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.