RA, Hollenbeck JR, Gerhart B, Wright PM. Human Resource
Management: Gaining a Competitive Advantage. New York:
McGraw‑Hill Education; 2017.
11. Farzadi F, Kazem M, Mafton F, Labaf R, Tabibzadeh R. The
number of general practitioners in the country and the feasibility
of implementing a family doctor plan from the human resources
dimension. J Payesh 2009;8:415‑21.
12. Anand S, Bärnighausen T. Human resources and health outcomes:
Cross‑country econometric study. Lancet 2004;364:1603‑9.
13. Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M,
et al. Human resources for health: Overcoming the crisis. Lancet
2004;364:1984‑90.
14. ZerehiMR. How is a Shortage of Primary care Physicians Affecting
the Quality and Cost of Medical Care?: A Comprehensive
Evidence Review. Philadelphia:American College of Physicians;
2008.
15. Hosseini Jebeli SS, Hadian M, Souresrafil A. Study of health
resource and health outcomes: Organization of economic
corporation and development panel data analysis. J Educ Health
Promot 2019;8:70.
16. Macinko J, Starfield B, Shi L. Quantifying the health benefits of
primary care physician supply in the United States. Int J Health
Serv 2007;37:111‑26.
17. Nguyen MP, Mirzoev T, Le TM. Contribution of health workforce
to health outcomes: Empirical evidence from Vietnam. Hum
Resour Health 2016;14:68.
18. Speybroeck N, Kinfu Y, Dal Poz MR, Evans DB. Reassessing the
Relationship between Human Resources for Health, Intervention
Coverage and Health Outcomes. Geneva: World Health
Organization; 2006.
19. Motkuri V, Mishra US. Human Resources in Healthcare and
Health Outcomes in India; 2018.
20. Baird S, Friedman J, Schady N. Aggregate income shocks
and infant mortality in the developing world. Rev Econ Stat
2011;93:847‑56.
21. Akinlo AE, Sulola AO. Health care expenditure and infant
mortality in sub‑Saharan Africa. J Policy Model 2019;41:168‑78.
22. Kosowan L, Mignone J, Chartier M, Piotrowski C. Maternal
social and economic factors and infant morbidity, mortality, and
congenital anomaly: Are there associations? Fam Community
Health 2019;42:54‑61.
5. The World Health Report. The World Health Report 2006‑Working
Together for Health 2006; 2012. [cited 2019 March 20] Available
from: http://www.who.int/whr/2006/en/index.html. [Last
accessed on 2019 March 20].
6. Pando C. The influence of number of physicians on infant
mortality across nations. Lehigh Preserve 2016; 24. Available
from: http://preserve.lehigh.edu/cas‑lehighreview‑vol‑24/35.
[Last accessed on 2019 May 13].
7. World Health Organization. In: Women’s Health and Human
Rights: The Promotion and Protection of Women’s Health through
International Human Rights Law; 1994.
8. Speybroeck N, Paraje G, Prasad A, Goovaerts P, Ebener S,
Evans DB. Inequality in human resources for health: Measurement
issues. Geogr Anal 2012;44:151‑61.
9. TaatiKeley E, Meshkini A, Khorasani Zavareh D. Evaluation of
distribution of specialists in public hospitals of Iran. J Health Inf
Manage 2012;9:548‑57.
10. Noe RA, Hollenbeck JR, Gerhart B, Wright PM. Human Resource
Management: Gaining a Competitive Advantage. New York:
McGraw‑Hill Education; 2017.
11. Farzadi F, Kazem M, Mafton F, Labaf R, Tabibzadeh R. The
number of general practitioners in the country and the feasibility
of implementing a family doctor plan from the human resources
dimension. J Payesh 2009;8:415‑21.
12. Anand S, Bärnighausen T. Human resources and health outcomes:
Cross‑country econometric study. Lancet 2004;364:1603‑9.
13. Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M,
et al. Human resources for health: Overcoming the crisis. Lancet
2004;364:1984‑90.
14. ZerehiMR. How is a Shortage of Primary care Physicians Affecting
the Quality and Cost of Medical Care?: A Comprehensive
Evidence Review. Philadelphia:American College of Physicians;
2008.
15. Hosseini Jebeli SS, Hadian M, Souresrafil A. Study of health
resource and health outcomes: Organization of economic
corporation and development panel data analysis. J Educ Health
Promot 2019;8:70.
16. Macinko J, Starfield B, Shi L. Quantifying the health benefits of
primary care physician supply in the United States. Int J Health
Serv 2007;37:111‑26.
17. Nguyen MP, Mirzoev T, Le TM. Contribution of health workforce
to health outcomes: Empirical evidence from Vietnam. Hum
Resour Health 2016;14:68.
18. Speybroeck N, Kinfu Y, Dal Poz MR, Evans DB. Reassessing the
Relationship between Human Resources for Health, Intervention
Coverage and Health Outcomes. Geneva: World Health
Organization; 2006.
19. Motkuri V, Mishra US. Human Resources in Healthcare and
Health Outcomes in India; 2018.
20. Baird S, Friedman J, Schady N. Aggregate income shocks
and infant mortality in the developing world. Rev Econ Stat
2011;93:847‑56.
21. Akinlo AE, Sulola AO. Health care expenditure and infant
mortality in sub‑Saharan Africa. J Policy Model 2019;41:168‑78.
22. Kosowan L, Mignone J, Chartier M, Piotrowski C. Maternal
social and economic factors and infant morbidity, mortality, and
congenital anomaly: Are there associations? Fam Community
Health 2019;42:54‑61.
Journal of Education and Health Promotion
Volume 9, Issue 10
October 2019
Pages 1-5

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