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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) |