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HSRP-supportive projects (UNFPA-Supply/Demand Project) improve integration through training
in evaluation of performance using specific formats, training of physicians and nurses and through
adding new ideas for evaluation of the performance of the health facilities (Souhag, Quena,
Alexandria).
Shortcomings of FHM: The performance of the service providers in the FHM facilities is not
good compared to the non-FHM facilities, because the training of family physicians is not of
acceptable quality and there is no referral system (Quena).
E-Referral Services
Positive impact of FHM: Referral system is implemented (Alexandria). There are views that
referral system is working, because it is linked with the FHU physician incentive system
(Menofia).
Shortcomings of FHM: The referral system is not working efficiently due to the high cost of the
referral process. The doctors do not know the standards/requirements for referral of cases. People
do not understand the benefits of referral process: enrolment for specialist services, follow up, and
feedback services (Menofia). In Quena the referral system is not working due to nonreceiving/delay
in receiving fund from FHF and the hospital staff is not motivated to provide care
to referred cases (Quena). In Suez there are no changes in the current system of referral from the
health unit to the general hospital.
Quotation (20): people do not like referral to hospital through FHU. There are many steps: folder, heath
unit visit payment, cost of enrolment for specialist services etc. The private physician is one step/less
cost service.
DPO Menofia
There is no relation between the DPO and the hospital, because the hospitals are affiliated to the
MOHP-curative care sector. The health district is concerned with the health units which are
affiliated to MOHP- preventive medicine sector. In either case the district cannot support the
hospital or the health units due to lack of resources at the district level (Suez).
F-Quality of RH services
Positive impact of FHM: The staff is aware about accreditation process, and how to achieve, and
the indictors used for periodic evaluation (Alexandria, Souhag) and the links between accreditation
and getting financial support (Suez).
Shortcomings of FHM: The quality indicators are set by the STSP without involvement of the
health district staff (Alexandria). The indicators used to monitor performance are concerned with
quantitative performance rather than quality (Quena). STSP does not provide enough support in
order to setting plans and providing resources to facilities to achieve accreditation (Quena). The
units are selected for accreditation by the health directorate, which provide resources to the
selected units. However, this support is incomplete and sporadic (Suez).
The allocation of 36% of the health facility revenue for maintenance of equipment, building of the
health facility etc., is not enough.
Cost-sharing policy limits the utilization of the health facilities, irrespective to quality services
(Menofia).
Quotation (21): Utilization of health services is related to cost rather than the quality. Out of the 26
FHUs, there were 4 non-accredited facilities. Non-accredited facilities had high case load due to low
cost of service
DPO Menofia
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Impact of FHM on supply of RH-services