Effect Of Corporate Parenting On Looked After Children Social Work Essay

Effect Of Corporate Parenting On Looked After Children Social Work Essay This dissertation is based around the role of corporate parenting in looked after children. It will discuss and explore the role of corporate parenting in general with the exposed group: looked after children as this is relevant to practice experience as it is based upon 80 days work placement. The concept of Corporate Parenting was first introduced in September 1998 by the Secretary of State for Health Frank Dobson, as one part of the governments Quality Protects program to make over childrens services. It emphasized the key role that chosen members would play. The Governments Quality Protects Initiative (1998) requires local authorities to identify children with additional family burdens and to provide services that are geared to ensure these childrens education and general development do not suffer. (www.doh.gov.uk/qualityprotects)à ¢Ã¢â€š ¬Ã…’   When a child becomes looked after, the responsibilities of their parent become the liability. And it is required to serve everyone working for the council as elected members of the council. This is known as corporate parenting and it is the collective responsibility of the council to provide the best possible care and protection for children who are looked after. As a corporate parent, we should act in the way we would if the child were our own. (http://www.southglos.gov.uk/NR/exeres/b10f32d0-3db1-4b38-980d-147f4ad1f6d4) 1.2 Who are Corporate Parents? Corporate parenting contains any person who has responsibility for the care and security of children. The concept of corporate parenting relates to the collective duties and responsibilities of the Local Authority for looked after children safeguard and to promote the life. Corporate Parenting is a collective responsibility of the Council, with Councillors having a distinct role to play in ensuring that the outcomes and life chances of looked after children are maximized ( The Role of Councillors as Corporate Parents May 2005 Scrutiny Review Group). The essential principle of Corporate Parenting is that all councillors and staff employed by the Council should parent the Looked After children and young people in their concern as they would their own children. All selected members of the Council have a duty to act as a Corporate Parent to children in the care of that Council. The function of the Corporate Parent (Councillors) is to make sure that the services provided by the Council as an entire contribute to achieving constructive outcomes for kids in care. Specifically, they must guarantee that children in their care are: healthy safe enjoy and accomplish in life make a positive input to society achieve economic security In order to implement this responsibility, Councillors must be: Should be well informed about the children for whom they are responsible Need to think about how they are affected by council decisions Must listen to what children and young people say Must be a supporter for children and young people. 1.3 Who are looked after children? The phrase Looked After was commenced by the Children Act 1989 and refers to children and young people: under the age of 18 who live away from their family or parents are supervised by a social worker from the local council childrens services department.   The term Looked after children applies to those children who are looked after by a local authority when either: They are accommodated by the LA at the request of a person with parental responsibility, or because they are lost or abandoned, or because there is no person with responsibility for them (S. 20 Children Act 1989) They are placed in the care of the LA by a court (part IV Children Act 1989) Interim Care Order or Full Care Order In very rare cases children and young people may also become looked after via Ward ship proceedings (High Courts exercise of its inherent jurisdiction independent of stature (Children Act 1989) Thais topic will initiate with the below questions and answers with brief explanation and references to be sorted out the focus upon right direction. They are subject to emergency orders to secure their immediate protection, (Part V Children Act 1989) Emergency Protection Orders or Police Orders or are remanded by a court to the care of the LA (S. 23 Children Young Persons Act 1969) In very rare cases children and young people may also become looked after via Wardship proceedings (High Courts exercise of its inherent jurisdiction independent of stature (Children Act 1989) For most children, care is proposed to be time-limited with the mean that the child will return home as soon as possible. (The Children Act 1989) aims to get a balance between the need to protect children from destruction and the need to protect children and families from unnecessary intervention. It encourages arrangements for services to children to be agreed between the parents and the service providers whenever possible. The Act embodies the belief that children are best looked after within the family unit without legal intervention unless this is inconsistent with their welfare and safety. 1.4 Why is corporate parenting necessary? Children may be looked after for many different reasons, including protection from harm and abuse. Children have had a long history of being looked after away from home, in such places as institutions, orphanages, foster homes, approved schools and borstals (Department of Health 1998a). Parents who are unable to look after their child may ask a local authority to do so. Children can become looked after for a numerous reasons; some children may have been abused or suffered distressing experiences, some may be in care due to family illness or the death of a parent. Others may have complex needs or disabilities and be unable to be cared at home. Often children who  become looked after for a short time period due to family problem like some children do not have a parent or relative to look after them, possibly because of death or serious illness  or because they have been separated. Young people aged over 16 years may choose to be looked after for a variety of reasons, including abuse, domestic violence or stress at home. Local authorities must provide accommodation for children who are lost, abandoned, or whose parents are unable to care for them. Authorities shall provide accommodation for any child in need in their area who appears to them to require it as a result of there being no person with parental responsibility for him, or because he is lost and abandoned, or because the person who has been caring for him is prevented from providing suitable accommodation or car (Section 20 (1) CA 1989) Section 20(3) of the Act gives local authorities a duty to provide accommodation for a child age 16 and 17 years if the authority considers that his welfare will be seriously prejudiced without such a service A local authority may provide accommodation for any young person who has reached the age of sixteen but is under twenty-one if they consider that to do so may safeguard and promote his welfare, even if their parent objects. (Section 20 (5)-(11) CA 1989) The Governments aim is for every child, whatever their background or their circumstances, to give the support they need to: Improving outcomes also involves narrowing the gap between disadvantaged children and their peers. The Government is focusing particularly on improving outcomes for looked-after children Ed Balls says in his letter to looked-after children: 2009 We want to make sure you have the same chances as other children to fulfill your dreams and to be happy. When there is breakdown and a child has to be removed from its family, the local authority is then expected to act as the corporate parent and to provide substitute care. The job is delegated to a local authority department, and its paid professional agents social workers, foster carers or residential staff act on behalf of the wider community. And when they leave care, they are on their own, having to find their way in the world. It is no wonder that a high proportion of care leavers end up in prison, or with mental health problems, or with unplanned pregnancies, or in abusive relationships. Chapter 02: METHODOLOGY The study aimed to discover from children their views on being looked after and the degree of power they felt they had to manipulate decisions made about them. Total fifteen looked after children were interviewed. Social workers were asked to identify children who met the criteria of between ten to seventeen and having been in care for at least two years. The children were given a questionnaire from the researcher to explain the purpose of the study and asked if they were ready to be interviewed. The method was selected, however, because confidentiality prohibited the researcher being given names and addresses without the childrens permission. It is not clear how many children were carry forwarded and rejected. Of those who initially said they would participate, later on dropped while arranging their interviews, leaving a total sample of fifteen. This comprised: Gender: Girls: 7 Boys: 8 Age: 10 years 1 14 years 4 15 years 4 16 years 3 17 years 3 Length of time in care (based on childrens report): 2 years 3 3 years 3 4 years 3 5 years 3 7 years 1 13 years 2 Type of care: only two were in residential care, the remainder in advance care. Children were given a common view of the research aim. But the interviews were decided to be conducted in unstructured way. They were informed that the examiner wanted to hear their vision on how much they are told about what is happening to them, whether they feel their standpoint is listened to, and whether they are supposed to feel as they are involved in decisions made about their lives. Research involving children creates particular moral dilemmas in that they are typically less powerful than the adult researcher (Thomas and OKane,1998). The unstructured interview was chosen in that it gave them maximum control over the research process and ensured that each child talked only of those topics that mattered to them and could avoid personal issues they did not want to discuss with a stranger. 