ارزیابی دهستان‌های استان اردبیل در برخورداری از خدمات بهداشتی – درمانی با رویکرد عدالت فضایی

A B S T R A C T
The healthcare as one of the most important social sections has decisive role in the health of the community members in every community; so, it is underlined by all of the countries in the field of social welfare as one of the universal human rights. The present study aims to evaluate Ardabil's rural districts to possess Healthcare services with space justice approach. This research is practical and descriptive-evaluative in terms of purpose and nature respectively. For this purpose, 13 healthcare indicators were selected according to different texts and available statistics and they were weighed by entropy method and they were determined using this data in order to analyze in different methods (Topsis, Vicor, Saw) and the Copland method was finally determined for development level of healthcare services from the view point of spatial justice in Ardabil's villages. Pearson Correlation Coefficient was also used to examine the relationship among the rural districts development with the population and its distance from metropolitan centers. The obtained results of each method reveals that each of the models indicates different levels of healthcare development in view of spatial justice. So, an integration technique was used as Copeland in order to get general consensus. The results obtained from the performance of Copeland technique revealed that Rezagholi-Ghashlaghi, Dojagh and the Angote Sharghi were in the first grade and Vilkije-markazi, Meshgine-sharghi and Yortchie-gharbi were in the final grade respectively due to have the healthcare indicators. Also, there is a meaningful relationship between the rural districts' development with the population and their distance from civil centers. The obtained results of the rural districts' ranking based on development grade regarding healthcare indicators in view of spatial justice reveal that Ardabil's rural districts are in an unequal state in terms of having their healthcare indicators. According to the research results, it is proposed that the rural districts with lower grade in terms of the healthcare indicators (more deprived) should be in priority for planning and application of development projects.
Extended Abstract
Introduction
The weakness and inefficiency of management and rural planning in optimal rural service have made the background to injustice in order to access rural different services especially healthcare services; this problem is necessary for optimal operation of the infrastructures and find out the inequalities of leveling in Ardabil's rural districts. It can made better management and planning by knowing infrastructures and their ranking in the areas level. Ardabil's rural districts are not in similar conditions to have healthcare services. So, the present research is in an unequal state following the villages' ranking based on development grade due to healthcare indicators.
Measuring the healthcare indicators and using the efficient models as the most desirable and suitable evaluation methods of the fair distribution of the healthcare indicators among Ardebil's villages is one of the methods to meet social justice of this part of the state. Also, the importance of this comparative study is that the life level of the people of an area can be well revealed with knowing bottlenecks, abilities and the areas development levels and again can be paid to offer some programs to decrease the deprivation of those areas and the space injustice and can be prepared suitable conditions to make area development. Therefore, the major purpose of this research is to investigate the situation of the healthcare indicators development in the Ardabil's rural districts level for planning in order to decrease spatial inequalities.
 
Methodology
Several researches have been done with different attitudes about spatial justice and regional inequalities and identifying lagging areas in geographic different levels which has been tried here to address healthcare level along with other levels for ranking the geographic different regions to the extent that studies are available. A summary and some samples of research records presented in the field of inequality in the development and ranking of regions indicate that most of them are based on different dimensions of development and a number of general and
 
 
combined indicators of the development of the regions and only a few cases have addressed the one-dimensional study of areas development such as healthcare development and these cases have also addressed the comparison and leveling states together and finally the cities each other. However, the study and analysis of healthcare services with spatial justice approach which is the subject of this research emphasizes the importance of recognizing the case of deficiencies in rural districts of Ardabil province in providing health services with a spatial justice approach
 
Results and discussion
In the research findings, 13 sub-criteria in terms of health and health indicators in the framework of spatial inequality were determined by the developmental and spatial disorientation methods (Topsis, Vicor and Saw) and the ranking of each rural district in Ardebil province. As Table 4 shows, according to the developmental coefficients obtained from each method, the ranking of villagers varies and fluctuates. So that, the higher ranked one to three in Topsis model were related to eastern Angot villages, Rezagholi ghashlaghi and Balghelu in Victor model were related to western villages, eastern Arshaq and Dojaq and they were related to Dojaq, Rezagholi ghashlaghi and Kalkhoran villages in Sav model and conversely in Topsis model, Dojaq village which was in higher grade in two previous models is in the last grade in this model. Also, Balghelu village which had the penultimate place in Saw model is one of the high ranks in other two models.
 
Conclusion
13 healthcare indicators were studied for 69 rural districts of Ardabil province in this paper using Topsis, Vico and Saw models and finally Copeland method in order to assess the extent of deprivation and inequality of each Ardabil rural district in this section for better management and identifying the status of different districts.
The results of analyzing different models showed that each model shows different answers and cannot be trusted. Therefore,
 
 
Copeland's integration technique was used for the final analysis to overcome this problem. The results of Copeland's technique show that the most developed districts of Ghashlaghi, Daudak, and Angoute are the most developed and West Urutchi villages, Eastern Meshkins and Central Wilkej are the most deprived rural districts in Ardabil province respectively in terms of facilities and health indicators.
The results of the research on the rural districts of the Ardabil province indicate that there is a severe inequality of spatial disparity among fully developed rural areas with relatively deprived and deprived rural districts in having healthcare indicators and the rural districts with more populations and near urban centers, especially the provincial capital, have a high level of development, indicating a high level of attention to these areas in the past.
Also, the findings of this study are consistent with the research on health rating and access to health sector indicators in the provinces of the country in 2006 by Amini et al. and Tahari Mehrjardi and colleagues in 2012; so that there is a severe spatial inequality in terms of health and health indicators in the study.
This pattern of healthcare can be explained based on the theory of the center and the periphery. In the center of the province and the city center, resources and promising economic activities flourish, while the perimeter remains marginal and undeveloped in the development process, and the severe polarization phenomenon emerge due to the unbalanced growth into the region. Accordingly, given that developed rural districts are mostly located in the center of the province or in the center of the cities, peripheral and border rural districts are at a moderate to low level in terms of enjoyment.
 
Funding
There is no funding support.
 
Authors’ Contribution
Authors contributed equally to the conceptualization and writing of the article. All of the authors approved thecontent of the
 
 
manuscript and agreed on all aspects of the work declaration of competing interest none.
 
Conflict of Interest
Authors declared no conflict of interest.
 
Acknowledgments
 We are grateful to all the scientific consultants of this paper.