The World Bank assessment of the implementation of the processes of procurement

Fiduciary aspects

59. The World Bank assessment of the implementation of the processes of procurement and financial management with regard to draft the development of health insurance systems in September / September and October / October 2009, respectively.
60. Financial Management. Meetings were held with the General Authority for Health Insurance and the Office of Technical Support to the Ministry of Health staff in order to understand the applicable financial management systems currently planned and to discuss arrangements for the proposed project and approval. The results of this assessment has concluded that the project implementation unit to be established for the purpose of this project will be entrusted with the financial management aspects.
61. Trace the General Authority for Health Insurance “unified accounting system,” the Egyptian in the preparation of its financial statements and, accordingly, the systems are not designed to fit in with the process of special-purpose financial statements required for a project funded by the World Bank prepared. Unit will implement the project the government created and financed the project received financial responsibilities of the evidence, and will follow the financial manager of the project, which will occupy this office – within the PIU team – accounts of the project and prepare reports periodically. And it raises the chief financial officer reports to the Director General of the unity of implementation of the project and director of the Finance Department of the General Authority for Health Insurance. The Ministry of Health has made in the past is implementing a project funded by the World Bank, where the reign of the financial aspects of this project to the financial manager. And it agreed that the World Bank team with the General Authority for Health Insurance to assume financial manager who has worked in this previous project: (a) preparing a draft financial management manual before that date illustrates the perceived and procedures, project controls, based on his previous experience in the health sector reform project, (b) assist unit the project to buy a financial management system and installed before the effective date, where it can be used in the registration of the project transactions and reporting, and (c) to provide support, training and transfer of a week Knowledge in the first year of the life of the project to the new CFO of the project implementation unit. The project will issue interim financial reports half-yearly financial statements and annual special project. The financial statements will be for the project to annual audits performed by an external auditor acceptable to the World Bank, according to internationally accepted standards are subject to revision. And it is committed to the General Authority for Health Insurance to submit the audit report to the World Bank in a period not exceeding six months from the date of closure of the financial year under review. The document is prepared powers and competencies related to the audit and present them to the World Bank for the purpose of adoption. And it will be expanding the scope of this document to include verification of the management and distribution of equipment to be purchased.
62. Procurement. General Authority for Health Insurance did not deal since it was founded in 1964 with any international competitive bidding or with the Procurement Guidelines Manual. World Bank, and the only body in the area of ​​procurement experience on the Egyptian Law on the organization of tenders and auctions 89 and before Law No. 9. In addition, the staff of the Procurement Authority limited experience in procurement procedures and other donor community.
63. considers the degree of risk classification purchases high to the project, especially in the initial stage of its implementation, and that if there was any delay in signing the verification and validation of the proposed company. The evaluation recommends the General Authority for Health Insurance to take the following measures to mitigate the risk of procurement: (1) include the procurement activity as one of the core activities of the responsibility only to the Office of Technical Support to the Ministry of Health until the establishment and implementation unit on a project for the development of health insurance systems project, which will continue this unit this task cooperation closely with the verification and validation company with regard to the technical aspects and contract management. (2) utilize the General Authority for Health Insurance Office of Technical Support also start the contracting process with the verification and validation and termination of the company. (3) Starting in this activity immediately prior purchases under World Bank procedures, knowing that pamphlets specifications and standard conditions of the tenders for the main contract systems package is already setup. (4) availability of government funding for contract verification and authentication (will recover the amount of the loan as soon as it enters into force), in order to facilitate the selection of the verification and validation company at the right time to contribute to the final selection of the package key information systems. It is expected when choosing a verification and validation that the company is working closely with procurement staff unity and implementation of the project within the overall program for health insurance management team.
64. The overall risk of the project in relation to a large procurement is, after the implementation of risk mitigation measures.
D. Social aspects