2.1 Findings: Because of the promise of confidentiality, care has been taken in reporting the findings to ensure that no individual can be identified. The importance of the social worker All mentioned the importance of the social worker in their lives. The social worker was seen as very powerful and, when the relationship worked well, as a very strong ally. One described the qualities needed in a social worker as: Someone who can talk to children, get to know them, take them out, and phone regularly so they keep in touch with what is happening. Most could remember at least one social worker with whom they had got on particularly well and who had made them feel well cared for and supported. She would sort out anything that was bothering me. The biggest complaint about social workers (from eight children) was the high turnover and the subsequent interruption for them. Social workers were also criticised for their reliability in everyday matters such as keeping appointments on time or holding reviews on time. Children interpreted this carelessness as a sign of their low priority in the social workers life. However, Butler and Williamsons research bears out both the approving and critical opinions. They report that many children are seeking a more emotional, empathic level of interaction but that the experience for many is, in contrast, an almost technical, allegedly robotic nature of professional interventions in childrens lives'(1994, p.84). Confidentiality It is essential to share information for good planning and care but, from the childs point of view, this can seem very intrusive. Again, the problem reflects the normal processes of growing up. Teenagers develop autonomy and increasing privacy as part of maturation but, for a child in care, it is difficult to achieve that same sense of privacy. Several of the older teenagers complained of the lack of confidentiality and, hence, a reluctance to share their thoughts and feelings because it would all get written down in their file and read by strangers. Butler and Williamsons research also highlighted the importance and perceived lack of confidentiality to children: there is a pervasive feeling amongst children and young people that even a commitment to confidentiality is, too often, a false promise and that information divulged will then be spread around without the consent of the individual concerned (1994, p.78). 2.2 Anti-discriminatory practice: Only one young person spoke his experience of racism. He was a seventeen year old black man who complained that he was continually stopped and questioned by the police and that white women looked fearful and crossed the road to avoid him. Since he had no record of crime or violence, he felt this was completely unfair and due to racism. 2.3 Debate This is only a small sample so the responses cannot be taken as representative of the views of looked after children in general. However, it is possible to examine the issues they raised and discuss the challenges they pose to professionals endeavoring to listen to their voices whether or not they are typical. Chapter 03: Literature Review There are approximately 61,000 children and young people in care in UK, with boys comprising 55% of that population. These statistics are almost a quarter higher than those of a decade ago. Of this group, more than two out of three children live in foster care, and just over one in ten in residential care (childrens homes). An estimated 1% of care leavers progress to University, compared with 37% of young people in the population as a whole (Jackson et al 2003). The outcome nationally is poor for looked after children and there is an over-representation of previously looked after children amongst those who are homeless, unemployed or in prison. In 2002, 6% of all school leavers were unemployed. Of this figure, 25% were young people in the care of were unemployed. Of this figure, 25% were young people in the care of Local Authorities. There is a high proportion of these children who suffer from poor mental health or become teenage parents with looked after children being 5 times more likely to develop mental illness than their peers. If the child also has a disability or comes from a black or minority ethnic background they face a double jeopardy and are at greater disadvantage. There remain a disproportionate number of disabled children accommodated by local authorities. Only one per cent of Looked After Children go to University. 3.1 THE ROLE OF CORPORATE PARENTING The role of corporate parent is defined in Think Child (1999) as the following: Finding out getting the facts and follow them up, Make decisions by playing your part in the business of the council, Listening to children and young people also finding out from them how councils services work for them and remembering that children are citizens too. To be a champion for children by taking a lead in the community in putting children first. This strategy embeds the following core values that all Children in Care should benefit from: A positive sense of identity and self-worth. Belonging to a family in the widest sense and also a community. Good health. A safe, healthy, child-friendly environment, including appropriate housing, play and leisure facilities. Freedom from bullying. A right to privacy. Equal access to services. Respect Children in care have a unique relationship with the state. The local authority fulfils some, or all, of the traditional parenting role this can happen on many levels, from decisions about their day to day care through to decisions about where a child will live and which school they will attend. This responsibility has become known as corporate parenting in recognition that the task must be shared by the local authority as a whole, from lead members to frontline practitioners. Strong corporate parenting arrangements are central to improving services for children and young people in care. Improving the role of the corporate parent, as part of childrens trusts, is key to improving the outcomes for children in care. It is with the corporate parent that responsibility and accountability for the wellbeing and future prospects of children in care ultimately rest. A good corporate parent must offer everything that a good parent would, including stability. It must address both the difficulties which children in care experience and the challenges of parenting within a complex system of different services. Equally, it is important that children have a chance to shape and influence the parenting they receive. 3.2 WHERE ARE THE PROBLEMS? The circumstances and experiences of looked-after children and young people have shown that they can experience many disadvantages. Research indicates that looked-after children experience poorer outcomes than other children across a range of measures, including health and education. To achieve these outcomes, councils must demonstrate their commitment to helping every child they look after wherever the child is placed to achieve their potential. The complicated role of parenting happens on many levels from basic decisions about their day to day care and the quality of the emotional support they receive, through to big decisions about where a child will live and what school they attend as well as imparting values which help to shape their future aspirations and ambitions. For most children, these different levels are fulfilled by the same people but it is more complex for children in care. And children and young people in care themselves have told us repeatedly that they want and need stability and continuity of care so that those who look after them do not change so frequently. The challenge, therefore, is to ensure that the quality of care which children experience meets their need for a secure attachment and promotes their resilience and that this is achieved as far as possible without the need for a series of placements before finding the right one. For the first time, the Department for Children, Schools and Families presented data on the emotional and behavioral health of looked-after children and young people, finding that about 60% of those looked after in England were reported to have emotional and mental health problems. It also reported that a high proportion of looked-after children and young people experience poor health, educational and social outcomes after leaving care (Department for Children, Schools and Families 2009c). A government strategy for children and young peopleà ¢Ã¢â€š ¬Ã… ¸s health noted that a third of all children and young people in contact with the criminal justice system have been looked after (Department for Children, Schools and Families and DH 2009). 