ABSTRACT
<B>Introduction</B><BR>Health Sector Reform Program (HSRP) in Egypt started in 1997 to improve equity, efficiency, quality and sustainability of Egyptian health systems. This study aims to review reports and publications regarding HSRP in Egypt and to analyze its achievements and problems.<BR><B>Methods</B><BR>Documents of international organizations and other relevant agencies, such as reports of health sector reform programs and statistics, were reviewed and analyzed.<BR><B>Results</B><BR>HSRP aimed to improve quality of health services and equality of access, and to establish sustainable health financing mechanisms, while focusing on primary health care. Major components of HSRP were: health service delivery, health financing, and evaluation. It started in five pilot governorates. Based on the Family Health Model (FHM), each family registered to a physician or a health facility, and was provided with essential medical services called Basic Benefits Package (BBP). Family Health Fund (FHF), the newly established financing agency of FHM, provided health staff with incentives from a pooled fund. Against the original plan, FHF could not function as a health insurance fund, and was financially unsustainable. Mechanisms of health facility accreditation and health services performance evaluation with incentives were installed to ensure the quality of health services.In addition, health staff training programs were enhanced, health facilities and equipment in rural areas were improved, and referral systems were strengthened.<BR><B>Conclusions</B><BR>HSRP introduced a family health model for the first time in Egypt in pilot governorates. Focusing basic health service provision, HSRP succeeded to improve equity, efficiency and quality of health services. However, sustainable health insurance mechanisms were not established yet, and involvement of private health service providers were very limited. It is needed to bring in commitment of Egyptian government across the sectors and to develop health systems that secure good quality of health services for all Egyptians.
ABSTRACT
Infertility in developing countries is important but neglected, while the issues of population growth control have been paid much attention. Female infertility rates in African countries were about 30 percent, which were three times higher than those of industrialized countries. It was reported that the most common cause of infertility was tubal dysfunction due to sexually transmitted infections, unhygienic delivery management, and unsafe abortion. The second common causes were male factors, which had been underestimated in developing countries. Thus, women were always blamed and often abused by their husbands and in-laws. Furthermore, infertile couples suffered from social discrimination and economic disadvantages. <br> Infertilities were often treated without appropriate examinations of both husbands and wives. Inexpensive treatments were commonly applied: e.g., treatment of sexually transmitted infections, encouraging timing intercourse, hormonal therapies. Assisted reproductive technology (ART) would be effective in developing countries where main causes of infertility were tubal dysfunction and male factors. ART has been performed in urban areas in some developing countries. However, it is difficult to promote ART in developing countries, because of high costs and lack of sufficient technical and ethical regulations. To decrease the burden of infertility in developing countries, first, both developing and industrialized countries have to recognize the significance of the issue. Then, it is needed to evaluate accurate rates of infertility, causes of infertility, and effectiveness of current treatment, so that the countries could develop prioritized strategies and interventions. <br> Infertility rates could be decreased with relatively low cost through building a system of proper diagnosis and treatment. International assistance might be required to negotiate the drug prices and to establish technical and ethical review mechanisms, which are the prerequisites of promoting ART. It is also important to provide people with knowledge and information regarding infertility, their causes and treatment.