Health care system Mostafa Elkhwaas

Health Care : “The prevention, treatment, and management of illness and the preservation of
mental and physical well- being through the services offered by the medical and allied health
professions ”

Health system :

Described by WHO as the : “Sum total of all the organizations, institutions and resources
whose primary purpose is to improve health ”

The health system delivers preventive, promotive, curative and rehabilitative

interventions through a combination of public health actions and the pyramid of health care facilities that deliver personal
health care.

Primary (1ry) health care : -Preventive -

Rehabilitive -Curative -Promotive

Key goals of a health system

A well functioning health system

responds in a balanced way to a
population’s needs and expectations by:

• improving the health status of

individuals, families and
communities
• defending the population against
what threatens its health
• protecting people against the
financial consequences of ill-health

•providing equitable access to people-

centred care
• making it possible for people to
participate in decisions affecting their
health and health system.
WHO Health system framework >>>

Building blocks, cont.

What is Governance?

It measures (1) the capacity of the government

to effectively formulate and implement sound
policies; and
(2) the respect of citizens, private organizations
for the institutions that govern them. (e.g. SHI,
Acc., relicenses).
What is health financing?
It is the function of a health system concerned with accumulation and allocation of money to cover the health
needs of the people in the health system.
What is Human Resources for health? All people engaged in actions whose primary intent is to enhance health.
What is Health Service Delivery?
The way inputs are combined (processed) to allow the delivery of a series of interventions or health actions.
What is Health Information System? A set of components and procedures organized with the objective of generating
information which will improve health care management decisions at all levels of the health system
 Health care system
(Egypt)

Public sector Private

sector

Governmental Institutional
Public Sector (parastatal)

A- governmental public sector (statal) :

activities of ministries that receive funding from the Ministry of

Finance (MOF).

organized as an integrated delivery system in which the

financing and provider functions are included under the same
organizational structure.

Include MOHP, ministries that provide some health services for

their employees (agriculture, teachers, railway, electricity, and
others), and facilities of the Teaching Hospitals Organization (9
hospitals), These university hospitals under the authority of
MOHE.

* Self funding is allowed in this sector

Government Sector

The Ministry of Health and populations (MOHP) is the largest provider of health services, the organizational structure of the

MOHP consists of two functional structures: *Administrative structure *Service delivery structure

Public health sector “MOHP”

• Administrative

-1Central head quarters: “13 under secretaries “ 2- Central administration for the ministers office
3-curative health services 4-population and family planning 5- basic and preventive health services 6-finance
• 28 Directorates “government level” Supervising 230 health districts
• 13 Under secretaries : PHC, endemic diseases, lab., curative care, research, pharmaceuticals, dentistry, nursing, FP
• Service delivery
• primary, preventive , curative through
• 5000 health facilities “ 1048 inpatient =80,000 bed”
 Administrative structure

Central Headquarter Governorate-level health directorates

• Planning • Reports to MHOP on technical matters
• Supervision • Reports to governorate administration
• Program management • headed by governor on administration and day
• Five sectors to day activities
• Curative health service • Each headed by undersecretary or
• Administration and finance • general director
• Population and family planning • They receive reports from 230 health districts (
• Basic and preventive health service each district has director
• Central administration for minister’s office
• Each sector is headed by undersecretary
Service Delivery Structure,

The MOHP is currently the major provider of primary, preventive, and curative care in Egypt, with around 5,000 health
facilities and more than 80,000 beds in
approximately 1,048 inpatient facilities
spread nationwide.
Other Governmental Players

• Many other ministries operate their own

health facilities that cater to their employees
• Ministry of Agriculture
• Ministry of Religious Affairs
• Ministry of Defense: Armed Forces
• Ministry of Transport: railway employees
• Ministry of Interior: police and the
prison population
• 14 medical schools (Faculties of
Medicine), affiliated with the major
universities
• 36 university hospitals: (secondary and tertiary care facilities, much more advanced in terms of technology and medical expertise in
comparison with MOHP facilities). Cairo University is considered the largest and most sophisticated hospital in this group. These
university hospitals are operated under the authority of Ministry of Higher Education.

Public Sector

B-institutional public sectors (parastatal):

*composed of quasi-governmental organizations in which government ministries have a controlling share of decision making
*includes the Health Insurance Organization (HIO), the Curative Care Organization (CCO), and other public sector organizations providing
mainly hospital services.
*governed by their own set of rules and regulations, have separate budgets, and exercise more autonomy in daily operations.
*from a political perspective, MOHP has a controlling share of decision making in institutional organizations.
Health insurance organization (HIO)
The Egyptian HIO was created in 1964. It is a parastatal, government-owned entity under MOHP.
classes of HIO beneficiaries (› 30 million):

• all employees working in the government sector; some public and private sector employees;
• pensioners; and widows. students and school-age children (SHIP presented in 1993) newborns (under one year) “at 1997”
HIO revenues come from four primary sources:

• The Social Insurance Organization and the Pensioners Insurance Organization receive contributions as a proportion of
employees’ salaries.
• SHIP receives contributions through a fixed amount from school registration fees and from government subsidy.
• in the form of copayments, primarily from government employees.
HIO manages :
39 hospitals, general practitioner clinics inside and outside factories,

7,141 school health clinics, 1,040 specialist clinics or polyclinics 51 owned and 49 contracted pharmacies

Private “non governmental “sector :

• The private sector has 2,024 inpatient facilities with a total of about 22,647 beds (16% of the total inpatient bed capacity in
Egypt)
• Provision of services include everything from traditional healers ,midwives, private pharmacies, private doctors and private
hospitals of different sizes
• NGOs providing services: ( religiously affiliated clinics and charitable organizations registered with MOSA)
• Private Voluntary Organizations (PVOs): Affiliated with charitable or religious organizations
• Nongovernmental Organizations (NGOs): e.g. Egyptian Family Planning
• Association (EFPA), clinical service improvement (CSI) (funded by USAID),…etc
Universal health coverage :

ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient
quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services.

major goal for health reform in many countries and a priority objective of WHO.

Impact of Universal health coverage :

universal health coverage is a critical component of sustainable development :
• enables people to be more productive and active contributors to their families and communities.
• ensures that children can go to school and learn.
• financial risk protection “prevents people from being pushed into poverty when they have to pay for health services
out of their own pockets”.
Health care reform
Defined as innovation and improvement of the health care system by reappraisal, alteration of services and removal of faults and abuses
in providing and distributing health services to patient
*It includes a repositioning of health services and health insurance to max. demographic elements “unemployed, poor,…” with reference
to coverage, pricing, hospitalization, insurers, cost containment, prescribed drugs, equipments, services
Health care reform in Egypt :
*Pilot program was started by MOHP to reform the provision of health care services which main goal is :
To provide all citizens “particularly women and children” with better quality primary care and preventive services in purpose to reduce
maternal and child mortality rates and incidence of communicable diseases through an integrated and organized system with primary
health focus .
Health care reform in Egypt cont.

Rational :

• High expenditure and low out come health care system

• Existing major inequities among population “access & financing”
• Structural problems :
1. Inadequate resources to cover poor/rural areas
2. Highly fragmented poorly integrated system “lack of coordination”
3. Unstable financing “mostly donor based”
practical application : “Universal access of basic benefits package “

Package include the following service:

Services of obstetrician, pediatrician, internists Out patient health services, home visits

Pre and post natal care Child birth Minor surgeries Essential drug Basic diagnostic
services “lab, x-ray”