Abstract
BackgroundAs low- and middle-income countries experience economic development, ensuring quality of health care delivery is a central component of health reform. Nevertheless, health reforms in low- and middle-income countries have focused more on access to services rather than the quality of these services, and reporting on quality has been limited. In the present study, we sought to examine the prevalence and regional variation in key management practices in Egyptian health facilities within three domains: supervision of the facility from the Ministry of Health and Population (MOHP), managerial processes, and patient and community involvement in care.MethodsWe conducted a cross-sectional analysis of data from 559 facilities surveyed with the Egyptian Service Provision Assessment (ESPA) survey in 2004, the most recent such survey in Egypt. We registered on the Measure Demographic and Health Survey (DHS) website http://legacy.measuredhs.com/login.cfm to gain access to the survey data. From the ESPA sampled 559 MOHP facilities, we excluded a total of 79 facilities because they did not offer facility-based 24-hour care or have at least one physician working in the facility, resulting in a final sample of 480 facilities. The final sample included 76 general service hospitals, 307 rural health units, and 97 maternal and child health and urban health units (MCH/urban units). We used standard frequency analyses to describe facility characteristics and tested the statistical significance of regional differences using chi-square statistics.ResultsNearly all facilities reported having external supervision within the 6 months preceding the interview. In contrast, key facility-level managerial processes, such as having routine and documented management meetings and applying quality assurance approaches, were uncommon. Involvement of communities and patients was also reported in a minority of facilities. Hospitals and health units located in Urban Egypt compared with more rural parts of Egypt were significantly more likely to have management committees that met at least monthly, to keep official records of the meetings, and to have an approach for reviewing quality assurance activities.ConclusionsAlthough the data precede the recent reform efforts of the MOHP, they provide a baseline against which future progress can be measured. Targeted efforts to improve facility-level management are critical to supporting quality improvement initiatives directed at improving the quality of health care throughout the country.
Highlights
As low- and middle-income countries experience economic development, ensuring quality of health care delivery is a central component of health reform
Egypt is a interesting country in which to examine health reform as it is a country in an epidemiologic transition [4], as is typical of countries developing from lower- to middle-income countries
National data have not been reported regarding the prevalence of key management practices than enable high quality care; such data are critical to ongoing evaluation of health reform efforts
Summary
As low- and middle-income countries experience economic development, ensuring quality of health care delivery is a central component of health reform. As one of the only countries on target for achieving the Millennium Development Goals [6], Egypt and its health system are under increasing pressure with the growing burden of chronic disease, emerging wealth among consumers demanding higher quality services, and persistent regional disparities in health [7]. In light of these pressures, the Ministry of Health and Population (MOHP) has implemented several health reforms including piloting social health insurance [8], establishing national health accounts and workforce projections for health planning [7], and developing accreditation systems for non-governmental facilities [9]. National data have not been reported regarding the prevalence of key management practices than enable high quality care; such data are critical to ongoing evaluation of health reform efforts
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