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

Egypt
The opportunity for the HSRP to enable the coverage of the underserved areas with family
health model and basic benefits package.
Unification of all health services under one system.
Dissemination of quality concepts among different types of health service providers.
It is beneficial for the Ministry of Health and Population to have private
nongovernmental organization providers to provide health services. This approach removes an
enormous burden from the Ministry, including the cost of infrastructure and management, and
overhead costs.
A risk for the private and nongovernmental organization providers is pursuing facility
accreditation, which is a costly procedure. Failure to maintain the contract could lead to the
loss of the investment without any returns. The incentive for such facilities is the guaranteed
number of families in their catchment area.
What is the payment mechanism of the contract with private nongovernmental
organization, and to what extent does it promote efficiency, equity and quality?
The percentage of incentives is determined based on the monthly performance of the
health team whose performance is appraised through a set of performance indicators. These
cover all aspects of service provision, whether curative or preventive, and reflect the
efficiency and quality. There are eleven performance indicators, each with a target standard as
shown in Table 1.
The performance indicators are divided into two main categories according to their
importance:
The first category comprises those indicators with the “all or none” rule, which means that if the
facility fails to achieve the targeted standard for these indicators, no incentive will be
paid, e.g. family planning, immunization, antenatal care and drug rationalization.
The second category comprises indicators with second priority, where the facility receives only
half of the amount of incentives allocated for these indicators if it fails to achieve the
targeted standards, e.g. referral rate, completing medical records, number of visits per day,
and patient waiting time.
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