تحلیل توزیع فضایی مراکز خدمات بهداشتی درمانی، مطالعه موردی: شهر اراک (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
از منظر عدالت فضایی برخورداری از خدمات بهداشتی درمانی، به وضعیتی اطلاق می شود که در میان اقشار و گروه های مختلف جامعه، شکاف و تفاوت به حدی نرسد که نابرابری ها به صورت گسترده در جامعه استمرار پیدا کند. تحقیق حاضر به لحاظ هدف، کاربردی و از نظر ماهیت یک مطالعه توصیفی - تحلیلی است. روش گردآوری داده ها از روشِ کتابخانه ای - اسنادی استفاده گردیده و به منظور تجزیه وتحلیل داده ها از روش تحلیل مسیر بهره گرفته شده است. علاوه بر این با استفاده از برآورد تراکم کرنل برای مشخص کردن تراکم و از روش توزیع جهت دار و نزدیک ترین همسایه نیز برای مشخص کردن توزیع و تحلیل الگو مراکز درمانی و بهداشتی شهر اراک استفاده شده است. یافته ها نشان می دهند که پراکندگی بیمارستان ها بیشتر در منطقه 2 شهرداری یعنی مرکز شهر بوده است و در برخی مناطق از جمله مناطق 3 و 5 بیمارستان وجود ندارد. وضعیت پایگاه بهداشت و مراکز بهداشتی - درمانی نیز به همین نحو تمرکز آن در بخش مرکزی شهر است. در مقابل وضعیت پراکنش پایگاه اورژانس در سطح شهر به صورت مطلوب پراکنده شده است. در مجموع بیش از 70 درصد شهر به مراکز بهداشتی شهر دسترسی دارند. به عبارت دیگر نزدیک به 75 کیلومترمربع از سطح شهر تحت پوشش حداقل یکی از مراکز درمانی بهداشتی قرار دارند. نکته قابل توجه اینکه مرکز و شمال شهر اراک کاملاً تحت پوشش مراکز درمانی است. اما در مقابل قسمت جنوب شرقی شهر یعنی منطقه 1 شهر اراک هیچ گونه دسترسی به خدمات بهداشتی - درمانی ندارد. همچنین نتایج نشان داد الزامات ساختاری در مقیاس شهری همچنان بر تمرکز در نقاط معدود و ایجاد صرفه های ناشی از تجمع و مقیاس دامن می زند و درنتیجه شهر به صورتی پیش می ورد که تمایل و ترجیح عدم عدالت فضایی در آن مشهود می شود. بدیهی است تا هنگامی که زمینه ها، فرایندها و سازوکارهای فرادست ملی و منطقه ای تمرکزگرا اصلاح نشوند، نظام شهری در مقیاس محلی به تعادل و توازن پایدار نخواهد رسیدMeasurement of Spatial Justice in the Distribution of Health Care Services based on Justice-Oriented City Indicators the Case Study of Arak city
From the point of view of spatial justice, having access to health care services refers to a situation where the gap and difference between different strata and groups of society does not reach such a level that inequalities continue in society. The current research is practical in terms of its purpose and a descriptive-analytical study in terms of its nature. The library-document method was used to collect the data, and the path analysis method was used to analyze the data. In addition, kernel density estimation was used to determine the density and the directional distribution method and the nearest neighbour was also used to determine the distribution and pattern analysis of health centres in Arak City. The findings show that the distribution of hospitals was mostly in the 2nd district of the municipality, i.e. the city centre, and there are no hospitals in some areas, including the 3rd and 5th districts. The state of the health centre and health centres is also concentrated in the central part of the city. On the other hand, the situation of distribution of the emergency base in the city is optimally distributed. In total, more than 70% of the city has access to the city's health centres. In other words, nearly 75 square kilometres of the city are covered by at least one health centre. It is noteworthy that the centre and north of Arak City are completely covered by medical centres. On the other hand, the southeastern part of the city, i.e. District 1 of Arak City, has no access to healthcare services. Also, the results showed that structural requirements in the urban scale continue to focus on a few points and create savings due to accumulation and scale, and as a result, the city develops in such a way that the desire and preference for spatial injustice is evident in it. The urban system at the local scale will not reach a sustainable equilibrium until the contexts, processes and centralizing mechanisms are not modified
Extended
Introduction
Social justice and one of its related dimensions, spatial justice, has formed a new approach in the field of urban planning. In addition to paying attention to physical and functional goals, urban planning must respond to the quality and psychological needs of people in the urban environment such as social identity, security and social welfare, sustainable employment, mental comfort, sense of beauty, solidarity and social belonging and so on. Today's cities, especially in developing countries, due to population growth and continuous urbanization, more than any other period need to pay attention to the establishment of spatial justice in the desired enjoyment of various urban services. The main effect of the accelerated growth of cities is the disruption of the service distribution system and the inadequacy of service distribution, in other words, the lack of spatial justice in the distribution of services, which is generally seen in all cities of Iran. Arak city in 1966, with the transformation of Markazi province into the center of smelting, foundry and machine-building industries, was introduced as one of the industrial hubs of the country. In the following decades, with the establishment of refineries, petrochemicals and other industries, it enjoyed increasing economic prosperity. The emergence of large industries in the economic structure of Arak city and industrial investments created new job opportunities in the city's employment mix which became the main source of massive population transfers to this city and it caused a new pattern of economic participation of the population and thus Arak city was exposed to new developments. Accordingly, in this study, the spatial distribution of health services in Arak has been studied.
