L1PHC_lecture final(1).docx

**[Health care system in Egypt, PHC and New Health Insurance System]** - **[Health System in Egypt:]** **Three sectors in health services delivery presented in Egypt:** +-----------------+-----------------+-----------------+-----------------+ | **Management | **Governmental | **Semi-gov...

**[Health care system in Egypt, PHC and New Health Insurance System]** - **[Health System in Egypt:]** **Three sectors in health services delivery presented in Egypt:** +-----------------+-----------------+-----------------+-----------------+ | **Management | **Governmental | **Semi-governme | **Private | | items** | sector** | ntal | sector** | | | | sector** | | +=================+=================+=================+=================+ | Type of health | MOHP | Health | Private | | facilities/prov | facilities, | insurance | doctors, NGOs , | | iders | university | organizations, | clinics in | | | facilities, | | mosques and | | | teaching | curative care | churches | | | hospitals | organizations | | | | affiliated with | | | | | ministries of | | | | | defense and | | | | | interior | | | +-----------------+-----------------+-----------------+-----------------+ | Served | Low and middle | Middle and high | Low, middle & | | population | income | income | high income | | | populations | populations | populations | +-----------------+-----------------+-----------------+-----------------+ | Registration | MOHP | MOHP | MOHP, Medical | | | | | syndicate & | | | | | Ministry of | | | | | social | | | | | solidarity | +-----------------+-----------------+-----------------+-----------------+ - **[MOHP health facilities:]** +-----------------------------------+-----------------------------------+ | **Urban PHC facilities** | **Family medicine units** | +===================================+===================================+ | - MCH centers, | Present in rural PHC facilities | | | that apply family practice. | | - Women health units | | | | ***  *with referral to:** | | - Health offices | | | | 1. Family centers | | **with referral to:** | | | | 2. General hospitals | | 1. Fever hospital, | | | | 3. Specialized hospitals | | 2. Chest hospitals | | | | | | 3. General hospitals. | | +-----------------------------------+-----------------------------------+ - **[Levels of care:]** **Level 1: Family health unit** The formal healthcare system with out-patient and public health services. **Level 2: Family health center** Secondary level of care with out-patient specialists services, normal deliveries and emergency in-patient services. **Level 3: District Hospitals** Tertiary level of care with in-patient and out-patient services within the main specialists (Medicine, Surgery, Gyn/Obs, Pediatrics). **Level 4: General Hospitals and Specialized Hospitals** Quaternary level with specialized medical care and specialized out-patient services. **Level 5: Teaching hospitals, Cancer treatment centers, Special purpose institutions and centers of excellence.** Fifth level of care with highly specialized medical care. - **[Egypt health system reform and Universal health coverage:]** - Universal health coverage (UHC) -- defined as all people having access to quality health services without suffering the financial hardship associated with paying for care. This definition of UHC expresses three related objectives **(Egypt Vision 2030)**: 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; and 3. People should be protected against financial-risk, ensuring that the cost of using services does not put people at risk of financial harm. - According to the Sustainable Development Strategy for achieving Egypt's vision 2030, Health Key performance indicators include: 1. Government spending on health reaches to 5% of the total GDP. 2. Ensure 100% coverage for each vaccination and expand national immunization schedule 3. Achieve equitable access to 80% of essential health interventions. **[Primary health care]** - **[Definition:]** PHC is an essential health care made universal to individuals & their families in the community through their full participation & at affordable cost. It is based on practical, scientifically sound, socially accepted methods & technology. - *As declared in Alma-Ata, during a United Nation conference on primary health care held in 1978.* - **[Essential Health Services in PHC (ELEMENTS):]** E -- Education for Health. L -- Locally endemic disease control. E -- Expanded program for immunization. M -- Maternal & Child Health including FP. E -- Essential drugs. N -- Nutrition. T -- Treatment of communicable & non -diseases. S -- Safe water & sanitation. - **[Characteristics of PHC:]** 1. 1st line of contact between health sector & public. 2. Health care system with high political commitment. 3. Accessible to urban & rural areas. 4. Socially accepted & affordable health delivery system. 5. Providing curative, preventive & health promotion services. 6. It allows active community participation. - **[Health services provided by PHC in Egypt:]** **\[1\] Curative services:** 1. Treatment of common communicable & non-communicable diseases 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. 6. Basic lab work & plain X ray. 7. Referral of needy cases to 2ry care facilities, feedback & follow up. **\[2\] Preventive activities:** 1. EPI: (Expanded program of immunization) to children & pregnant. 2. Food safety. 3. Early detection Neonatal congenital & metabolic problems. 