65. The main activity of the project seeks to develop the health insurance systems to prepare a business model that proved its usefulness for the management of the health insurance system operations in the three governorates in Egypt, so that can then be circulated as a springboard to include all parts of the country. The project’s success does not depend greatly on the technical merits of the system to be developed only but also on the extent of the response of the system to the needs and capacities identified beneficiaries him are yet, as well as the General Authority for Health Insurance and the Ministry of Health’s ability to mobilize committed by a group of institutional support at the time of the the implementation of the change in the provincial table. The beneficiaries understand all of the participants, National Authority new health insurance, and service providers who have contracted this body, and individuals insured. Several key issues may arise during the implementation of the proposed project.
66. IT is considered one of the important aspects of the project design, and so are the management of these systems, there is a need to incorporate the input of service providers in the system (ie applications, claims, cases, etc.). And realizes the General Authority for Health Insurance team wide recognition that there is a wide range of technological capabilities within the service providers group in Egypt, ranging from rural clinics equipped with basic computer to hospitals, which has customized information management systems. Moreover, the claims processing costs recovered under the current health insurance system is almost the whole manual way. Commission staff believes that the system operations and management of the new point of payment will be develop “and interfaces for service providers” take into account explicitly this broad range of technological capabilities for service providers. It will be the development of these interfaces based on the information available to clinics and hospitals systems already developed information in the context of other health and Ministry of investments, supplemented by consultations held with service providers supply company.
67. The broader question here is how the government plans to manage successfully a major reform program at a time when trying to achieve a significant increase in the level of efficiency. The update requires health insurance in Egypt developing new working procedures for social health insurance system, adoption and use by the National Authority for health insurance at the national and provincial levels. The leading public body for health insurance this process, along with the Ministry of Health, but the experience at the international level shows that this kind of effort beset him resistance risks and discouragement of the various groups that have a vested interest in the survival of the case as it is. It seems that the Ministry of Health and the General Authority for Health Insurance well aware of these risks has undertook the strategy of the three axes: an open dialogue with the public, and consultations with stakeholders from the provinces and the staff of the General Authority for Health Insurance and service providers, the gradual approach to the dissemination of the reforms. It will be the National Health Insurance Authority Board of Directors also representatives from key stakeholder groups, including service providers involved in it, and its structure is similar to a large current structure of the Council of the General Authority for Health Insurance extent. It will develop the health insurance system works project in the context of these broader change management strategy and the broader benefits from the advantage of building on the supervision structures, which established the National Corporation for health insurance themselves, and the general reform of the system of social health insurance efforts.
68. One of the other related to the new system of social health insurance important issues in order to expand coverage to the poor and direct financial support for payment of contributions for the poor, who are unable for the services they receive. The Ministry of Finance is committed to the payment of the funds required to cover the eligible beneficiaries who are unable to afford subscription fees and other service expenses of the new system. The Ministry of Health has agreed to measure the actual level of income and other social measures targeting provided by the Ministry of Social Solidarity test. Have been targeted measure the actual income level of the provinces of Alexandria and Menoufia test in the context of health sector reform program, it was to draw lessons which will be used for further improvements to the targeting approach in the future.
E. the environment

69. The Environmental Category for the project is a Category C where they will have only minor effects or adverse environmental effects will not leave at all.

