Which Approach Is More Effective in Maternal and Child Health; Primary Health Care or Specialization?

It was an honor to read “Equity in the Distribution of Maternal and Child Care Providers at the Second Administrative Level: Evidence from Iran” in an earlier issue of Shiraz E-Medical Journal. In this article, the authors claimed that the distribution of pediatricians and gynecologists in Lorestan Provincewas relatively equitable; however, its distribution trend has declined during 2011 - 2015 in comparison to the country-wide. They concluded that this shortcoming could increase the mortality rates among mothers and babies (1). It was confirmed that women’s health in different periods might be threatened by an unequal distribution of resources and facilities (2). During 2010 - 2012, in Iran, the trend showed the number of health workforces, including general practitioners (GPs), midwives, pediatricians, and gynecologists per10,000 populationwas increased for GPs and pediatricians and decreased for gynecologists and midwives (3). In addition, the trend of human resource per population ratio (HRPR) in Lorestan was increasing for midwives and pediatricians, almost constant for gynecologists, and decreasing for GPs during 2010 - 2012 (3). According to the findings, the decrease or increase in human resources throughout a country does not merely lead to a better or worse human resource distribution (3). The experience of the USA and Japan also verified no evidence of equal distribution by increasing the number of physicians and health workforces (4). More importantly, primary health care (PHC) interventions in maternal, newborn, and child health have a prominent role in preventing maternal, neonatal, and infant mortality (5). Maternal death surveillance and timely response are the key strategies to reduce preventable deaths among mothers and babies. In other words, mortality audits and reviews help health system managers take corrective actions and improve the quality of care (6). To provide effective healthcare, policies should focus on improving both the coverage and quality of services simultaneously. In this way, PHC has improved access to healthcare at a low cost.