4. Early detection Mental disorders in the community 5. Screening TB among high risk groups, High risk pregnancy & complicated cases, Reproductive malignancies (Breast & Cervix). 6. Referral of needy cases to higher levels of care. **\[3\] Health promotion services:** 1. Health education & counseling 2. Growth monitoring & micronutrients supplementing to under 5 children. 3. Support of breast feeding 4. Family planning activities & over population control. 5. Environmental sanitation & safety. 6. Outreaching remote areas to provide essential health services. **[(Egypt's New Universal Health insurance System (NUHIS)]** - **[Definition]:** It is a compulsory system, 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. The system is managed through the separation of funding from service provision, and apply its provisions gradually to the governorates. - **[Goals of the New Universal Health Insurance System:]** **A- General Goals:** 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 through subsides from the state. 4. One law that regulates all acts of health insurance. 5. Avoid the disadvantages of the current laws and current insurance system. 6. Extend health insurance coverage geographically and demographically and level of service. 7. Coverage unit is the family and not the individual, as in the current system. 8. Regaining public s trust in the current HIO by providing improved quality health services. **B- Financial Goals**: 1. Redirecting funds from line budgeting to programmatic budgeting 2. Increasing the total spending on health as a percentage of the GDP to reach 3% 3. Decreasing the out- of pocket spending through the transformation of the financial risk from the individual to a pooled risk fund. 4. Extending the umbrella of social protection to include all citizens in an integrated system that provides high quality health services and achieves financial sustainability, so that the dependence of the new system on the public treasury is reduced and it becomes a self-sustaining system. - **[Implementation Strategy:]** The Universal Health Insurance system will be progressively implemented across Egypt, with the aim of covering all Egyptian governorates by 2032. The implementation process will take place over six phases, each phase focusing on a different geographic area (i.e. a cluster of governorates). **Phase** **Timeline** **Governorates** ----------- -------------- ------------------------------------------------------------ 1 2018-2020 Port Said ,South Sinai, Ismailia, , and Suez, Luxor, Aswan 2 2021-2023 Matrouh, the Red Sea, and Qena, and North Sinai 3 2024-2026 Alexandria, Damietta, Beheira, Kafr El Sheikh, and Sohag 4 2027-2028 Beni Suef, Assiut, Minya, New Valley, and Fayoum 5 2029-2030 Dakahlia, Gharbia, Sharqiya, and Menoufia 6 2031-2032 Cairo, Giza , Qalyoubia - **[The Beneficiaries of the New Universal Health Insurance System:]** 1. 90% of Egyptians residing within the Arab Republic of Egypt (excluding military personnel 2. Enrolment optional for Egyptians working or staying with their families aboard. 3. The government has committed to provide the policy free of charge to approximately 25% of the population who cannot afford it. 4. UHIL allows coverage for all foreign residents, subject to reciprocal agreements with their respective countries. - **[The Services Covered by the New Universal Health Insurance System through : ]** - Family physician. - Specialist and consultant concerning dentistry. - Home health services when appropriate. - Treatment and hospitalization (at hospitals, sanitariums or specialized centers), surgeries and other treatment modalities. - Medical imaging, laboratory and other investigations and workout. - Rehabilitative services and restorative devices according to basic lists issued by the comprehensive social health insurance organization‟ - **[Reform strategy for Health Insurance Organization (HIO) in Egypt:]** A reform strategy for the HIO was formulated based on the following principles that underlie a future vision for the organization: 1. **Universality:** All Egyptians should be assured coverage for a basic set of primary care services. 2. **Equity:** The financial burden of providing the covered services should be shared fairly. No one should be denied covered services for want of ability to pay. 3. **Efficiency:** Services should be provided in a cost-effective way in keeping with the principles of universality and quality. 4. **Quality:** Covered services should be provided according to accepted standards of scientific and clinical practice and at a level that will be perceived as adequate by the beneficiaries. 5. **Sustainability:** There should be enough resources to adequately finance the basic set of services in the short and long term. **References:** 1. **Book: Egypt's New universal health insurance system (Dr. Marwa Rashed)** 2. **Supporting Egypt's Universal Health Insurance System: stakeholder Engagement and Information Disclosure Plan** **https://documents1.worldbank.org/curated/en/947651585454659082/pdf/Stakeholder-Engagement-Plan-SEP-Supporting-Egypt-s-Universal-Health-Insurance-System-P172426.pdf** 3. **WHO, EMERO report:** **Health systems strengthening towards universal health coverage. http://www.emro.who.int/egy/programmes/health-systems-strengthening.html** 4. **Community medicine book , volume 2, Mansoura university (Staff members)**