3.3 EVERY CHILD MATTERS Green Paper, 2003, led to the Children Bill, which was presented to Parliament in March 2004 and is now enacted as the Children Act 2004. The Act sets out a long term programme for change for childrens services across the country. It places a duty on all Local Authorities to produce a plan which addresses disadvantage, raises achievement and safe guards children and young people in their area. This legislation is the legal underpinning for Every Child Matters, which sets out the Governments approach to the well-being of children and young people from birth to age 19. The aim of the Every Child Matters program is to give all children the support they need to: be healthy stay safe enjoy and achieve make a positive contribution achieve economic well-being. The Every Child Matters agenda has been further developed through publication of the Childrens Plan in December 2007. The Childrens Plan is a ten-year strategy to make England the best place in the world for children and young people to grow up. It places families at the heart of Government policy, taking into account the fact that young people spend only one-fifth of their childhood at school. Because young people learn best when their families support and encourage them, and when they are taking part in positive activities outside of the school day, the Childrens Plan is based around a series of ambitions which cover all areas of childrens lives. The Plan aims to improve educational outcomes for children, improve childrens health, reduce offending rates among young people and eradicate child poverty by 2020, thereby contributing to the achievement of the five Every Child Matters outcomes. http://www.dcsf.gov.uk/everychildmatters/about/ This strategy reflects many of the initiatives recommended in the Children Bill and subsequent Act and demonstrates the commitment of the Council to discharge its duties and improve childrens services. The development of Childrens Trust arrangements will bring together representatives from key agencies and Primary Care Trusts. Whilst the Councils responsibilities towards looked after children are discharged primarily through the and Young Persons Department, the Council recognises the significant contribution to the well being of looked after children and their carers to be made by other Council departments and therefore requires, as part of this strategy, the effective and executive engagement of all service departments in meeting the needs of this group of vulnerable children and young people. 3.4 WHAT IS THE GOVERNMENT DOING ABOUT THIS PROBLEM? In 2003, the Government published a Green Paper called Every Child Matters alongside the formal response to the report into the death of Victoria Climbià ©. After a thorough consultation process, the Children Act 2004 became law. This legislation is the legal underpinning for Every Child Matters, which sets out the Governments approach to the well-being of children and young people from birth to age 19. The aim of the Every Child Matters programme is to give all children the support they need Looked-after children have a right to expect the outcomes we want for every child. These are that they:Enjoy the best health and live a healthy lifestyle .Are kept safe from harm and neglect and feel secure at all times .Are given the chance to learn and achieve, and enjoy leisure time .Are given the opportunity to make the most out of life and take a full part in the community .Grow up in a strong and secure family situation and achieve rewarding adult lives .( The Charter for Children and Young People ) ( Every Child Matters Agenda)

Minority Report: From Story to Screen Essay -- Movies Film Comparison

Minority Report: From Story to Screen Adaptations are never carbon copies. A prime example is Philip K. Dick’s short story and Steven Spielberg’s 2002 film, Minority Report. The structure of the storytelling is indeed different as well as other key elements. The narrative transforms its structure into a more episodic approach when brought to the screen. Words on paper take on a new identity when brought to life on a visual basis. Philip K. Dick’s Minority Report, written in 1956, was ahead of its time. The short story explores the consequences of technology and science and how the technology echoes the present state of society. Both the story and the film emphasize the same basic themes, however the actual plot is almost completely diverse. The film takes place around the year 2054. For five years (six in the film), the Pre-Crime Unit has successfully made murder a thing of the past. Their astounding technology is credited to three pre-cogs. These â€Å"idiot† pre-cogs identify killers before they commit their crimes, drastically cutting the crime rate by â€Å"ninety-nine and a decimal point eight percent† (in the film this rate was zero) (Dick 74). However, this infallible system runs amuck when Commander Anderton, played by Tom Cruise, is accused of a future murder. Anderton finds himself with only 24 hours (36 in the film) to discover who set him up and in the process, flee fr om the hands of the authority he once governed. If he fails, Anderton will fall victim to the perfect system he co-created. Both the story and the film are suspenseful and ask the question, â€Å"Is pre-crime justified?† The notion of innocent until proven guilty is virtually discarded. The accused murderers are based upon pure metaphysics... ...short story, it would be pretty dull. The timeliness of Minority Report is uncanny, given the current situation in politics. Philip K. Dick’s short story emerged in 1956. The script for the film, written by Jon Cohen and Scott Frank, was completed well in advance of the shock of the post-9/11 terror frenzy. Dick’s intuitions of pre-crime enforcement have been brought to the big screen at just the moment when his seemingly sixth-sense is starting to be seen in real life. Both the story and the film warn the future of society of the suffocating effects of an encroaching police state. Works Cited Dick, Philip K. Minority Report and Other Classic Stories. New York City: Citadel Press, 1987. 71-102. Minority Report. Dir. Steven Spielberg. Perf. Tom Cruise, Colin Farrell, Samantha Morton. DVD. Twentieth Century Fox and Dreamworks, 2002.

Distorted Perceptions in Fitzgeralds Tender is the Night Essay

Distorted Perceptions in F. Scott Fitzgerald's Tender is the Night    Any visitor to the French Riviera in the mid-1920s, the setting of F. Scott Fitzgerald's Tender is the Night, would describe Dr. Richard Diver as a charming, respected, well-mannered physician. Dick is a noble man who has dedicated his life to the health and protection of his beloved wife without thought to himself. Furthermore, he gives wonderful parties and is a reliable source of help to any friend in need. In fact, "to be included in Dick Diver's world for a while was a remarkable experience" (Fitzgerald, Tender, 27). Under this faà §ade of composure, however, lies a tormented personality. The stresses in Dick's life are numerous, as he deals with Nicole's breakdowns and other aspects of his career and social relationships. He has no one to help him through these difficulties but he still manages to rescue his friends in countless instances. He does his best to play his role as husband, father, friend, and physician, but he is clearly not comfortable with his responsibilities, and his confusion manifests itself through his obsession with youthfulness. Not only does Dr. Diver try to appear young and vital to the outside world, he also has an unhealthy obsession with much younger women in his life. This paternal attitude toward females mingled with sensual desire is a sign of Dick's hidden instability which slowly becomes more visible. Several events point to Dick's desire to appear younger and as his immature attitude about life. He has a strong need for social approval and tries to ensure his social standing by being a gracious and charming host to a myriad of friends and acquaintances. He is very concerned with each guest's opinion of him, and i... ...cceeding experiences. A major component of the disintegration of Dick Diver, therefore, is his confusion and immaturity regarding relationships with younger women, as well as his own need to seem youthful. His reputation and well-liked persona are achieved despite his childlike attitudes, but as he slowly loses his ability to conceal his true personality, he is deserted by everyone. Just as the incestuous actions of Nicole's father led to her illness and his private torment, Dick Diver's distorted perceptions of appropriate relationships lead to his own fall into obscurity. Works Cited Fitzgerald, F. Scott. Tender is the Night. New York, NY.: Simon & Schuster, Inc., 1982. Stanton, Robert. "'Daddy's Girl': Symbol and Theme in Tender is the Night." Critical Essays on Tender is the Night. Ed. Milton R. Stern. Boston, Ma.: G.K. Hall & Co., 1986. 118-124.

