The Effect of Health System Reform Plan on Neonatal Outcomes: A Case Study in an Educational Hospital, 2011-2016, (Iran)

Abstract

Background and Objectives: Health system reform plan is a plan for improvement of health systems in Iran, which started on May 15, 2014 in hospitals of Ministry of Health of Iran. In this study, changes in neonatal outcomes following the implementation of the health system reform plan, were investigated.   Methods: This cross-sectional study (before and after exposure) was conducted in a public educational hospital. The study population was all deliveries (normal and cesarean section) performed at Izadi educational treatment hospital (2011-2016), which were selected using Stratified random sampling. Information was collected using a checklist based on hospital records. The data were analyzed by t-test and Chi square test.   Results: According to the results of this study, after implementation of health system reform plan, the ratio of normal delivery significantly increased (p<0.001). There was also no significant difference between the two groups (before and after the reform plan) in terms of maternal age, gestational age, and infants' weight. Among the outcomes following the implementation of the reform plan, the need for admission (from 7% to 12.6%) (p=0.001) and newborn seizure (from 0 to 0.7%) (p=0.031), significantly increased. The neonatal death was not significantly different between the two groups.   Conclusion: The results of the study showed that health system reform plan has a positive effect on the reduction of cesarean delivery and has reduced the ratio of cesarean delivery to normal delivery. Accordingly, it can be concluded that the health reform plan for the promotion of normal delivery has somewhat achieved its goals. However, the implementation of this plan has increased some minor neonatal complications that did not affect the death rate.    

Keywords

• cesarean section
• health system reform plan
• normal labor
• obstetric labor complications.