extension phase of health sector reform program...
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Evaluating Impact:Evaluating Impact:Turning Promises into EvidenceTurning Promises into Evidence
Dr. Dr. LailaLaila MoustafaMoustafa, Dr. Isaac El, Dr. Isaac El--MankabadiMankabadi, Dr. , Dr. HalaHala ZayedZayed, Dr. , Dr. WaelWaelElEl--RaiesRaies, Dr. Mohamed Nouh, Dr. Mohamed Nouh
January 2008January 2008
Extension Phase ofExtension Phase ofHealth Sector Reform Program HSRPHealth Sector Reform Program HSRP
(Identification and exemption of poor)(Identification and exemption of poor)
Group 11Group 11
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In early 1996, the MOHP launched a re-assessment of the health sector situationand recognized a need to explore alternatives for a comprehensive reform.
As a result MOHP adopted the HSRP for Egypt , which lays out a framework for undertaking a comprehensive reform of the health sector over the medium- and long-term.Having made situational analysis in details , highlighting points of weakness and strengths and defining actual needs.
1. Background
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Family Health Model
The selection within each region was based on criteria
1. Level and depth of poverty 2. health status; concentration of
women, children and other vulnerable groups
3. existing delivery capacity; 4. commitment to reform;
administrative capacity5. representativeness and replicability
The implementation of the Family Health Model started in five pilot governorates which presented the three major regions in Egypt,
namely, urban, Lower and Upper Egypt as each has different characteristics and constitutes a different market.
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CHALLENGES FACING NATIONAL ROLLOUT
Financial sustainability is crucial for the continuation of the Family Health Model quality standards. Without maintaining the financial flow, the Family Health Model will be considered as service improvement rather than a component of a health reform process. After termination of donor funding, covering service recurrent costs will require substantial new commitments of public funds, which will have to progressively increase as the model expands. .
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Egypt Health Insurance
Egypt has health insurance system covering about 52% of population.Health financial reform has been launched to address the problem of uninsured population specially the poor.This was done through establishing Family Health Funds (FHF) in pilot governorates aiming at providing universal insurance coverage.
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What Do FHF Do?
P u r c h a s e r P u r c h a s e r P r o v i d e rP r o v i d e r
P u r c h a s e r P u r c h a s e r
P u r c h a s e r P u r c h a s e r
B e n e f i c i a r yB e n e f i c i a r y
B e n e f i t sB e n e f i t s
R o s t e r i n g
E l i g i b i l i t y
C o n t r a c t
R e g i s t r a t i o n
B B P
P u r c h a s e r P u r c h a s e r P r o v i d e rP r o v i d e r
P u r c h a s e r P u r c h a s e r
P u r c h a s e r P u r c h a s e r
B e n e f i c i a r yB e n e f i c i a r y
B e n e f i t sB e n e f i t s
R o s t e r i n g
E l i g i b i l i t y
C o n t r a c t
R e g i s t r a t i o n
B B P
Core Business Functions of Family Health Fund
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THE FAMILY HEALTH FUND CONTRACTED FACILITIES DELIVERS BETTER PRIMARY CARE THAN TRADITIONAL MOHP MODEL
After reformBefor e reform
Quality indicators significantly increased after reformAccreditation score in reformed clinics
After reformBefor e reform
Quality indicators significantly increased after reformAccreditation score in reformed clinics
Reformed clinic
Unreformed clinic
Patient satisfaction has significantly increased after reform of MoHP clinicsPatient satisfaction score
Indicators of ongoing improvements in performance are encouragingAccreditation score (%), Alexandria
Initial assessment1-year assessment2-year assessment
Similar Improve-
mentsobserved in Sohag, Menoufiaand Suez
Indicators of ongoing improvements in performance are encouragingAccreditation score (%), Alexandria
Initial assessment1-year assessment2-year assessment
Similar Improve-
mentsobserved in Sohag, Menoufiaand Suez
39
1911
2835
00
2933
0
677170
8377
5652
767572
Laundry
Lab services
Emer-gency services
House-keeping
Patient rights
Patient care
Sterili-zation
Infection control
Em-ployee health
Pharm-acy
656358656265
8085
7282
8790 8392
8188
80
92
Clinic 1
Clinic 2
Clinic 3
Clinic 4
Clinic 5
Clinic 6
16.210.7
29.833.2
10.4
42.4
19.2
86.6
66.0
88.881.6
92.796.895.1
Physical standard of facility
Quality of clinical service
Dentistr yLab services
Phar macy
Manage-ment
Overall satisfaction
Source: FHF, MoHP, team analysis
Better clinical quality
Better patient
satisfac-tion
Ongoing improve-
ment
Quality of care: metrics in reformed FHF clinics are more than double that of unreformed clinics (hygiene, appropriate treatment and consistency)
Service impact: Patient satisfaction in reformed clinics is double that of unreformed clinics (standard of facilities, standard of treatment and availability of treatment)
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FHF were piloted in 2 governorates (Alexandria and Menoufia).