Walcotts Collected Poems and Roys The God of Small Things :: comparison compare contrast essays

Post-Colonial and Post-Modernist View of Walcott's Collected Poems and Roy's The God of Small Things      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   "Language was not so much a distinguishing sign of a soul or spirituality, which animals do not possess, as a social practice which enhanced survival of the species"-Nietzche. Nietzche reminded twentieth century intellectuals of the decisive role of language in the construction of human experience of 'reality'. With his 'perspectivism' and relativism, truth, whether artistic or scientific was seen as a social matter and a linguistic product, the displacement of one set of figures of speech by another, with knowledge the interrelations of signifiers in a field of experience made of prior interpretations. (Irving Howe, 80).    Thus in Walcott's poems and in Roy's 'The God of Small Things' modernism was further routed by inversion of ethical values as power tools for survival and exploitation, and of art as a veil over a reality describable only as wanton, godless procreation. This conception of a dynamic world of super changed energies of unimaginable force, often in violent conflict and ever-changing relations, came to resemble Freud's concept of id.    We observe, in their writings (Walcott and Roy) the apparently rational surface of consciousness hides a mass of tangled and conflicting desires, impulses and needs. The outer person is a mere papering-over of the cracks of a split and waring complex of selves driven by life and death instincts.    Walcott in his poem 'The Divided Child' writes,    There was your heaven ! The clear glaze of another life, a landscape locked in amber, the rare gleam. The dream of reason had produced its monster : a prodigy of the wrong age and colour. (Walcott 145).    According to him, language was not the transparent tool for the objective representation of a stable reality: ethics was not expressive of a discovered system of absolute values or religion other than a desire for parental protection throughout life.    He writes in his poem 'Lampfall,' And I'm elsewhere, far as I shall ever be from you whom I behold now, Dear family, dear friends, by this still glow The lantern's ring that the sea's Never extinguished Your voices curl in the shell of my ear. (Walcott 95).    When Roy was asked in an interview, 'What does it mean to be Indian?' she replied: 'Do we ask, 'What does it mean to be American or to be British?

Education and Training that supports the Changing Economy

Our mission is to provide a commonly available education with an international perspective, receptive to the needs of the individual and the economy at large.We contend that quality education and training is a vital requirement for a knowledge-based economy.   We consider deeply in the inherent value of life-long learning.   Our commitment with industry, business, and higher educational colleges highlight the foundations on which the School has been established.   Our nucleus and ways of working are that we:Place students and teachers at the center of all our activities;Promote and coerce for high standards and achievements;Are dedicated to excellence in all our tasks;Are a comprehensive school that encourage lifelong learning and equal opportunities;Promote team working and the distribution of knowledge, information and experiences;Value and energetically hearten respect for the environment; andDemeanor all our operations in a professional manner, with integrity, competence, a ccountability and collective dependability.Strategic AimsThe strategic objectives upon which this strategic plan is based are:To augment and widen the contribution of students, raise accomplishment whilst ensuring succession and equal opportunities;To induce competence, accountability and value for money;To provide a secure, convivial, friendly and superb teaching and learning environment;To consistently develop and sustain a professional, technically competent and effective staff;To construct effective national and international partnerships, school links, university links and collaborative arrangements;To sustain and enhance a positive approach towards equal opportunities irrespective of unjustified differences;To adopt a marketing oriented approach in research, analysis and catering for the target markets;To meet the training needs of staff through consultations with professional bodies and employers; andTo become a key player and a centre of distinction with respect to internati onal students.References:Johnson G.; Scholes K.; Whittington R. (2005). Exploring Corporate Strategy. Seventh Edition. England: Pearson Education Limited.Rugman M. A.; Verbeke A. (1998). Corporate Strategy and International Environmental Policy. Journal of International Business Studies, Vol. 29, Issue 4.Wagner T. (2000). How Schools Change: Lessons from Three Communities Revisited. New York: Routledge Falmer.

Method Essay

Case Problem 4 WORKFORCE SCHEDULING Davis Instruments has two manufacturing plants located in Atlanta, Georgia. Product demand varies considerably from month to month, causing Davis extreme difficulty in workforce scheduling. Recently Davis started hiring temporary workers supplied by WorkForce Unlimited, a company that specializes in providing temporary employees for firms in the greater Atlanta area. WorkForce Unlimited offered to provide temporary employees under three contract options that differ in terms of the length of employment and the cost. The three options are summarized: Option Length of Employment Cost 1 One month $2000 2 Two months $4800 3 Three months $7500 The longer contract periods are more expensive because WorkForce Unlimited experiences greater difficulty finding temporary workers who are willing to commit to longer work assignments. Over the next six months, Davis projects the following needs for additional employees: Month January February March April May June Employees Needed 10 23 19 26 20 14 Each month, Davis can hire as many temporary employees as needed under each of the three options. For instance, if Davis hires five employees in January under Option 2, WorkForce Unlimited will supply Davis with five temporary workers who will work two months: January and February. For these workers, Davis will have to pay 5($4800) _ $24,000. Because of some merger negotiations under way, Davis does not want to commit to any contractual obligations for temporary employees that extend beyond June. Davis’s quality control program requires each temporary employee to receive training at the time of hire. The training program is required even if the person worked for Davis Instruments in the past. Davis estimates that the cost of training is $875 each time a temporary employee is hired. Thus, if a temporary employee is hired for one month, Davis will incur a training cost of $875, but will incur no additional training cost if the employee is on a two- or three-month contract. Managerial Report Develop a model that can be used to determine the number of temporary employees Davis should hire each month under each contract plan in order to meet the projected needs at a minimum total cost. Include the following items in your report: 1. A schedule that shows the number of temporary employees that Davis should hire each month for each contract option. 2. A summary table that shows the number of temporary employees that Davis should hire under each contract option, the associated contract cost for each option, and the associated training cost for each option. Provide summary totals showing the total number of temporary employees hired, total contract costs, and total training costs. 3. If the cost to train each temporary employee could be reduced to $700 per month, what effect would this change have on the hiring plan? Explain. Discuss the implications that this effect on the hiring plan has for identifying methods for reducing training costs. How much of a reduction in training costs would be required to change the hiring plan based on a training cost of $875 per temporary employee? 4. Suppose that Davis hired 10 full-time employees at the beginning of January in order to satisfy part of the labor requirements over the next six months. If Davis can hire full-time employees for $16.50 per hour, including fringe benefits, what effect would it have on total labor and training costs over the six-month period as compared to hiring only temporary employees? Assume that full-time and temporary employees both work approximately 160 hours per month. Provide a recommendation regarding the decision to hire additional full-time employees.

