The role of contractual arrangements in improving health sector ...

INTRODUCTION
Egypt
The health sector reform programme established the Family Health Fund to act as the
main contracting and purchasing agency for quality health care services on behalf of the
beneficiaries, the population of Egypt, with the following objectives:
• to separate service finance from service provision, which will ensure both high-quality
service and competition between service providers to contract with the fund on equal
criteria based upon quality of service.
• to act as an agent and contractor to purchase health services for families (both under
social insurance and non-insured individuals) through health units (Public, NGO and
Private).
• to ensure sustainability of finance.
• to act as the precursor to the National Health Insurance Fund.
The Family Health Fund is a financially independent body established as a pilot
financing and insurance unit to put into effect the separation between service provision and
finance. Its policy and strategy were developed by the Ministry of Health and Population and
it is being implemented as technical support and projects in the current phase. This phase is
pending forthcoming legislation and establishment of the National Family Health Insurance
Fund as a national goal to be gradually realized progressively, in conformity with the strategic
plan for health sector reform.
The Family Health Fund is permitted to contract with a wide range of public and private
providers. The main role of the Fund is to purchase curative and preventive primary health
care to be extended to secondary care in the future. The process takes place by contracting
health service providers in both governmental and nongovernmental sectors through current
and future health care provision organizations designated for all family members in the
community, within the framework of recognized quality standards. Thus, it is actually paving
the way for competition and availability.
The Fund applies necessary finance mechanisms to collect and disburse resources in a
cost effective manner within the framework of regulations, legislation and the Constitution.
Currently the Fund is contracted directly with public and nongovernmental organization
health facilities. The Family Health Fund also has several contracts with the District Provider
Organizations in which the latter provide a defined packages of services to the district
population. This is achieved through public, private and nongovernmental organization
providers according to the national standards of quality and with agreed upon prices subject to
monitoring and evaluation mechanisms.
Including the private and nongovernmental organization sectors in the programme adds
a significant dimension, compared with working only with the Ministry of Health and
Population facilities. Improving the quality of health services during the implementation of
the module is the first priority for the Ministry facilities, followed by the cost and revenue of
services. Typically, private and nongovernmental organizations facilities put cost and revenue
65