Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Community Medicine

Egypt health system has challenges related to efficiency and effectiveness that contributed to plateau in maternal, children and family planning impact indicators. Despite efforts of MOHP to strengthen capacity of PHC through referral services, mobile teams and clinical supervisors; sustainability of integrated services between PHC and secondary level of health care is perplexing issue. Goal: Improving health of rural population through access to specialists services in rural PHC units. Objectives: Explore legal and regulatory environment for the policy of specialists{u2019} visits to rural PHC units, develop strategy of scheduled visits of district hospital Gynecologist to target RHU and evaluate impact of gynecologists{u2019} visits to PHC unit. Methods: Settings MOHP/HQ, Giza health directorate, Elbadrashin Health district and Hospital, and Met-Rahinah rural health unit. Study design and sampling: The study included qualitative (9 In-depth interview and 4 FGDs) and quantitative research (quality checklist, services statistics for FP, and structured interview with clients(pre n=210 and post n=209). The study was interventional operations research using separate sample pre-test post-test design. Results: Legal and regulatory environment for specialist{u2019}s visits policy indicated that health system in Egypt is fragmented at central, directorate, district and facility level. There was increase in efficiency by 12% in six months of intervention compared to previous six months. Clients{u2019} satisfaction increased from 27% (before) to 73% after intervention (p=0.000 OR=7.5 CI=4.9-11.6). Conclusion: Specialists{u2019} scheduled visits to PHC facilities increases the efficiency and clients{u2019} satisfaction

Issued also as CD