the new law of social health insurance

Moreover, the new law of social health insurance and will provide expected to be submitted to parliament at the end of the 2009 financial, legal and structural framework necessary for each of the system point of payment. It will also have the desired revenue collection principles, civil identification, and public mechanisms to package the benefits of health insurance services included in the program in the future.
50. puts social health insurance scheme cornerstone to achieve long-term system of social health insurance sustainability, through the strengthening of the necessary management capacity and dimensions of this third payment. And efforts will be directed in particular towards the tightening of stringent budget management and maximize the use and control of the levels of use of services. Due to the commissioning of new point of payment compared to a much broader tasks of the General Authority for Health Insurance existing in terms of scope and quality of care to be purchased, the need to develop other capabilities will be crucial.
51. adopt sustainable models and systems of work that are developed through the project after its completion – on a number of factors: the current success of the project and the extent of the realization of this success; and the continuation of the General Authority for Health Insurance management commitment (and its successor body) and a Ministry of Health Management; and the process of the transfer of skills to the bodies Egyptian; and clarity necessary funding for the ongoing maintenance and abide by the process. The Intergovernmental Panel invested tremendous effort in the review of the project scope and design, as well as the technical requirements for system management point of payment and who want to develop and piloted through the project, and circulated throughout the country. Indicates preset management and follow-up document for the project on the part of high-level Ministry of Health figures, as well as the steering committee for the system of health insurance and social guidelines – a strong ownership of the project and a willingness to take the necessary steps in order to reduce the inevitable risks associated with long-term projects on the management of health insurance information systems .
E. Risk critical potential and controversial aspects

52. involve all projects that support the development of health insurance systems based on information technology risk, and this project is no exception, as the degree of overall risk a big rating for the proposed project. It was built for preventive action mechanisms within the project itself, and that will reduce the risk to acceptable levels.

Risk Factors

Description Risk
The degree of risk rating
Mitigation measures
The degree of residual risk rating
First. Sector and the policies and institutions of governance
Political commitment there is a delay in the adoption of the new social health insurance system of law. As there is a general support for reform by the President of the Arab Republic of Egypt and the steering committee of high-level system of social health insurance is headed by the Prime Minister. Both the Minister of Finance and Minister of Health has worked in close cooperation on the formulation of the provisions of this law, is expected to be submitted to parliament at the end of 2009. In addition, the Ministry of Health has conducted an active and frank public discussions on this subject within the framework of consultation with stakeholders process. M
In contrast, government pressure leads to accelerate the implementation of reforms to overcome the key elements of the reform process. As the Ministry of Health has made a tremendous effort to develop a strategy to manage change, and is now in the process of implementation. The government will continue the difference (from the Ministries of Health and Finance) and the World Bank in close and continuous dialogue on the reform program. The Steering Committee will be a high-level health insurance system and social progress in the reform review process in general, addressing key strategic bottlenecks, and working on modifying strategy whenever the need arises. M
Change management to change the choice of the government body which will serve as the point of payment may hinder the process G was created new point of payment already in the first pilot project in Suez, supported by effective leadership and support from the General Authority for Health Insurance. This is expected to continue transitional model in each province. This approach aims to reduce the uncertainty and the unknown possibilities at a time when reforms are circulated all over the country. K
Sector wages result in a big difference in wages between the public and private sectors to increase the turnover of staff in critical jobs. As in the public sector, the General Authority for Health Insurance enjoys a positive difference wages. In spite of this, being as well as the preparation of training plans anticipate the possibility of high staff turnover. M
The financing of the health insurance system and social non-availability of the necessary funding for the dissemination of the system in all parts of the country as has been clearly defined funding required under the leadership of the Ministry of Finance through the process of preparing actuarial models. M
Beneficiaries providers relations services providers information systems services are not developed enough a development p General Authority for Health Insurance envisages the development of interfaces and service providers with capabilities to service providers systems group. In addition, you can take advantage of the funding for the project to develop the health insurance systems in the investments in this area, in the event that it is required at a later date. There is a suggestion that the point of payment staff are working in the service providers to help enterprises in electronic transactions. K
Second. Private operation risks
Technical design project scope is clearly defined as the exact wording of the document, powers and terms of reference in order to purchase information system M.