Health System in Egypt

Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO Contents F O R E W O R D †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 5 1 E X E C U T I V E S U M M A R Y †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 7 2 S O C I O E C O N O M I C G E O P O L I T I C A L M A P P I N G †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 11 2. 1 Socio-cultural Factors †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢ € ¦Ã¢â‚¬ ¦ 1 2. 2 Economy †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 11 2. 3 Geography and Climate †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 12 2. 4 Political/ Administrative Structure †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 12 3 H E A L T H S T A T U S A N D D E M O G R A P H I C S †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 14 3. 1 Health Status Indicators †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 4 3. 2 Demography †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 15 4 H E A L T H S Y S T E M O R G A N I Z A T I O N †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 17 4. 1 Brief History of the Health Care System †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 17 4. 2 Public Health Care System †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 17 4. 3 Private Health Care System†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 20 4. 4Overall Health Care System †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 21 5 G O V E R N A N C E /O V E R S I G H T †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 23 5. 1 Process of Policy, Planning and management †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 23 5. 2 Decentralization: Key characteristics of principal types †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 24 5. 3 Health Information Systems†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢ € ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 27 5. 4 Health Systems Research†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 8 5. 5 Accountability Mechanisms †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 28 6 H E A L T H C A R E F I N A N C E A N D E X P E N D I T U R E †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 29 6. 1 Health Expenditure Data and Trends †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 29 6. 2 Tax-based Financing †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚ ¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 32 6. 3 Insurance †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 33 6. 4Out-of-Pocket Payments †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 40 6. 5 External Sources of Finance †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 41 6. 6 Provider Payment Mechanisms †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 41 7 H U M A N R E S O U R C E S †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 45 7. 1 Human resources availability and creation †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 45 7. 2 Human resources policy and reforms over last 10 years†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 55 8HEALTH SERVICE DELIVERY†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 59 8. 1 Service Delivery Data for Health services †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 59 8. 2 Package of Services for Health Care †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 63 8. 3 Primary Health Care †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 63 8. 4 Non personal Services: Preventive/Promotive Care †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 75 8. 5 Secondary/Tertiary Care †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 7 8. 6 Long-Term Care †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 90 8. 7 Pharmaceuticals †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚ ¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 89 8. 8 Technology †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 100 9 HEALTH SYSTEM REFORMS†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 101 9. 1 Summary of Recent and planned reforms †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 101 10REFERENCES †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 107 11. ANNEXES †¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 11. 1 Ministry of Health and Population Organogram†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 1 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO List of Tables Table 2. 1 Socio-cultural indicators Table 2. 2 Economic Indicators Table 2. 3 Major Imports and Exports Table 3. 1 Indicators of Health status Table 3. 2 Indicators of Health status by Gender and by urban rural 2006Table 3. 3 Top 10 causes of Mortality Table 3. 4 Demographic indicators Table 3. 5 Demographic indicators by Gender and Urban rural Table 6. 1 Health Expenditure Table 6. 2 Sources of finance, by percent Table 6. 3 Health Expenditures by Category Table 6. 3. 1. Health care financing i n Egypt: coverage, eligibility and benefits Table 6. 4 Population coverage by source Table 6. 4. 1 Distribution of HIO beneficiaries by law (1995–2002) Table 6. 4. 2 Comparison between 2002 and 1995 estimates Table 6. 4. 3 Comparative expenditures and subsidies from MOF to hospital services, financial year 2004/2005Table 6. 4. 4 Performance Indicators Table 7. 1 Health care personnel Table 7. 1. 1 Staff registered with syndicates Table 7. 1. 2 Comparison of staff registered and in post in MOHP, December 2005 Table 7. 1. 3 Staff registered and in post in MOHP plus percentage increase in difference over 20 years Table 7. 1. 4 Physicians and nurses by health sector (%) Table 7. 1. 5 Geographical distribution of MOHP physicians and nurses Table 7. 1. 6 Distribution of physicians and nurses by governorate per 100,000 population (2005) Table 7. 2 Human Resource Training Institutions for Health Table 8. 1Service Delivery Data and Trends Table 8. 1. 1 Improvement in hospital based se rvices (1996–2005) Table 8. 1. 2 Distribution of health facilities across Egypt (2006) Table 8. 1. 3 Distribution of health care workers in Egypt (2006) Table 8. 1. 4 Comparison of specialists (2005) Table 8. 1. 5 Comparison of specialists (2005) Table 8. 1. 6 Comparison of MOHP and HIO registered and in post personnel2005 Table 8. 1. 7 Distribution of physicians with private clinics by number of jobs (%) 2 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO Table 8. 1. 8 Governorates distribution according to phasesTable 8. 1. 9 Basic preventive and promotional public health services Table 8. 2 Inpatient use and performance Table 8. 2. 1 National distribution of inpatient beds by type of facility (2005) Table 8. 2. 2 Change in hospital beds by type of provider (1991, 1997, 2001) Table 8. 2. 3 MOHP strategy (1997, 2001, 2017) Table 8. 2. 4 Distribution of physicians among some service providers (2002) Table 8. 2. 5 Bed distribution by health provider in go vernorates Table 8. 2. 6 Beds/population by governorate and type of provider (2005) Table 8. 2. 7 Private sector providers (2005) Table 8. 2. 8Private sector services (2002) Table 8. 7 expenditure by type of provider and ownership (2005) 3 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO List of Figures Figure 1 Uses of health resources, by categories of providers Figure 2 Sources of revenues for the health sector, 1995 Figure 3 Distribution of HIO beneficiaries by law (1995–2002) Figure 4 Distribution of physicians and nurses by governorate per 100,000 population (2001) Figure 5 Beds per populations in governorates Figure 6 Growth trends in the pharmaceutical market Figure 7 Expected value of the market size in 2010Figure 8 Trend in drug consumption as expenditure per capita Figure 9 Drug expenditure in private and governmental sector Figure 10 Distribution of drug consumption by therapeutic category (2001–2002) 4 Health Systems Profile- Egypt R egional Health Systems Observatory- EMRO F OREWORD Health systems are undergoing rapid change and the requirements for conforming to the new challenges of changing demographics, disease patterns, emerging and re emerging diseases coupled with rising costs of health care delivery have forced a comprehensive review of health systems and their functioning.As the countries examine their health systems in greater depth to adjust to new demands, the number and complexities of problems identified increases. Some health systems fail to provide the essential services and some are creaking under the strain of inefficient provision of services. A number of