Mapping the workload in family health centers in istanbul with geographical information systems and developing a workload density index

The zeitgeist is transforming health needs and demands. Now, the zeitgeist on healthcare requires the prevention of diseases and promoting health through the provision of Primary Health Care (PHC). This high-volume provision is applicable via a well-organized health workforce (HWF). Supply and demand (S&D) imbalance in healthcare is a global problem today. Capacity building on HWF is one of the Sustainable Development Goals (Goal 3c). PHC is providing by family physicians at Family Medicine Units (FMU) in Turkey. HWF planning in PHC is vital for the health system. HWF has always been a central component of healthcare planning in Turkey. According to the plans made until today, certain resources are assigned to a certain population. However, an equal number of populations may not create an equal healthcare demand. Social stratification in society is also reflected in the demand for healthcare services, and different levels of demand occur in regions with different socioeconomic statuses. In this case, planning by estimating the healthcare demand of the population in different regions is important for the efficient use of HWF. In this study, it is aimed to develop a human resource planning tool in order to ensure homogeneous distribution of workload among FMUs in Istanbul. By using this tool, it becomes possible to proportionally reduce or increase the registered population of a FMU working under a high or low workload. In addition, the expected workload and the employment need in a region where there is no FMU yet can be estimated. In the study, service statistics of 4,041 FMU in Istanbul for 2017 and sociodemographic variables belonging to Istanbul subdistricts were analyzed. A scoring system was created to calculate the workload of FMUs, then the geographic distribution of the workload was analyzed, and then the AiHekim Index was developed to estimate the service demand of regions with different characteristics. By 2017, there are 4.041 FMUs, 985 Family Health Centers (FHC) and 958 subdistricts in Istanbul. The average registered population per FMU is 3,634 (SD: 915), the average annual total number of medical examinations is 8,411 (SD: 3519). The number of FMUs with a registered population of 4000 and above (n = 1.227) is 31.96% of all FMUs. The average number of pregnant women in active follow-up period in an FMU at any time of the year was 30.18 (SD: 13.22), the number of puerperals was 9.21 (SD: 4.28), the number of infants was 54.93 (SD: 23.27), the number of children was 253.21 (SD: 94.82). The average number of total vaccines per year was 973.16 (SD: 401.61) per FMU. When the average workload of FMUs is accepted as 100 points, the workload in FMUs in Istanbul is distributed in the range of 28 - 241 points. FMUs are classified into 3 groups according to their workload distribution: group A is low (n = 552), group B is moderate (n = 2504), group C is high workload (n = 528). With the AiHekim Index, the workload in a region can be estimated with 63.4% accuracy using 3 features (age, education, household size). In this way, registered populations of FMUs can be optimized according to the workload. It is insufficient to focus only on increasing quantity to develop HWF capacity. In order to use the existing capacity efficiently, it is necessary to prevent the waste of HWF and to ensure that S&D meet at the optimum point. The AiHekim Index is a strategic tool for decision makers for planning HWF in PHC. This tool offers the opportunity to take HWF planning in PHC to the next level.