complement the clinical information system in hospitals

• it should also complement the clinical information system in hospitals in an orderly fashion so as to cover the benefits package of health services provided by hospitals. It is clear, even now, through indicators that the standard package of benefits (services) Stmathl closely approved the package in the General Authority for Health Insurance, which is quite a comprehensive package. Targeted clinical information system designed to provide referral unit to support the audit function (gate-keeping) in the form of family health, will be the Ministry of Health and the General Authority for health insurance you need to develop and test referral protocols to be adopted in the new social health insurance system.
39. Lessons learned from the experiences and international experiences. One of the important lessons to be learned here from international experience is that it is difficult for the projects ambitious reform of health insurance systems that include components of information systems to comply with the timetable and budget agreed upon. In many cases that have been reviewed, some problems have arisen as a result of the widening scope of the project, which probably was not allowed to give sufficient attention to component information systems. One of the key lessons that have been applied in the development of the proposed health insurance systems in a project to determine the scope of the project unnecessary specifically very well and to be realistic, with a primary focus on the work system and technical requirements. Supervision of information technology and management of contractors as employees of their affairs is of paramount importance in ensuring the success of this project. It is likely to result in inadequate supervision of contractors to project failure. The lesson of this fundamental pillar for the inclusion of the project on the company assume the function of verification and validation in the framework of its core activities. The general level of participation has emerged as Body on Implementation of the concerns in some cases, where the high level of participation is crucial. It is also important to be consulted with a direct interest in all stages of this process, the owners, and that the current regulations to address developed to meet their needs, and that there is a steady flow of tools that will help them in their daily activities (see annex 13).

40. It is noted that there is close cooperation between the General Authority for Health Insurance and the Ministry of Health in Egypt in order to create new social health insurance system. The minister personally oversee the change management effort, which represents Chairman of the General Authority for Health Insurance Administration the right arm and an assistant minister, are currently being implemented strong outreach strategy with respect to various stakeholders. There is also a follow-up of high-level minutes through a steering committee for health and social insurance system headed by the Prime Minister. Finally, it will not be the design of the system requirements and procurement process only after the adoption of the project or the validity of its effective date, which represents one of the main sources of delay in the information systems activities. In the case of Health Insurance Systems Development Project, in charge of Egypt’s authorities have begun their work before the adoption of the project or the validity of its effective date well in advance where he developed the requirements and strong requirements for technical systems, drafted brochures specification standard tenders and conditions, and has already initiated the process of inviting bids. They also expressed their wish to strengthen these pamphlets with advice provided by the Review Group on strengthening the quality of the technical specifications.
E. Alternatives that have been studied and the reasons for rejection
41. The choice of lending tool. The World Bank team look at each of the Development Policy Loan (DPL) and specific-purpose investment loan (SIL). The issue of delegated environment and structures of governance are what led the team to wonder whether it is better project design using DPL or using a specific investment loan purposes. The team acknowledged at the same time that the project was designed using DPL may increase from the perspective of the governance structures of power delegated environment. It was the European Union’s projects to support the budget related to the reform of the government’s health sector program, with a total support budget of 83 million euros, and adopted the segments that support the exchange to achieve a phased completion points (starting points) has been coordinating closely and carefully with the World Bank team. Hence it is clear that the proposed project is in fact may actually preceded and supported by two mechanisms Chaphan development policy loans. Therefore, this proposed loan (investment loan specified purposes) will provide supplemental assistance focused and specific in the field of a high degree of technical complexity.
42. unification of software and hardware in a single contract in exchange for independent contracts. One of the key issues in these complex systems based on the use of technology to ensure the development of computer software and equipment to ensure that the material expected to be implemented by actually compatible with each other. For there to be a clear line of responsibility to ensure this compatibility, the government took into account the inclusion of the technical specifications of the equipment in the contract to develop the same systems option. It has been shown, after the various effects of the budget, it is preferable to separate the applications software package, training and equipment for the material, and will be this way the purchase of equipment – which typically go through cycles of short innovation – and delivered only after testing the software applications and adoption of production.
Third: execution
a thousand. Partnership Arrangement

