Community 1 PDF - Health Care System in Egypt

Health care system in Egypt 3 0 HealtH care system in egypt (PHC & New Health Insurance System) I Sectors of health services delivery...

Health care system in Egypt 3 0 HealtH care system in egypt (PHC & New Health Insurance System) I Sectors of health services delivery in Egypt There are 3 sectors: MCQ GOVERNMENTAL SEMI-GOVERNMENTAL PRIVATE SECTOR TYPE OF HEALTH FACILITIES (PROVIDERS) ① MOHP facilities. ① Health insurance org. ① Private doctors. ② University facilities. ② Curative care org. ② Clinics in mosques & churches. ③ Teaching hospitals. ③ NGOs. ④ Hospital affiliated with ministries of defense & interior. SERVED POPULATION (LOW, MIDDLE OR HIGH INCOME POPULATIONS) ▪ ▪ ▪ ▪ Low ▪ Low ▪ Middle ▪ Middle ▪ Middle ▪ High ▪ High REGISTRATION ▪ ▪ ▪ MOHP MOHP MOHP + ▪ Medical syndicate. ▪ Ministry of social solidarity. MOHP: Ministry Of Health & Population NGOs: Non-Governmental Organizations Dr. Ziad Mahana 4  FAMILY MEDICINE COMMUNITY - 1 MOHP health facilities FAMILY MEDICINE UNITS URBAN PHC FACILITIES PRESENTS IN Rural PHC facilities that apply family practice MCH centers - Women health units - Health offices WITH REFERRAL TO Family centers - General hospitals - Specialized hospitals Fever hospital - Chest hospitals - General hospitals. MCH: Maternal and Child Health PHC: Primary Health Care facilities Levels of care MCQ Written LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4 LEVEL 5 (Formal healthcare system) (Secondary level of care) (Tertiary level of care) (Quaternary level of care) (Fifth level of care) PRESENTS IN ① General Hospitals. ① Teaching hospitals. ② Specialized Hospitals. ② Cancer treatment centers. Family health unit Family health center District Hospitals ③ Special purpose institutions. ④ Centers of excellence. SERVICES PROVIDED BY THIS LEVEL ① Outpatient. ① Out-patient specialists. ① Out-patient. ① Specialized out-patient. ② Emergency in-patient. ② In-patient. ② Public health. ③ Normal deliveries. (Within the main specialists ② Specialized medical Highly specialized medical care. care. “Medicine - Surgery - Gyn/Obs - Pediatrics”) Dr. Ziad Mahana 5  FAMILY MEDICINE COMMUNITY - 1 II D EFINITION OF U NIVERSAL H EALTH C OVERAGE (UHC)  All people having access to quality health services without suffering the financial hardship associated e paying for care. This definition of UHC expresses 3 related objectives: Written ① Equity in access to health services:  Everyone who needs services should get them, not only those who can pay for them. ② The quality of health services:  Should be good enough to improve the health of those receiving services. ③ People should be protected against financial risk:  Ensuring that the cost of using services does not put people at risk of financial harm. Written “Acc to the Sustainable Development Strategy for achieving Egypt’s vision 2030” Health Key performance indicators include: MCQ ① Government spending on health reaches to 5% of the total GDP (It was 1.7%). ② Ensure 100% coverage for each vaccination & expand national immunization schedule. ③ Achieve equitable access to 80% of essential health interventions. GDP: Gross Domestic Product Dr. Ziad Mahana 6  FAMILY MEDICINE COMMUNITY - 1 III D EFINITION OF P RIMARY H EALTH C ARE (PHC) Written As declared in Alma-Ata, during a United Nation conference on primary health care held in 1978 ▪ Primary health care is essential health care that…  Based on practical, scientifically sound, socially accepted methods & technology.  Made universal accessible to individuals & their families in the community through full participation.  At affordable cost. Essential Health Services in PHC ELEMENTS Written ❶ Education for Health. ❷ Locally endemic disease control. ❸ Expanded program for immunization. ❹ Maternal & Child Health including FP. FP: Family Planning ❺ Essential drugs. ❻ Nutrition. ❼ Treatment of communicable & non-diseases. ❽ Safe water & sanitation. Characteristics of PHC: Written ❶ 1st line of contact () health sector & public. ❷ Health care system with high political commitment. ❸ Accessible to urban & rural areas. ❹ Socially accepted & affordable health delivery system. ❺ Providing curative, preventive & health promotion services. ❻ Allows active community participation. Dr. Ziad Mahana 7  FAMILY MEDICINE COMMUNITY - 1 Health services provided by PHC in Egypt: Written 💊 Treatment of: ① Common diseases: Communicable & non-communicable. ② Childhood illnesses ⇢ ARI - DD - fevers (Through IMCI). ③ Endemic/priority diseases ⇢ TB - Hepatitis - Schistosomiasis. ④ Infectious outbreaks & epidemics. ⑤ First aids, minor surgery & emergency actions. ⑦ Basic lab work & plain X ray. CURATIVE ⑧ Referral of needy cases to 2ry care facilities, feedback & follow up. ❶ SERVICES Basic laboratory tests ▪ Hemoglobin. ▪ Urine & stool analysis. ▪ ESR. ▪ Liver & kidney function. ▪ Blood group. IMCI: Integrated Management of Childhood Illness DD: Diarrheal Disease ARS: Acute respiratory Infections ① EPI: to children & pregnant. ② Food safety. ③ Early detection of:  Neonatal congenital & metabolic problems.  Mental disorders in the community. PREVENTIVE ④ Screening of: ❷ ACTIVITIES  TB among high-risk groups.  High risk pregnancy & complicated cases.  