الفهرس 
1. IntroductionOnly 14 pages are availabe for public view
 |  | from | 186 |  |  |
| | | from | 186 | | |
Abstract
The findings of this study showed alarming inequities in coverage
and accessibility of health services. There were wide differences in
coverage and accessibility between upper and Lower Egypt health
facilities as well as between rural and urban health facilities.
Though one of the key objectives of the HSRP was to cover all
families of the pilot governorates (Alexandria, Menoufia, Sohag, Qena
and Suez governorates) with basic benefits package of primary health
care services, HSRP interventions covered only 84% of PHC facilities in
Menoufia Governorate. In Beni-Suef, (extension governorate) this
percentage dropped to 66%. Most facilities in the two selected
governorates were in rural areas (90%).
It was wise to focus on rural communities where the targeted
population was less than the urban ones; they were more deprived of
health care services besides collection of health enumeration data by
health worker was easier in closed rural communities.
Lack of proper clinics (infrastructure) and / or manpower (human
resources) in both governorates was a major cause that restricted the
extension of HSRP intervention to cover all families. (Initial coverage)
The PHC facility would have for sometimes no physician at all or
be over-staffed, but always the turnover of its physicians is high!
Menoufia PHC facilities suffered from significant shortage in qualified
family physicians and specialists. These phenomena strike PHC facilities
of Beni-Suef (Upper Egypt) more. There was complete lack of Family
Physicians and specialists in Beni-Suef PHC facilities.
Most facilities were physically accessible. Nevertheless, increased
cost of services delivered plus annual subscription in Menoufia’s facilities
contracted with FHF limited the affordable access to health services
which was reflected on decreasing service output.
National standard for service output (The number of people who
have contacted the service) were not met in all facilities. Such defect
indicated that service performance wasn’t appraised by customer
satisfaction. In other words there were defects in actual coverage
dimensions (Acceptability and adequacy of service). Actual coverage
deals with the perception of people towards different aspect, such as
quality of service, cost or personal treatment. It is the actual contact
between the service provider and the user.
Family medicine new model of practice were going better in rural
and lower governorate’s facilities, but in general it seemed to be not
favored by both health workforce nor targeted population. Physicians do
not prefer staying in PHC facilities or choosing specialty of Family
Medicine. Most of patient’s visits were outside the recording system in
both governorates’ facilities wither the defect in the recording process or
in patient willing to be involved in the new model of practice. It is a red
flag. In addition there was improperly functioning poor referral system in
all settings.
Family medicine new model of practice was the cornerstone of the
health sector reform program. Family health folders reflect the general
health status of both citizen and the whole society through ongoing
analyses of practice patient care data besides offering documented
performance measurements. Absence of such data makes the role of
HSRP in improving the population health status minimal or almost
absent.