43. United States Agency for International Development is working, and is a partner of the Ministry of Health for a long time to end its support for the health sector gradually, with reduced support for the process of reform of the health system significantly. But at the same time it will play an active role in the issue-specific areas as programs targeted capacity to train health sector building managers, especially at the level of service providers (hospitals).
B. Institutional arrangements and implementation arrangements
44. The Ministry of Health General Authority for Health Insurance to be the competent body to implement the Health Insurance Systems Development Project funded by the World Bank. And it is currently being enactment of a new legislation for the system of social health insurance, which would create a new body, the National Authority for health insurance, to be the only point of payment across the country. If the government decided that this new body is the most appropriate body to become the implementation of the project has been transported to the responsibilities of project implementation body, where the mechanism has been integrated in the project documents to allow this if the World Bank has agreed to this as acceptable.
45. formed a steering committee for the system of social health insurance members participate at the level of the Council of Ministers and the ministries of health, finance, social solidarity and other ministries and chaired by the Egyptian Prime Minister, in order to guide the development of a comprehensive system of social health insurance reform process. In addition, the government will form a steering committee for the project between the ministries by the Ministry of Health in order to help overcome any bottlenecks in the implementation of the project may encounter and require coordination between the various ministries.
46. ​​The unit will be created implementing a project funded by the government resources in the final stage, and that within one month from the date of entry into force of the project, explains Appendix 6 detailed the role of the Project Implementation Unit and structure. Once the establishment of the National Authority for health insurance, it is also expected that the unity of the implementation of the project, a project to develop the health insurance system – is responsible for reporting to the board of this body because the core mission of this project is to develop processes and management systems of the body in question.
Jim. Monitoring and evaluation of outcomes / results
47. outputs and outcomes of the current information system data will be derived indicators developed. The preparation of regular reports include outputs standard part of the system requirements, and will be applied to the internal controls systems and training of personnel, supervisors and managers during the development of information systems, so as to ensure the accuracy of the information and then take actions and measures under it. It is measuring standard outputs, which regards the application of the various units of information systems based on information provided by the company verification and validation of the unity of the implementation of the project, a project to develop health insurance systems.
D. Sustainability

48. The Egyptian government is committed to expanding health insurance coverage to include all citizens through social health insurance system, according to the announcement by Mr. / President of the Republic in 2005. The establishment and operation of the new body, which holds the payment of costs arrangements (point of payment) a critical component of importance in reform efforts, since this will be the collection of social health insurance and the purchase of services to members of subscriptions in this program. The presence of the purchase of a single unified mechanism that greatly enhance the overall sustainability of the health care financing system in general, because it will allow for the introduction of a large and significant improvements in efficiency compared to the situation that currently exists.