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Challenges
After FHF implemented cost-sharing mechanism, since 2004 till now, the following points were observed:
Low enrollment rate of poor and uninsured.Poor Facilities’ Utilization rate.Inadequate purchasing capacity of FHF.
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Trend in pilot Governorates
Trend in Av. Number of Tickets in FHUs & FHCs in All Governorates in Six Months Period Before & After
Implemetation of MD 147
0.0
500.0
1,000.0
1,500.0
2,000.0
2,500.0
3,000.0
Jan Feb Mar Apr May Jun
Month
Av.
Num
ber o
f Tic
kets
Av. FHUs Before Av. FHCs Before Av. FHUs After Av. FHCs After
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Program Description
The program was designed to Identify the poor and offer them free enrollment in health insurance scheme and conduct promotional campaigns for the non-poor uninsured in Alexandria and MenoufiaGovernorates.
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Objectives
The program was designed to achieve the following Project Development Objectives:
To increase the enrollment of the poor and the uninsured in Alexandria and Menoufiabased on achievable quarterly targets To improve the efficiency and performance of the delivery of family health servicesTo strengthen the purchasing capacity of FHF in both governorates
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2. Results Chain
InputsInputs ActivitiesActivities OutputsOutputs OutcomesOutcomes ImpactImpact
• HR
• Health care facilities (providers), Infrastructure
•Financial resources …
•Training
•Establish &/or renovate facilities
•MIS (FHIS), CIS
•Coordination with other agencies as MOSS, MOF
•Review BBP content
•Costing & Pricing
•Promotion campaigns
• …
•Better health status of poor & uninsured
•Less impoverishing effect
•Improved efficiency…
•Increase average utilization rate (2.5 visit/person/year)
•Contracts on output basis
•…
•Enrollment of poor & uninsured (targeted groups)
•Accredited/Contracted HC facilities /providers
•Developed FHF
•Targeting tool or cooperation protocol with MOSS & MOF
•Exemption policy
•Model contracts with various PPMs
•…
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3. Primary Research Questions
Does Identifying the poor and offering free enrollment in health insurance scheme to them, will increase Health services utilization?Will promotion campaigns of FHF insurance schemes, increase the enrollment of the non-poor uninsured.
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4. Outcome Indicators
287 FH facilities (100%)
191(66.5%)
Percentage of targeted FH facilities contracted with FHF
24(100%)
16.2(67%)
Average no. of daily encounter per physician
2.5(100%)
2(80%)
Utilization Rate of Family Health Facilities (all enrolled beneficiaries/ exempted poor/ un-exempted uninsured)
1086600(100%)
437189(40.2%)
Number of enrollment uninsured beneficiaries
825816(100%)
126607(15.3%)
Total No. of exempted (uninsured) poor beneficiaries covered by the FHF to receive the B.B.P. of PHC services
Target(Mar. 2009)
Baseline(Dec. 2007)
Indicator
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5. Identification Strategy/Method
Randomized Promotion Method will be used in each governorate.
Promotion campaigns will be implemented in randomly selected districts in each governorate.
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6. Data Management
ME system is used tocollect required dataData originate fromfacility level and FHF level and aggregated atMOHP (TSO)Monitoring Data iscollected on quarterlybasisData Quality is assuredby external concurrentauditor on quarterlybasis
Alexandria
FHF
Menoufia
FHF
MOHP (TSO)
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Data Analysis and Report elaborationand dissimination
Impact Evaluation will be conducted
121211111010
Monitoring data will be collected andaudited quarterly
Implement the program and thepromotion campaigns
Deploy CIS in FH facilities
Develop Enrollment and UtilizationMIS and implement in FHF
Update Data collection forms(Operational Templates)
Baseline Data is available (Dec. 2007)
ActivitiesActivities 44332211 88776655 1199 22 33
7. Time Frame/Work Plan2008 2009
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Thank You …
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