الفهرس 
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Abstract
Egypt has a high complicated health care system, with many public and
private Provider and financing agent, .health services in Egypt are currently
managed, financed and provided by agencies in the various sectors of the
government under Different laws, operating with variable levels of
independence and by also provided by private providers of variable categories
and at variable levels of intervention . Health Sector reform Program( HSRP)
is a program to transform Egypt’s health sector between 1997 and 2020
with the overall goal of shifting the focus of health care from a heavily
reliance on vertical programs and inpatient care to a more integrated and
less costly, quality, universally accessible and sustainable primary health
care . The basic goals of a health care system reform are Improving
population health status and social well-being, ensuring equity and access to
care, ensuring efficiency in the use of resources, enhancing clinical
effectiveness, improving quality of care and consumer satisfaction and
assuring the system’s long-term financial sustainability . Building blocks of
Health Sector Reform program are establish a new Family Health Care Model,
Separation of Finance from Provision of health care, decentralization, focus on
(BBP), Application of Quality and Accreditation, Coverage of new population
groups with insurance scheme.
The reform activity in Egypt is still young and limited in scope. Information
about important issues remains unavailable and many aspect of the reform
are still not tested or implemented.
Aim of the work :
To evaluate the effectiveness and the efficiency of the Egyptian Health
Sector Reform Program .
Methods:
A simple random sample of 10 family health units and 3 hospitals will be
selected from the total 220 units and 17 general and district hospitals of
Menofia governorate.
Each selected unit of chosen group will be subjected to:-
• Data collection and analysis of coverage, preventive and curative
utilization, Infrastructure , referral system, Training programs and
measuring of quality standard using Egyptian Accreditation standards.
• Questionnaire for sample of patients and providers measure their
satisfaction
• Follow up the referral process from units to the chosen hospitals.
Results
This study shows that for all type of population there is a big difference
between coverage with family health fund and active enrollment ,Also the
percentage of coverage are significantly higher among un-insured non
exempted (86%) and insured population (83% ) than un insured exempted
77% with p value < 0.001, the percentage of active enrollment are
significantly higher among un-insured non exempted (60%) and insured
population 44% than un insured exempted (14%) with p value < 0.001.
Our study reveals that according to Egyptian Accreditation Program, the
average of final Quality standard evaluation of the family health units at the
present study is( 55%) ,while the mean of final Quality standard evaluation of
the family health units at the time of accreditation at 2010 was (83%) .
Average evaluation of each quality aspects for all selected 10 FHU, for
sterilization and infection control is 85%, average evaluation of Cleanness
and House keeping is 82%, Environmental Safety was 80%, patients rights
was 75% Facility management program was 44%, Quality improvement
program standard was 41% , The present study reveals that the average
Patient care indicators of all units was 39% .
Table 4 Show that the average cost per visit in year 2012 equal (33) LE ,
the fund target at 2oo7 was (18) LE , average operational cost per visit in
year 2012 equal (8)LE , the fund target at 2oo7 was (4) LE, average revenue
per visit is (6) LE, the fund target at 2oo7 was (3) LE , percentage total
revenue/total cost is (19%) while the fund target at 2oo7 was (100 %) LE .
Table 5 show that there is a significant difference in distribution of
instruments at the family health units , the average numbers for each
instruments kind are , ( 2) ”ECG”, (1) ultrasound ,( 2)blood sugar measure
instruments ,(1) dentist units ,( 9) computers and (2 )autoclaves .
Figure1 shows that there is significant positive correlation between
evaluation of Quality indicators and over all patient satisfaction ( p value <
.0001).
Figure2 reveals that only (11% ) from the referral cases have returned back
information to family health units from the referred hospitals and ( 89 % )
of them not have any feed back information.
Discussion
The overall results from this study are show us the degree of effectiveness
and efficiency of HSRP in achieving its goals and principles
The Government of Egypt (GOE) has articulated its long-term goal which is
achievement of universal coverage of basic health services for all its citizens. It
has also stated as its priority objectives the importance of targeting the most
vulnerable population groups.