the development of the proposed health insurance schemes project

Project Description
a thousand. Lending tool

33. will finance the development of the proposed health insurance schemes project through an investment loan for a specific value of US $ 75 million provided by the International Bank for Reconstruction and Development. The Egyptian government will (the borrower) entered into a loan agreement, as the General Authority for Health Insurance (body implementing the project) to conclude a project agreement; and pass the money from the government to the General Authority for health insurance under a subsidiary loan agreement. The project has a duration of five years, and a closing date is June 30, 2015.
B. Project Development Objective and basic indicators
34. The proposed project for the development of health insurance systems to support the Egyptian government’s program aimed at the establishment of a social health insurance and national efficient and effective system. The development objective of the project is to assist the borrower (the Egyptian government) in improving the financial sustainability and efficiency of the operations of its own social health insurance, through the adoption of a business model proved its usefulness in the operation of social health insurance systems and managed by a single national body to function pay arrangements Service in the context of social health insurance system. This project will require the development and use of formal working procedures of the function only body which holds the payment of the cost of service arrangements, system operation and management of information for the project based functions, and develop the skills necessary operating and management at the point of payment. And key performance indicators are:
Rationale key performance indicators
1. New operating procedures for the management of contributions, claims processing, and management levels use the services, including the formal adoption of measures to combat manipulation and fraud. It indicates that the homogeneity of operating procedures in national programs, and reflects the stakeholders in response to the outputs of the design under the main contract for the system to work.
2. Percentage of social health insurance claims that are monitored and processed through the new work management systems in terms of payment in the three pilot provinces. It indicates that the homogeneity of the social health insurance system operations, reflects the new point of payment personnel who are assigned tasks in response to the transaction processing procedures and controls work activities included in the main work system.
3. The percentage of claims processed electronically, which are rejected by or escalation of medical relevance compared to the rates that have been identified through a manual review of the three pilot provinces. It demonstrates the effectiveness of the social health insurance system operations, reflects the new point of payment staff assigned to them in response to the financial audit functions and review of health services and operational mechanism of information and preparation of reports on the risks of supporting computer in the main work system.
4. The annual reports of the Steering Committee for Social Health Insurance system of government – documented data produced by the systems. It demonstrates the effectiveness of corporate governance, and reflects the management team of operational information and information management bodies produced by the main labor system response.
5. percentage point staff payment to the insured population in the three pilot provinces. It demonstrates the efficiency of operations (excluding investment costs paid at the beginning of the project) and reflects the combined response to employees who are assigned management tasks and duties of the operational procedures, processes and controls, and information provided by the main work system.
Jim. Components of the project

35. works to develop health insurance schemes to finance the establishment of operations based on information technology has the only national health insurance body which holds the payment of service costs under the new arrangements in the National Health Insurance Programme project (in the provinces of Suez and Sohag, and Alexandria). This includes the development and implementation of business processes and systems to-date information on job two special operation and management of health insurance (ie management contributions, claims processing, and management levels of use of services, and management bodies proxy). It also includes training on the operation and management activities in the framework of the new working procedures, as well as create an interface to receive the service providers’ claims. Based on the experience and capabilities that are developed under the Health Insurance Systems Development Project, it will circulate the Egyptian government health insurance in all provinces model, followed by the expansion of users and service providers base.
36. Although focused scope of the project, the implementation of business processes and systems, the new information is a task challenging. The project requires, among other things, the close coordination of project activities and strong technical support to the Beneficiary of it. Accordingly, the development of health insurance systems from a single component called the operation and management of the National Authority for health insurance, which pays the cost of service arrangements Information System project (point of payment), which is in turn funded by three decades of intense interdependence and integration among them composed. These contracts are: (a) hold the main work system: to provide an integrated package of development of work procedures operations, programs and computer applications, and training on the operation and management activities, and technical support services extended; and (b) contract for the provision of physical equipment: providing the necessary communications computer technologies to activate the new business functions in the three provinces that are the pilot project where implementation; and (c) contract verification and validation: where a company specialized will be in the field of health insurance to provide practical support in terms of new Egyptian payment in relation to decision-making, and coordination of activities and technical advice / objectivity, and services verification and authentication. The target verification and validation contract explicitly ensure close coordination of the two others is true integration of business processes resulting innovations with institutional development in terms of payment, as well as the wider reform program.
37. The introduction of the new system gradually work in the pilot provinces, and will consist of a number of necessary units in terms of payment in order to play its role to the fullest. Including: management of users affairs, including the processing of applications for registration (with the exemption of social situations) and choose family physicians; and management providers Affairs health care services, including order processing and record details of the contracts; and the maintenance of the service pack log, including details and prices of the quota of payments that have to beneficiaries paid; and claims management affairs, including the receipt of claims and resolution, and the application of the rules of appreciation and networking, and payments; and procedures for monitoring the levels of use of the services and functions of reporting; and case management, including tracking referrals of patients; and support the work activities, including the functions of the types of business resources such as finance and accounting plans, human resources, payroll, and legal affairs, and fixed asset management.
D. Lessons learned and reflected in the project design
Lessons from Egypt