issues including governance in health, financing of health care, human resource imbalances, access and quality of health services, along with the impacts of reforms in other areas of the economies significantly affect the ability of health systems to deliver.Decision-makers at all levels need to appraise the variation in health system perfor mance, identify factors that influence it and articulate policies that will achieve better results in a variety of settings. Meaningful, comparable information on health system performance, and on key factors that explain performance variation, can strengthen the scientific foundations of health policy at national, regional and international levels.Comparison of performance across countries and over time can provide important insights into policies that improve performance and those that do not. The WHO regional office for Eastern Mediterranean has taken an initiative to develop a Regional Health Systems Observatory, whose main purpose is to contribute to the improvement of health system performance and outcomes in the countries of the EM region, in terms of better health, fair financing and responsiveness of health systems.This will be achieved through the following closely inter-related functions: (i) Descriptive function that provides for an easily accessible database, that is co nstantly updated; (ii) Analytical function that draws lessons from success and failures and that can assist policy makers in the formulation of strategies; (iii) Prescriptive function that brings forward recommendations to policy makers; (iv) Monitoring function that focuses on aspects that can be improved; and (v) Capacity building function that aims to develop partnerships and share knowledge across the region.One of the principal instruments for achieving the above objective is the development of health system profile of each of the member states. The EMRO Health Systems Profiles are country-based reports that provide a description and analysis of the health system and of reform initiatives in the respective countries. The profiles seek to provide comparative information to support policy-makers and analysts in the development of health systems in EMRO.The profiles can be used to learn about various approaches to the organization, financing and delivery of health services; descri be the process, content, and implementation of health care reform programs; highlight challenges and areas that require more in-depth analysis; and provide a tool for the dissemination of information on health systems and the exchange of experiences of reform strategies between policymakers and analysts in different countries.These profiles have been produced by country public health experts in collaboration with the Division of Health Systems & Services Development, WHO, EMRO based on standardized templates, comprehensive guidelines and a glossary of terms developed to help compile the profiles. A real challenge in the development of these health system profiles has been the wide variation in the availability of data on all aspects of health systems. The profiles are based on the most authentic sources of information available, which have been cited for ease of reference. For maintaining consistency and comparability in the sources of 5Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO information, efforts have been made to use as a first source, the information published and available from a national source such as Ministries of Health, Finance, Labor, Welfare; National Statistics Organizations or reports of national surveys. In case information is not available from these sources then unpublished information from official sources or information published in unofficial sources are used. As a last resort, country-specific information published by international agencies and research papers published in international and local journals are used.Since health systems are dynamic and ever changing, any additional information is welcome, which after proper verification, can be put up on the website of the Regional Observatory as this is an ongoing initiative and these profiles will be updated on regular intervals. The profiles along with summaries, template, guidelines and glossary of terms are available on the EMRO HSO website at www. who. int . healthobservatory It is hoped the member states, international agencies, academia and other stakeholders would use the information available in these profiles and actively participate to make this initiative a success.I would like to acknowledge the efforts undertaken by the Division of Health Systems and Services Development to help countries of the region in better analyzing health system performance and in improving it. Regional Director Eastern Mediterranean Region World Health Organization 6 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO 1 E XECUTIVE S UMMARY Egypt is going through a demographic and epidemiological transition that is affecting both the size and health status of the population. The population growth rate has fluctuated from a low of 1. 92% a year during 1966–1967, to 2. 5% annually during 1976–1986, later declining to 2% a year during 1980–1993 and 2. 1% annually in 2001. Changes in fertility and mortality rates ha ve been the major source of population growth in Egypt. The population pyramid has a wide base with children aged under 15 representing 37% of the population, reflecting relatively high fertility in recent years. The proportion of children aged under 10 years is smaller than the proportion aged 10–14 years. The rate decreased from 80 in 1988 to 69 in 2000, so the proportion of productive group aged 15–64 years has increased.The average age of the population has risen, with a life expectancy from birth of 65. 5 years for males in 1996 to 69. 2 years in 2006. It is higher for women than for men (69. 2 and 73. 6 years, respectively). Egypt is a lower-middle-income country with a per capita gross national product (GNP) that doubled between the years 1993 and 1999, from US $600 to $1200 (DHS, 2000). The Egyptian economy has witnessed a turnaround in growth performance following a period of economic slow-down that started in 1986.The adoption of the open door policy in 1975 afforded the Egyptian economy a decade of rapid economic growth, supported by large inflows of foreign assistance, workers’ remittances, and oil and tourism revenues. The drop in oil prices in 1986 signaled the end of a decade of economic boost, underscoring the volatility of Egypt’s key revenues sources and the constraints of an inward-oriented growth strategy. With the success of the stabilization program in achieving its objectives, Egypt has been successful in reversing the slow growth rates that characterized the period 1991–1995.Real GDP grew annually at an average of 3. 8% during 1993–1996 and at an average of 6% during 1996–1998. Inflation has been brought down from a peak of 21% in 1992 to 7% in 1996 and 3. 6% by 2000 (UNDP, 2000). While public expenditure on health in terms of budget share appears to be low in Egypt, overall spending at 3. 7% of GDP is also low, when compared to other comparable income countries. The Ministry of Health an d Population (MOHP) budget, as part of the entire Government budget, increased from 2. 2% in 1995/1996 to 3. % in 2000/2001 and the MOHP expenditure per capita increased from LE26. 8 in 1996 to LE56. 7 in 2001. The health financing system in Egypt today manifests significant systemic inefficiencies and inequities that severely limit the effectiveness of the health system as a whole. Any attempts to expand the scope of services or increase the revenues and expenditures on health care without first addressing these systemic bottlenecks in the health financing system will result in further exacerbating the inefficiencies and inequities in the system.The existing system of health financing mechanisms in place today, whether it is through the general revenues Ministry of Finance or the Health Insurance Organization system or through private spending, establishes a regressive pattern of resource mobilization and resource allocation. Inequities are evident across many dimensions, in terms of income levels, gender, geographical distribution (rural and urban, and by governorate levels), and health outcomes. 