Methodology
This research is applied in terms of purpose. The research method is descriptive-analytical in terms of nature. In order to collect information in line with the framework and theoretical foundations related to the subject, including the concepts of justice-oriented city, spatial justice, as well as quantitative and qualitative indicators of health services, the library-documentary method has been used. Also, after collecting the indicators and criteria, Arc GIS software was exerted to measure and analyze the variables. In order to analyze the data and determine the functional radius of each uses of health services, the network analysis method based on the urban transportation network has been exploited.
Results and discussion
Most of the hospitals in Arak cover only the city center and cover an area of 31.03 square kilometers from an area of 107 square kilometers. Since they play a decisive role in the analysis of the road network, the return route was also considered in the radius of the hospital. For this reason, some hospitals have a limited operating radius. The findings show that the directional distribution of this land use is west-east. In addition, the kernel density function also shows that the density of hospitals is higher in the central part of the city and in the 4th district of the city. The southeastern part of the city has very poor access to this land use. In the following, using the directional distribution method and kernel density function, the distribution and dispersion of emergency bases in Arak city is shown. According to the findings, it can be said that the directional distribution of this land use is also west-east, of course, tends to the southwest and northeast. In addition, like the hospital, this land use is most focused on the north and the city center, especially in areas 4 and 5 and the city center. Findings show that urban health centers are more concentrated in areas 4 and 5 and the city center. Of course, in general, except in the southeastern part of Arak, this land use is scattered throughout the city, but its performance radius does not cover the entire city. From an area of 108 square kilometers of the whole city, this land use covers 36.19 square kilometers. In addition, the kernel density function also indicates that the health base density is in the city center and north of the city. The east and south of the city also have poor access to this land use. At the city level, the findings showed that more than 70% of the city has access to the city's health centers. In other words, about 75 square kilometers of the city are covered by at least one health center. It is noteworthy that the center and north of Arak are completely covered by medical centers. But in front of the southeastern part of the city, district 1 of Arak, there is no access to health services. In order to show the final situation of Arak city in terms of distribution and density of health-care land use, the kernel density function and directional distribution model have been used. Directional distribution of Arak city is in the northern part and its direction is southwest-northeast. In addition, its density is higher in the city center and the southeastern part is useless.
Conclusion
Studies related to the distribution of health services showed that the directional distribution of Arak is in the northern part and its direction is southwest-northeast. In addition, the density of health centers is more in the city center and the eastern part of the city is deprived of these services. In addition, nearly 25 percent of the city is not covered by any of the health service centers. Therefore, according to the research findings, the suggestions are as follows:
-Participating citizens and not considering their needs in the distribution of health services;
-Adopt a specific definition of health care land uses and define the scale (local, district and regional) in the urban planning system.
Funding
There is no funding support.
Authors’ Contribution
All of the authors approved thecontent of the manuscript and agreed on all aspects of the work.
Conflict of Interest
Authors declared no conflict of interest.
Acknowledgments
We are grateful to all the scientific consultants of this paper.
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