38. There is a positive constructive developments in the project which was implemented recently in some provinces such as Monofia in the context of health sector reform program, and will use them as building blocks in the new project.
• The health sector reform program developed a series of performance-based contracting, implementation and payment systems, including primary health care premiums and categories of diagnostic classification systems for surgical patients in hospitals beneficiaries. And it is currently being evaluated those experiences and practical experiences formally in the framework of this program, in order to take advantage of the results in the implementation of the new contract and payment and escalation and increase systems under the new social health insurance system.
• New systems will depend on good management information systems as well. Health sector reform program has been experimenting with a new clinical information system. It was run version 6 and version 7 in more than 300 units of family health in the provinces covered by the project (Alexandria, Menoufia) by the middle of 2007. According to the Ministry of Health that all units are fully equipped with all the necessary networks and equipment information technology. The final version is currently being tested at the central level in the Ministry of Health. It is necessary now to address two key issues: (1) lack of clinical information system to interface with the contact information of existing systems in family health funds, which is crucial in completing

heads of departments involved in the management of users affairs

Ministry of Health) was also positions the main managers (ie the head of the authority responsible for payment arrangements, and heads of departments involved in the management of users affairs, claims management, and management of service providers Affairs). It was determined as well as the initial work procedures, and staff received the required training, which will continue during the implementation period.
22. Willie Suez pilot implementation project two pilot projects in the governorates of Sohag, Alexandria. In Sohag, its challenges of rural character, who dominated most of the population is facing to mention the high rates of poverty among them, and Alexandria are densely populated province and predominantly urban character, with a large participation of the private sector in the provision of health care and health insurance services. While these conditions pose challenges during the initial implementation phase, it will allow the responsible authorities experiences and great experiences will prove useful when it comes time to circulate in the system throughout the whole country. Based on the model proved its usefulness in the three provincial level to implement the reform of the health insurance system and the delivery of health care services, it will be circulated gradually at the national level through the application in the province after the other. The target plan is to start circulating in 2012 this model and continue for a period lasting several years.
23. The first phase focused on the development of channels and measures to contain the risk strategy, as well as tested. The strategy will focus subscribe to the authority responsible for paying the costs of treatment arrangements first on slides that are easily accessible, starting with slide insured currently in the General Authority for Health Insurance (who will be transferred to the new social health insurance system, which shall pay the cost) arrangements. Will be the initial focus as well be on the poor, who are unable and children under school age, and then targeting the social health insurance system at a later stage segments of the population is poor in the informal sector and slides involving under the umbrella associations and trade unions, and then follows it to target the rest of the informal sector through marketing activities and initiatives to increase patient awareness, through communication and awareness programs.
24. There are four main risks obstacles to the sustainability of social health insurance system, namely: (a) the misuse of public insurance services, (b) inflation of health care services prices, (c) low-paid subscriptions rates and the weakness of measuring income levels, (d) limited participation, including the problem of adverse selection (adverse selection) of resorting to patients without insurance misfits. And are easing the risk of use through the application of a referral system is based on the “audit function gatekeeper” small joint and payments. It is expected to increase inflation, or prices of health care services, and that when these services are approaching the care provided and the cost structures of the private sector which patterns. And the mitigation of the risks of escalation of costs through the application of cost recovery mechanisms based on the outputs, and that will motivate providers to increase the level of efficiency. The risks related to contributions and income are mitigated through flexible payment mechanisms are sufficient degree of simplicity, where residents are encouraged to participate, and mitigate the risks come to participate in the insurance system by offering attractive benefits package and the activities of communication and awareness-raising and marketing.
25. successful implementation leads to the activation of several factors, including regulatory and administrative capacity in terms of facilities and payment service providers. And it has the Ministry of Health currently has two tools to address the skills gaps: (a) training center on the operational activities and (b) Leadership Academy. The training focuses on the center of health care workers who hold jobs is administrative, and The Leadership Academy focuses on training managers in order to develop future leaders who Simeskun the reins of the health care system in Egypt.
B. Reasons and rationale for the participation of the World Bank in this project

