Egypt : Complete Profile - What is GIS - World Health Organization

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Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO The salary scale is low and is considered a major reason why doctors also engage in private practice. The conditions are rather inflexible and do not provide a strong career structure. All public employees are entitled to an unlimited unpaid leave without the loss of benefits or tenure if they pay the yearly tax while on leave. They are also entitled up to six years unpaid maternity leave without any loss of benefits. This benefit can impose a tremendous burden on the staff establishment of an organization, and on productivity, especially in specialties where there are shortages in the country. Supervision of the health workforce is in general rather limited. Procedures such as medical audit to identify and correct weaknesses are rarely applied. Monitoring of prescribing patterns does, in theory, occur but appears to have little impact on work performance. Most of the public sector physicians also practice privately. Physicians earn over 80% of their income from their private practice. Physicians are allowed to use public facilities to consult with private patients after their hours of duty. Physicians often continue to keep their positions in the public sector along with their private practice. This is primarily because the public sector job offers various benefits i.e. job security, prestige, and social status. By keeping their public positions physicians also have access to postgraduate training and to hospital beds and equipment. The lack of clear delineation between physicians’ public and private practice often results in a loss of discipline among physicians. This dual system of practicing both in the public and private sector is widely prevalent among the various categories of health professionals. Access and coverage Egypt has an extensive network of physicians and facilities with 95% of Egyptians living within 5km of a health facility, however, access to and utilization of the system is not equitable or conducive of generating the best possible health outcomes. The current strategy aims at universal access to a basic primary care package. Several aspects of the performance of the health service delivery system including its utilization, efficiency, and quality will be discussed below within health services utilization. Egypt’s MOHP data (NICHP) show that Egyptians use significant levels of both inpatient and outpatient services. Inpatient care utilization MOHP data from 2001 show that hospital (general and district) admission average 29per 1,000 population, or 0.029 admissions per capita per year (in the upper middle range for developing countries). If we consider the admission to specialized hospitals, this figure rises to 36 per 1,000 population, an average length of stay of three days. Nearly 85% of all inpatient stays occurred in either a government or public facilities with only 15% of inpatient stays being accounted for by private facilities. The average turnover rate in Egypt is 65 patients per bed, per year. Regarding hospital admissions, there is a total of 1,926,675 (29 per 1000 population per year) in general hospitals, the specialized hospitals have an additional 435,054 admissions making a total of 2,361,729 (36 per 1000 population admissions per year). Surgical operations totaled 1,094,672 at general hospitals and 119,624 operations in specialized hospitals. Causes of hospital admission (sample of 10% of MOHP admissions) are listed below. 61
Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO − Trauma, accidents, poisoning, 18.97% (main age range 15–45 years, 53% male) − Pregnancy, labor, and their complications, 18.61% (females, aged 15–45 years) − Gastrointestinal, mainly acute appendicitis and inguinal hernia, 13.01% (aged 15–45 years) − Respiratory system, 11.16% (25% are under 5 years, 22% are tonsillitis cases) − Urogenital system, 10.08% − Cardiovascular system, 6.53% − Infections and parasitic infestation, 7.49% Hospital Occupancy in 1994–1995 in Egypt was 45% (Data for Decision Making, 1995). However, the household survey conducted in 1996 showed even a lower occupancy rate of 32%. Both studies confirm the low occupancy rates of Egyptian hospitals. This figure rises to 38.4% in 2001 (NICHP), still indicating the low utilization of MOHP beds. The average length of stay (ALOS) is three days (six days in 1996) and varies according to case mix and cause of admission. Sample average stays in different areas are listed below. − Psychiatry, 18 days − Plastic surgery, 8.8 days − Obstetrics and gynecology, 1.7 days − Incubator care, 4 days Outpatient service utilization Data show that on average households reported four outpatient visits per capita per year, a relatively high rate by international standards. This includes and complements high levels of pharmaceutical consumption. Total number of outpatient visits depends on the following points. • General and district hospitals 21,455,240 (0.33 visits per capita per year) and emergency rooms 7,025,918 (0.10 visits per capita per year) with a total of 28,481,158 (0.43 visits per capita per year). • Specialized hospitals 8,952,960 (0.10 visits per capita per year). • Primary health care center outpatient visits 19,277,708 (0.29 visits per capita per year) . • Dental outpatient visits 4,197,350 (0.06 visits per capita per year). • Total MOHP outpatient visits 1.4 visits per capita per year, and all outpatient visits per capita per year is 3.98. Improvement in hospital-based services is illustrated in Table 8.1.1. 62
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