To meet these principles and ensure the universal coverage the exemption
policy has been implemented since 2006 as apart of the Ministerial Decree
231 for year 2006 , Target exempted is established by the World Bank as
17% of total population .
Our study show that there is low coverage of exempted people in comparison to
insured and un-insured population, the percentage of coverage are significantly
higher among un-insured (86%) and insured population (83% ) than exempted
(77%) with p value < 0.001, the percentage of active enrollment are significantly
higher among un-insured (60%) and insured population 44% than exempted
(14%) with p value < 0.001
Uninsured beneficiaries are the category which pay by them self, it is very
important to calculate the active enrollment to uninsured as it give us much
accurate image about pattern of health care utilization and the degree of patient’s
satisfaction and convenience about the health services .
The present study reveals that Active enrollment for un-insured people is (60%)
which is higher than active enrollment for insured people (44%) to target (Table
1) . This mean even insured patients have no interest to active registered and visit
the units although their visits is free. This explain and show that the cause of this
low active Registration and low utilization is not due to financial burden or high
registration fees but it refer to the quality of services and the degree of
convenience of family health model .
The present study reveals that according to Egyptian Accreditation program
there is a big gab between evaluation of quality standard at the
time of present study, the mean of final Quality standard evaluation of the
family health units at the present study(2012) is(55%),the mean of final
Quality standard evaluation of the family health units at the time of
accreditation was (83%)
One of the objectives of HSRP to provide safe services HSRP ensure
introduce quality services in health facilities with satisfactory infrastructure
provide safe services including environmental safety , clinical safety and basic
requirement including good Location and accommodation , good accessibility,
surveyed land, functional, hygienic high building standard, electricity supply,
availability of transportation, clean surrounding environment and provide
good services by qualified staff, and available facilities for waste disposal.
Our study show that the best indicators are those which related to
infrastructures, environmental safety, clinical safety, sterilization, infection
control and cleanness, average evaluation of sterilization and infection
control was (85%) , the average evaluation of Cleanness was (82%),
Environmental safety was (80%) .
The basic goals of a health care system reform are Improving population
health status and social well-being , ensuring equity and access to care,
Enhancing clinical effectiveness.
The present study reveals that the average Patient care indicators of all units
was 39% . which is very low and shocked results as it is the main indicators
which related to clinical services and did not achieved the previous
mentioned basic goals of a HSRP which Improving population health status
and social well-being,
Increase the health care budget if done without make cost analysis and cost
effectiveness will not lead to improve the situation, simply putting more
money into an inefficient system might lead to more financing problems
facing the Egyptian Health care system , absence of cost analysis
,Inappropriate incentives, and inadequate accountability are major causes
of problems throughout Egypt’s health system, including the HIO.
The result of our study agree with this as we found that the last cost analysis
was done at year 2007 by Menofia Family Health Fund and till now there is
no any cost analysis done,also there is no any monitoring and evaluation of
financial indicators for family health units to follow up and measure the
degree of achievement from the target and evaluate the efficiency of the
health sector reform program to achieve the sustainability.
Performance measurement. can be done by comparing current costs with
those who were expected or standard costs to the degree of knowing which
of them have been controlled. Deviations of expected with the current -
variances - can be identified, evaluated and discussed by managers.
Our study show that the family health units cannot achieve the target for
cost indicators which is put in 2007 , and we are far from achieved this
targets as the present study show that the average cost per visit in year 2012
equal (33) LE , the fund target at 2oo7 was (18) LE , average operational
cost per visit in year 2012 equal (8)LE , the fund target at 2oo7 was (4) LE,
average revenue per visit is (6) LE, the fund target at 2oo7 was (3) LE ,
percentage total revenue/total cost is (19%) while the fund target at 2oo7
was (100 %) .
Patient satisfaction is an important outcome of health care services and can
affect the compliance with medical advice .service utilization and the
clinical –patient relation ship. patient’s positive perception of the given care
is of fundamental importance in measuring quality of care. it could give
information about the success in meeting patient’s values and expectation.
This study shows that there is significant positive correlation between
evaluation of Quality indicators and over all patient satisfaction ( value .0001)