26. The implementation of a large health insurance in Egypt, socially and institutionally enormous technical effort system (albeit through a pilot project). The World Bank has a proven track record of working with the client countries in the areas of health care and its financing, which is also in a good and firm at the level of the transfer of international experience and expertise in a large number of components of health care involved in doing this effort systems mode (as well as the Strategic Project Management) , the World Bank and also enjoy a party as honest a strong record of bringing together many of the parties involved her direct interest in such reforms in order to build a consensus, which is a necessary condition for success.
27. The World Bank has a long history of working with the Egyptian authorities in the areas of health care financing and delivery of services, and health outcomes. The project will help to create the appropriate conditions necessary to increase the efficiency and effectiveness of the health sector management in general, I mean that a modern system of social health insurance in the country’s administration. The project, in this sense, a natural extension of the continuous cooperation between Egypt and the World Bank on the reform of the health sector and benefit from activities under the health sector reform project.
28. Although the project, which is funded by the World Bank highly concentrated scale, the Bank team will continue its support to the Egyptian government in the broader health insurance systems reforms agenda, through a combination of policy dialogue and technical assistance. They can include broader areas – among other things – health care financing, social targeting, monitoring the levels of use of services, and monitoring and evaluation.
Jim. Top goals that the project contributes to the achievement

29. The main objective top of the health sector to achieve a consistent high levels of health outcomes (low death rates and ill health) to achieve maximum efficiency in the utilization of available resources. The elements of success include: the availability of financial resources, and strong technical capabilities (skills – equipment – facilities, etc.), and the organizational structure of an efficient and effective device management and are fully aware of, as well as to the appropriateness of incentives for users and service providers. Health insurance is one of the basic tools in a position to help smelting of these elements in one pot. Therefore, the effective health insurance in turn depends on the availability of proper legislation / and regulations appropriate, and device management sturdy, and raise awareness among the masses, and the sub-sector service providers respond to incentives, and the system of governance and public administration accountable.
30. The project seeks to support efforts to achieve the objectives of the health sector by creating a fitter model for the management of social health insurance system. It also aims in particular to assist in the implementation of pilot projects for the hand which holds the payment of costs arrangements within the framework of the new social health insurance system in the three provinces, where he applied a new working procedures and technology program supports new applications in the three pilot provinces. It is expected that this will lead to finding administrative organs functioning in the pilot provinces, including the information base used in the responses of users and service providers to manage an array of financial incentives produced by the new social health insurance model. In addition, pilot projects will lead to the development of a functional and organizational model for the management of health insurance at the county level, which would allow an experienced mainly in order to implement this innovative actions in all parts of the country.
31. must recognize that most of the expected benefits of the project will be realized probably after a planned period, following the circulation of the new model in the whole of Egypt and the gradual introduction of amendments to the behavior of the beneficiaries and health care services paid by considerations of a financial instrument for health insurance. These benefits include strengthening the financing of health care and increase its ability to continue – through increased efficiency on both sides of the service providers and users, and through the political and social support derived from the obvious rise in the level of quality of health and medical services provided in exchange for the cash value paid (value-for-money) . The benefits also include reduced mortality and ill health, and a more equitable distribution of these health outcomes – through financial incentives-based management to the evidence and the evidence, and activated in the health insurance system. Given that increase the sustainability of funding for the health sector and in health outcomes is a key element of national spending, but they relate to the welfare of the entire population, it will have a positive impact on social and economic development of the country.
32. With respect to the strategy of country assistance to Egypt, the World Bank and the update that you enter in the Progress Report 2008 “(Report No. 43476-EG), the project will contribute to the achievement of the third strategic goal of” promoting justice and equity “, which is directly linked to the outcome No. 3.3 “the ability to expand access to health care” and the index of the final outputs of the CAS, “the adoption of the reform of health insurance, reflecting international best practices process.”