7 Health Systems Profile- Egypt Regional Health Systems Observatory- EMROThe coverage of the Egyptian population with the National Health Insurance scheme is increasing through the addition of new population groups under the umbrella of social health insurance, for example school children and newborn children. In the year 1980, the coverage was 4% of the total population, and it doubled in 1990. In the year 1995, it reached 36% and increased over the last ten years to 45%. Out of pocket spending has been rising over past decade and currently stands at 62%. HIO does not reach 80% of the private sector workforce.Highest governmental healthcare spend is proportionately in lowest income quintile. The 1952 Constitution pronounced free medical care as a basic right for all Egyptians. The Government has been the sole provider and financier of all primary/preventive and mos t inpatient curative care in Egypt. However, over the past two decades governmental budgetary constraints have resulted in relatively stagnant health expenditures. The structural adjustment program has also reduced the government's resource position vis-a-vis allocation for social services sectors in general, and health services in particular.The Egyptian health system has a pluralistic nature with a wide range of health care providers competing and complementing each other, allowing clients freedom of choice when seeking care according to their needs and ability to pay. However, the Government is committed to providing health care to poor and unprivileged population groups. Parallel to, and related to, its demographic transition, Egypt is currently facing an epidemiological transition that is characterized by:  ¦ Reduced mortality rates among infants and children from diarrhea, immunization-preventable diseases and respiratory infections. Rising prevalence of risk factors such as obesity, smoking and hypertension, responsible for chronic diseases.  ¦ A changing socioeconomic environment leading to different diets, increased industrialization, and increased motor vehicle traffic accidents. The distribution of the burden of diseases has changed from a predominance of infectious and parasitic diseases to a different mortality pattern whereby cardiovascular diseases are currently the leading cause of mortality (45% in 1991, compared to 12% in 1970 and 6. 3% in 2001).Egypt is therefore affected by a dual burden of disease, thus associating the morbidity and mortality patterns of developing countries with those induced by modernization. As a result of the demographic and epidemiological transition, the major health and population challenges are: 1. Population growth 2. Burden of endemic and infectious diseases 3. Maternal, infant and childhood mortality 4. Burden of chronic diseases, renal failure and cancer 5. Injuries and accidents 6. Smoking, other addiction s, and their complications 7. Disabilities and congenital anomalies 8 Health Systems Profile- EgyptRegional Health Systems Observatory- EMRO 8. Human resources (capabilities, skills, knowledge, allocation, salaries and incentives) 9. Infrastructure (buildings, equipment, furniture and maintenance) 10. Basic public services (housing, unplanned areas and slums, potable water, sewage disposal). The health system has significant strengths and weaknesses resulting from its continuing evolution. The performance of the sector with respect to health services, human resources, physical infrastructure, financing, organization and management, and the pharmaceutical sector will be assessed in following eight sections.Ministry of Health and Population has decided on a reform program based on the strengths of the current system, while at the same time rectifying its weaknesses. The Government of Egypt has embarked on a major restructuring of the health sector. This reform was deemed necessary bec ause the MOHP and its main partners had identified fragmentation in the delivery of health services, excessive reliance specialist care and low primary care service quality as the main constraints to achieving universal coverage.The Egyptian Health Sector Reform Program (HSRP) was officially launched in 1997. The World Bank (WB) started its contribution by designing the Master Plan for Montazah Health District in Alexandria Governorate, in May 1998. By the following year, in 1999, United States Agency for International Development (USAID) was the first donor to begin field-level operations, while the European Commission (EC) joined the HSRP in November 1999. The African Development Bank (ADB) initiated its work through designing Master Plans for three health districts in June 2003.The most recent partner at HSRP is the Austrian Government, which directs its participation to improving the district hospitals as part of health district approach. The overall aim of the HSRP is twofold. Firstly to introduce a quality basic package of primary health care services, contribute to the establishment of a decentralized (district) service system and improve the availability and use of health services. Secondly to introduce institutional structural reform based on the concept of splitting purchasing/providing and the regulatory functions of the Ministry of Health and Population.Coverage would be provided by a National Social Insurance System. The ultimate goal of health sector reform initiatives is to improve the health status of the population, including reductions in infant, under-five, maternal mortality rates and population growth rates and the burden of infectious disease. The HSRP has meanwhile initiated a new primary care strategy in accredited facilities, known as Family Health Units (FHU’s). Facilities are being contracted by a purchasing agency -the Family Health Fund (FHF) – to provide services to the population.It is envisaged that the HSRP will g radually extend its scope to the secondary level by establishing â€Å"District Provider Organizations†. The FHF will consequently develop in the direction of a full purchasing agency of services from the public and private sector. The newly introduced Family Health Model (FHM) constitutes one of the cornerstones of the reform program. It brings high quality services to the patient and will integrate most of the vertical programs into the Basic Benefit Package of services.To date the FHM has been introduced in 817 health facilities, which present 18% of the total public primary health care facilities. HSRP has an ambitious five years plan, by the end of year 2010, to cover the entire public primary health care facilities with the Family Health Model. The Egyptian Health Sector Reform Program went through several stages, including the preparatory stage from 1994 to 1996. During this stage, several valuable studies were conducted and used later to develop the â€Å"Strategies for Health Sector Change† study. 9 Health Systems Profile- Egypt Regional Health Systems Observatory- EMROThis was an analytical report on the Egyptian health sector. Designing the health Master Plans stage for the three pilot governorates followed this. Experimenting stage of the Family Health Model took place in one of the primary health care facilities, which took about two years to implement. This was followed by piloting stage of the Model in three governorates followed by another two governorates and included activities such as: Building staff pattern, designing the contents of the Basic Benefits Package and Essential Drug List, and other components of the Family Health Model.The Program has shifted its strategy in March 2003 from health facility oriented approach to the district approach, which was called the District Provider Organization. As of 2005, the HSRP has gradually expanded its operations to ten additional governorates, pushing the total number of involved gov ernorates to 15, which presents more than 50% of the country coverage.The Health Reform Program has three main components; (1) Service component as seen in the Family Health Mode, (2) Mandate role and functions of the Ministry of Health and Population, and (3) Introduction of a sustainable universal health insurance system. It is envisaged that all three goals and objectives can be achieved in an Integrated District Health System model. All the necessary elements are available and the Sector for Technical Support and Projects (STSP) is in developing process for an integrated health system based on a district that is evaluated internally and externally and be replicable.The Integrated District Health System (IDHS) is the district that covers the following criteria; (1) fully implements the District Provider Organization, (2) has financial sustainability, (3) separates providing from financing of health services, (4) implements the content of the district health coverage plan, (5) pro vides basic benefits and secondary care packages through public, private and NGO, (6) and applies quarterly measures for the achievements of HSRP’s five objectives. 