Reproductive malignancies (Breast & Cervix). ⑤ Referral of needy cases to higher levels of care. EPI: Expanded Program of Immunization ① Health education & counseling. ② Growth monitoring & micronutrients supplementing to under 5 children. HEALTH ③ Support of breast feeding. ❸ PROMOTION ④ Family planning activities & over population control. SERVICES ⑤ Environmental sanitation & safety. ⑥ Outreaching remote areas to provide essential health services. Dr. Ziad Mahana 8  FAMILY MEDICINE COMMUNITY - 1 IV D EFINITION OF N EW U NIVERSAL H EALTH INSURANCE S YSTEM (NUHIS) Written ▪ It is a compulsory system that…  Based on social solidarity.  Covering all citizens residing in the Arab Republic of Egypt: - The state bears the burden of non-able. - The family is and to be the main unit of insurance coverage within the system.  Managed through the separation of funding from service provision & apply its provisions gradually to the governorates. Goals of the New Universal Health Insurance System: ① Creating a more effective system…  That is based on high quality health services for all citizens in Egypt. ② Reaching all categories to achieve UHC…  Which helps accomplish social solidarity. ③ Covering 90% of the population by the end of the completion of the NUHIS either through:  Paying contribution.  or Subsidies from the state. ❶ GENERAL GOALS ④ One law: That regulates all acts of health insurance. ⑤ Avoid the disadvantages of the current laws & current insurance system. ⑥ Extend health insurance coverage geographically & demographically and level of service. ⑦ Coverage unit: ✔ The Family ✘ Not the individual “As in the current system” ⑧ Regaining public trust in the current HIO:  By providing improved quality health services. HIO: Heath Insurance Organization Dr. Ziad Mahana 9  FAMILY MEDICINE COMMUNITY - 1 ① Redirecting funds from line budgeting to programmatic budgeting. ② ⮅ The total spending on health as a percentage of the GDP to reach 3% ③⮇ The out- of pocket spending…  Through the transformation of the financial risk from the individual to a FINANCIAL ❷ pooled risk fund. GOALS ④ Extending the umbrella of social protection to include all citizens in an integrated system that achieves financial sustainability…  So that the dependence of the new system on the public treasury is ⮇ & it becomes a self-sustaining system. Implementation Strategy of Universal Health Insurance system: Written MCQ FOR WHOM? ▪ Progressively implemented for all Egyptian governorates. DEADLINE ▪ It will cover all Egyptian governorates by 2032. PLAN ▪ The implementation process will take place over 6 phases (Each phase focusing on a different geographic area “i.e. a cluster of governorates”) as following: PHASES 1 2 3 4 5 6 TIMELINE 2018 - 2020 2021 - 2023 2024 - 2026 2027 - 2028 2029 - 2030 2031 - 2032 - Port Said - Matrouh - Alexandria - Beni Suef - Dakahlia - Cairo GOVERNORATES - South Sinai - The Red Sea - Damietta - Assiut - Gharbia - Giza - Ismailia - Qena - Beheira - Minya - Sharqiya - Qalyoubia - Suez - North Sinai - Kafr El Sheikh - New Valley - Menoufia - Luxor - Sohag - Fayoum - Aswan Dr. Ziad Mahana 10  FAMILY MEDICINE COMMUNITY - 1 The Beneficiaries of the New Universal Health Insurance System: Written  Egyptians (3 Groups): - Egyptians residing within the Arab Republic of Egypt ⇢ 90% of them are enrolled. - Egyptians working or staying with their families aboard ⇢ Enrolment optional. - ≈ 25% of the population “who cannot afford it” ⇢ The government has committed to provide the policy free of charge to them.  Non-Egyptian residents (All foreign residents): UHIL allows coverage for them subject to reciprocal agreements with their respective countries. Reform strategy for Health Insurance Organization (HIO) in Egypt: Written ❶ UNIVERSALITY  All Egyptians should be assured coverage for a basic set of 1ry care services.  The financial burden of providing the covered services… ❷ EQUITY  Should be shared fairly: No one should be denied covered services for want of ability to pay.  Services should be provided in a cost-effective way “ In keeping with the ❸ EFFICIENCY principles of universality & quality”  Covered services should be provided… ❹ QUALITY  According to accepted standards of scientific & clinical practice.  At a level that will be perceived as adequate by the beneficiaries.  There should be enough resources why? ❺ SUSTAINABILITY  To adequately finance the basic set of services in the short & long term. Dr. Ziad Mahana 11  FAMILY MEDICINE COMMUNITY - 1 Q1 - Enumerate essential Health Services in PHC? See page 7 Q2 - Specify the Beneficiaries of the New Universal Health Insurance System? See page 11 - Mention principles of reform strategy for Health Insurance Organization (HIO) in Egypt? Q3 See page 11 Case Scenario Saeed is 57 years old, work as a teacher in a rural school at Mit Ghmees (a village in Dakahlia governorate). Saeed had history of hypertension 10 years ago and diabetes from 8 years but not controlled. Saeed went to Mit Ghmees family medicine unit suffering from severe headache, blurring of vision & edema in lower limb. Q1 How can the family physician manage Saeed’s condition? Q2 Is it right from Saeed to seek medical care in a family health unit? Dr. Ziad Mahana 12