Four years since the adoption of the landmark Egyptian Universal Health Insurance (UHI) law, work on improving access to health services goes ahead continuously in Egypt, while the major overhaul brought the separation of financing from the provision of health services. This was reflected in the establishment of three new health bodies: Universal Health Insurance Authority that procures health services; General Authority of Healthcare that provides services; and General Authority for Healthcare Accreditation and Regulation, which oversees accreditation and regulation. Realizing UHC is a national priority and a main target of Sustainable Development Goal 3, “Good Health and Well-being”.

WHO supports the implementation the UHC in Egypt and achieving health security to enable access for health for all by all. To do so, WHO depends on fundamental elements of health systems including health information systems.

Challenges in Egypt’s health sector

While major leaps have been made in Egypt’s health sector especially by the Law, it is yet fragmented in different categories of health service providers, diverse operating procedures and imbalances in staffing and a lack of shared clinical standards. Which can make it challenging to define a set of services, also known as Services Benefits Package (SBP), that can be financed and provided universally to every Egyptian.  This has implications on the degree of cost efficiency of quality health services.

WHO’s role

Thus, in a bid to provide a common structure and terminology for the description of health interventions and specify indicators for monitoring implementation of UHC which is in line with GPW 13, WHO has been working to support national authorities to adopt a Service Based (SBP) according to International Classifications of Health Interventions (ICHI), a common tool for reporting and analyzing health interventions, to incorporate them into national classifications. The move came after ICHI was designated by MoHP as a coding system.

Why is ICHI important?

ICHI belongs to the family of WHO international classifications of coding which allow exchange of data. ICHI is a basic requirement of information systems of health care delivery in general and universal health insurance in particular. It works as a basis for patient management, clinical audit, performance monitoring, costing, pricing, claim management, and research and studies which are all integral components needed for UHI and UHC. Organizing an SBP could bring consistency and structure to health services and standardizing of the system's inputs in line with international standards which in turn makes them more accessible and of better quality.

What has been done?

WHO three levels worked with Egyptian clinical consultants. WHO supported the process working initially on the already existing Standard Procedures/Services package from MOHP by conducting a wide range of orientations, capacity building workshops. WHO ensured full engagement and coordination of key relevant stakeholders including members of the UHI Service Package Committee, Senior Ministry policy makers at Ministry of Health and Population (MOHP), consultants and Professors of different medical specialties and physicians from the ministry who have experience in coding and medical terminology.

The activity started in 2019 with intense review and adjustment of terminology, language refinement, amendment and coding that continued over 2 years to be more in line with ICHI that culminated with summing up and dissemination workshop with all interested parties that included representative of University Hospitals and private sector beside Ministry of Health and Population.

What were the outcomes?

As a result, lists of essential clinical developed interventions in all  specialties  is ready to be transformed to the electronic medical records at the health facilities in the areas of  billing, clinical management, and claims management, that  are crucial components for information exchange of various insurance processes among providers and insurance entities, in  a total of 1712 hours; clinical experts (1493 hours) and workshops (108 hours), meetings with UHIA (39 hours) and lists revision (72 hours). Gender balance was taken into consideration throughout the whole process.

Additionally, country capacity in data, digitalization and innovation is being strengthened at this stage at the central level through enabling implementation health information system with international standards, developing a new explicit SBP for the new UHI and medical records for both outpatients, inpatients, and ancillary services in PHCs and secondary and tertiary hospitals as well as providing Arabic translation for financial services.

The outcome of all this work is a refined Services Basic Package, which is uniform and up to date with the international standard. The refined SBP improves the quality of medical records of patients in primary, secondary and tertiary health care. And improved electronic medical records help health workers to care for more people and to so in a way that is attuned to individual needs.

What’s next?

MOHP/WHO will scale up the articulation of, and ICHI usage by health care providers through capacity building measures and monitoring the utilization and impact of ICHI use on health outcome.  It will support the health sector to continuously update the Egyptian version of UHI SP using prescription and utilization data, with a requirement for constant review and refinement as new evidence, new technologies, and even new preferences emerge.

In this context, WHO will continue its support of the country’s strategic direction for digital transformation to build “digital Egypt”, which will increase the quality of performance in health services and support the decision-making process towards achieving UHC.

Photo caption: WHO supports the development of service benefit package towards UHC.

Photo credit: WHO