Health outcome inequities and the health system: A case study of Egypt

The documentation of health outcome inequities between population groups and/or geographical areas is important to provide evidence for policy actions and for promoting health equity. This paper aims to support the development of a data base on health inequities, consisting of indicators based on aspects of the wider health system, including health inputs, process and outcome indicators. A framework for the health system indicators is used as well as equity measures are applied to highlight inequities in health outcomes and link them to inequities in the health system to answer the question of whether the health system in Egypt is pro-disadvantaged groups. It is found that health outcome inequities pose a challenge for Egypt. Analyzing both determinants and symptoms of health outcome inequities in Egypt demonstrates that the current health system does not help reduce such inequities; on the contrary it leads to increase them

Experiences of women using reproductive health services in Egypt: one health system in two governorates

AimTo examine and compare the viewpoints of women who have sought reproductive health care at units applying the health sector reform programme in two governorates, Menoufia and Alexandria, in Egypt. MethodsA two-stage cluster sampling method was used in which four health units were randomly selected from these two governorates. Cluster sampling was again used to select households from the village where each selected health unit was situated. Women who had used clinic services for reproductive health care during the three months preceding the study were interviewed at home. ResultsUsers came for treatment at the units mainly because of convenience and close proximity rather than for the quality of the services offered. Application of the system of booking appointments was found to be different in the two study governorates. Each governorate applied different systems for registering users with physicians. The freedom to choose the physician was missing from the programme. Many basic reproductive health questions were not asked and investigations not performed during the encounter with the physician. ConclusionsAlthough both governorates are supposed to be following the same health system with the same guidelines, findings have shown that the system varied in its application in many instances. The different rates of client turnout in the two governorates, together with complaints of long waiting times, difficulty in appointment booking, the lack of seating facilities in waiting areas, lack of choice of provider and/or forced registration with physicians according to lists assigned at district level, are all problems that should be further investigated if the needs of reproductive health service users are to be addressed. Physicians should accurately follow the examination guidelines set by the programme