10 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO 2 S OCIO E CONOMIC G EOPOLITICAL M APPING 2. Socio-cultural Factors Table 2-1 Socio-cultural indicators Indicators 1990 1995 2000 2004 – – – – Literacy Total: 48. 8 (92) 57. 7 (98) 67. 4 (02) 69. 4 02) Female Literacy to total literacy: 35. 3 (92) 65. 9 (98) 63. 4 (01) 67. 4 02) Women % of Workforce 29. 2(93) 18. 0(96) 18. 5(01) 21. 8(02) Primary School enrollment 98. 0(92) 98. 5(98) 91. 7(01) 99. 2(02) % Female Primary school pupils 80. 4(92) 84. 5(98) 93. 2 107. 1(02) %Urban Population 44. 0(86) 43. 0(96) 42. 8 57. 6 Human Development Index: Source: NICHP Report, Ministry of Health and Population, 2005. Egypt Human Development Report, 1995, 1999, 2003, 2004. . 2 Economy Key economic trends, policies and reforms Lack of substantial progress on economic reform since the mid 1990s has limited foreign direct investment in Egypt and kept annual GDP growth in the range of 2%-3% in 200103. However, in 2004 Egypt implemented several measures to boost foreign direct investment. In September 2004, Egypt pushed through custom reforms, proposed income and corporate tax reforms, reduced energy subsidies, and privatized several enterprises. The budget deficit rose to an estimated 8% of GDP in 2004 compared to 6. 1% of GDP the previous year, in part as a result of these reforms.Monetary pressures on an overvalued Egyptian pound led the government to float the currency in January 2003, leading to a sharp drop in its value and consequent inflationary pressure. In 2004, the Central Bank implemented measures to improve currency liquidity. Egypt reached record tourism levels, despite the Taba and Nuweiba bombings in September 2004. The development of an export market for natural gas is a bright spot for futu re growth prospects, but improvement in the capital-intensive hydrocarbons sector does little to reduce Egypt's persistent unemploymentTable 2-2 Economic Indicators Indicators 1990 GNI per Capita (Atlas method) current US$ 2000 2004 NA GNI per capita (PPP) Current International Real GDP Growth (%) 1995 1. 9 (91-92) 5 (95-96) 3. 4 (00-01) 4 (03-04) 11 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO Real GDP per Capita ($) (91- 92) 769 1,285 1,036 9. 2 (91-92) Unemployment % (estimates) 1,143 9. 6 (91-92) 9. 0 (01) 10. 2 (03) Source: Egypt Human Development Report, 2003. Ministry of Foreign Trade, Egypt, Monthly Economic Digest, February 2005. Table 2-3 Major Imports and Exports Major Exports:Crude oil and petroleum products, cotton, textiles, metal products and chemicals. Major Imports Machinery and equipment, foodstuffs, chemicals, wood products and fuels. 2. 3 Geography and Climate Map of Egypt Arab Republic of Egypt is located at the northern Africa, border ing the Mediterranean Sea, between Libya and the Gaza Strip, and the Red Sea north of Sudan, and includes the Asian Sinai Peninsula. Total area is 1,001,450 sq km (land: 995,450 sq km, water: 6,000 sq km). A total of 2,665 km border countries: Gaza Strip 11 km, Israel 266 km, Libya 1,115 km, Sudan 1,273 km.Coastline is 2,450 km. The climate is desert; hot, dry summers with moderate winters. Natural resources; petroleum, natural gas, iron ore, phosphates, manganese, limestone, gypsum, talc, asbestos, lead and zinc. 2. 4 Political/ Administrative Structure The chief of state is the President, head of government is the Prime Minister. Bicameral system consists of the People's Assembly or Majlis al-Sha'b (454 seats; 444 elected by popular vote, 10 appointed by the president; members serve five-year terms) and the 12 Health Systems Profile- Egypt Regional Health Systems Observatory- EMROAdvisory Council or Majlis al-Shura – which functions only in a consultative role (264 seats; 1 76 elected by popular vote, 88 appointed by the president; members serve sixyear terms; mid-term elections for half the members). People's Assembly election is in three phase voting, last held 19 October, 29 October, 8 November 2000 (next to be held October-November 2005); Advisory Council – last held May-June 2004. The Shoura Council was established constitutionally in 1980. The Shoura Council is mainly a â€Å"think-tank† to advise the Government on national policies.A committee of the Shoura Council on Health, Population and Environment examines issues relevant to these areas prior to their discussion in the Shoura Council’s plenary sessions. Although it does not have a direct legislative role, laws impacting significantly on broad government policy are required to be discussed by the Shoura Council before being passed to the People’s Assembly Laws, before going to the plenary sessions of Parliament, are referred for preliminary study to the relevant c ommittees. These specific committees are currently 22 in number; an example is the Committee for Health and Environment.This committee, consisting solely of Members of Parliament, often invites experts to its meetings for the purpose of obtaining a more comprehensive view of topics under study. The committee influences health policy changes planned for the future 13 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO 3 H EALTH STATUS AND DEMOGRAPHICS 3. 1 Health Status Indicators Table 3. 1 Health Status Indicators 1990-2005 Indicators 1990 1995 2000 2004 2005 65. 3 (92) 66. 9 (98) 67. 1 (01) 70. 1 (02) – – – – – – 63 66 24. 5 22. 4 20. 5 – 3. 9 (97) 33. 8 28. 6 26. 2 174 (92) 96 (98) 84 (01) 68 (02) 3 – – – – – 26 29. 8 28. 7 NA 17. 6 Prevalence of wasting 3. 4 4. 6 Source: NICHP Report, Ministry of Health and Population,2005. 2. 5 NA 3. 9 Life Expectancy at Birth HALE Infant Mor tality Rate Probability of dying before 5th birthday/1000 Maternal Mortality ratio Percent of Normal birth weight babies Prevalence of stunting Egypt Human Development Report,2004 Table 3-2 Indicators of Health Status by Gender and by urban rural 2006 Indicators Urban Rural Male Female Life expectancy at birth – – 69. 2 73. 6 HALE – – – – Infant Mortality Rate 27. 7 15. 3 – – Probability of dying before 5th birthday/1000 3. 9 20. 6 27. 6 24. 7 Maternal Mortality Ratio – – – – Percent of Normal Birth Weight Babies – – – – – – – Prevalence of stunning/wasting Source: NICHP Report, Ministry of Health and Population,2005. WHO Web Site,August 2005 14 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO Table 3-3 Top 10 causes of Mortality Mortality Y2005 Rank Intra-cerebral hemorrhage 21,473 Essential (primary) hypertension 20,354 Fibrosi s and cirrhosis of liver 18,434 Hepatic failure, not elsewhere classified 11,353 Atherosclerosis 10,800 Arterial embolism and thrombosis 8,233 Elevated blood glucose level ,000 Acute myocardial infarction 6,645 Cerebral infarction 6,334 Others 320,011 Total 431,637 Source: NICHP Report, Ministry of Health and Population, 2005. The Burden of Disease and Injury in Egypt (Mortality and Morbidity). 2004. 3. 2 Demography Demographic patterns and trends Total population of Arab Republic of Egypt is 77,505,756 (July 2005 est. ). The age distribution is 0-14 years presents 33% (male 13,106,043/female 12,483,899), 15-64 years presents 62. 6% (male 24,531,266/female 23,972,216), 65 years and over presents 4. 4% (male 1,457,097/ female 1,955,235) (2005 est. ).Net migration rate is -0. 22 migrant(s)/1,000 population (2005 est. ). Sex ratio: at birth 1. 05 male(s)/female, under 15 years it is 1. 05 male(s)/ female, 15-64 years it is 1. 02 male(s)/female, 65 years and over it is 0. 74 male(s)/fem ale, for the total population it is 1. 02 male(s)/female (2005 est. ) The median age is 23. 68 years, 23. 31 years for males and 24. 05 years for females (2005 est. ). Eastern Hamitic stock (Egyptians and Bedouins) presents 99%, Greek, Nubian, Armenian, other European (primarily Italian and French) presents 1%. Muslim (mostly Sunni) 94%, Coptic Christian and other 6%.Arabic is the official language, English and French are widely understood by educated classes. 57. 7% of the population (age 15 and over) can read and write. Male presents 68. 3% and female presents female: 46. 9% (2003 est. ). 15 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO Table 3-4 Demographic Indicators Indicators 1990 1995 2000 2004 2005 – 27. 9 1997 27. 9 27. 0 (03) 25. 8 (05) – 6. 4 1997 6. 3 6. 4 (03) 6. 4 (05) 2. 4 (60. 86) 2. 08 (86-96) 2. 3 (96-02) 2. 0 (03) 19. 1 (05) 74. 7 1992 69. 7 1998 69. 9 (01) 69. 9 (02) – – 37. 8 1996 38. 8 (03) 37. 4 – 3. 90 1992