Egypt's Transition towards a Third Wave of Health Sector Reform (2)
Egypt’s health sector has entered into a transition since its Cabinet has resigned in January 2011. The spirit of the revolution empowered health sector staff and a number of activists to raise a number of issues on their priority list. A number of facebook groups interested in the health sector were formed allowing extensive exchange of views and in some cases lobbying for their views. Monitoring feedback from these groups, the key issues raised were related to: (i) health workforce management and compensation; (ii) organization, governance and leadership of the health sector; (iii) health sector finance; (iv) responsiveness of the health system; and (v) quality of service delivery. A common theme presented dissatisfaction with the performance of the health sector and an explicit sense of low morale.
On the positive side, these groups proposed solutions for the problems raised by them. One specific group, the Egypt Health Sector Reform Group, on its page proposed a list of priority actions to be tackled during Egypt’s transition. Some of these are of short-term nature potentially capable of producing quick wins, as well could pave the way for a third wave of health sector reform once an elected government is in place.
The purpose of this blog is to present an excerpt of this brainstorming, as I understood it. Following a health systems framework, TWO proposed priority actions were selected under each element of this framework possibly feasible to be accomplished during the transition. It’s a message to those who are or will be in a decision making position in the health sector from those who are interested in the future of that sector.
Two key objectives to be achieved during the transition could be defined:
- Raising the morale of health sector staff and restoring people’s confidence in the management of the health sector and its services provision
- Preparing for the period after the transition
Objective 1: Raising Staff Moral and Restoring People’s Confidence in the Health Sector
1. Increase responsiveness of the health service delivery system in terms of improved coverage, utilization, and quality of health services and accordingly client satisfaction and people’s confidence in the health sector
· Through introducing improvements in the public health system by addressing priority gaps in service delivery and treating patients with respect.
· Through expanding health service delivery by partnering with the civil society and contracting NGOs for a minimum quality of service delivery agreed upon for a defined package of services
2. Motivation of health workforce and raising staff morale
· Introduction of payment for performance for the health workforce to improve staff compensation for better performance, quality, and system responsiveness taking in consideration different incentives for different geographic locations.
· Training of middle management for preparation of calibers needed for management and potential for staffing for senior management.
3. Making available funds by reallocation from other sources
· From the newly allocated budget for the Program for Treatment on the Expense of State; and from investment budget lines for payment for services for CSOs (as mentioned above), payment for performance for public health sector staff, and procurement of drugs, supplies, maintenance, and training.
· Postponing the social health insurance law until an elected people’s assembly is in place to decide about the health system appropriate for Egypt
4. Improving Governance
· Establishing of an independent Quality Organization to accredit public and NGO providers for a defined package of services
· The separation between the payor and provision functions within the organizational structure of the Health Insurance Organization.
Objective 2: Preparing the Health Sector for the period after transition
· Broad participation by key health stakeholders in discussions on Egypt’s health sector problems and its possible solutions including reaching a consensus on the health system that Egypt should adopt (National Health System or Social Health Insurance) based on the society’s values and expectations.
· Joint Expert/Politician Reviews to the health sector to prepare a paper on Egypt’s vision for the health sector
· Based on the health sector vision, an Expert team to prepare a Health Sector Strategy.