211. 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 is developing a series of contracting and payment tied to performance and implementation of systems, including primary health care premiums and categories of diagnostic classification systems for surgical patients in hospitals beneficiaries. And it is currently being evaluated formally those practical experiences in the framework of this program, and will 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 the forefront of touch with the information existing systems in family health funds, which is very important in the complete cycle of information in order to improve these funds service; and (2) the quality of data in care facilities health and completeness.
• it should also complement the clinical information system system in hospitals so that the benefits package covering health services provided by hospitals. It is clear, so far, of the indicators that the standard package of benefits (services) Stmathl closely approved the package in the General Authority for Health Insurance, a fully inclusive package. The clinical information system has been designed in order to allow the support of referral unit to function port (gate) model of family health, but the Ministry of Health and the General Authority for Health Insurance will that needed to develop referral protocols and tested for the adoption of the new system of social health insurance.
Lessons learned from the international experience
212. There are several examples of projects include programs to manage health information that allows lessons relevant, including: reform of the health insurance programs and widespread in Bulgaria and Slovenia, and the introduction of health management information system in Latvia, and the application of an automated system to manage claims in Lebanon. Of course, these projects are very different in terms of scope and size, but each of them is relevant to the proposed project.
213. Bulgaria. The health sector reform project in Bulgaria is extending the program for the past 5 years, was launched in 2000 with a loan from the International Bank for Reconstruction and Development, worth US $ 63 million, and the financing of government-peer amounted to US $ 24 million. He was a multi-faceted program, consist of the following key elements: (1) repair the units primary care hospitals, which included the supply of necessary equipment and devices, information systems, training and public awareness campaigns, and strategies to adapt labor conditions to deal with medical surplus labor; (2) national health insurance fund, which included ensuring the availability of adequate information and training systems for the Fund to be able to manage a national program for health insurance; (3) building the capacity within the health system, and specifically the national Health insurance Fund and the Health Ministry.
214. The overall assessment of the Bulgarian project outputs as reasonably satisfactory. As has been the administrative costs reduce national health insurance fund of more than 5 per cent in 2000 to about 2.6 per cent in 2008, as well as decreased the period of hospitalization from 11.5 days in 2000 to 6.5 days in 2008; while the number of installed information systems in units of primary care and hospitals from zero in 2000 to 4024 (primary care) and 154 (hospital) in 2008. factors that contributed to the success of the project: large government commitment to the initial reform process, and pre-analysis enormous by a variety of groups in order to determine the approach appropriate. The one aspect of the fundamental deficiencies, adopted in this project approach was ambitious unbridled nature of the project, with the implementation of many reform activities at one time.
215. The meaning of the project – with respect to component information systems of national health insurance fund – to build on the work of existing information contracted by the government by the technology. In fact, the contractors failed to deliver their product, resulting in a period of considerable delay of the project. And had to re-design the entire information system from scratch has not been launched definitively only in 2005, and did not complete integrated solution, but dropped in 2009. This prolongation in the duration of the project administrative burdens on the borrower and the World Bank. There is concern of sustainability steady information system, since the ownership of the project in the hands of the Ministry of Health is not in the National Health Insurance Fund grip, making it more difficult to create a maintenance and support contracts. This discontinuity in the process of developing the information system has led to the postponement of facilitating the establishment of disaster or the backup, which is what still needs to be addressed. Despite this, there was a feeling that the introduction of the information system is one of the most important achievements of the project.
216. Latvia. It was planned to be the development of management information system for the benefit of health insurance funds at a cost of 3.99 million US dollars, in the context of health reform project funded by the World Bank in Latvia and was introduced in 1999. In addition, it has been allocated US $ 969,200 from the grant free Agency Swedish international development. And it has had the purpose of the system that allows for decision-makers, medical and economic data they need, and can enter data, and make inquiries from service providers using a specially-developed package based on personal computers. Approach also included an international competitive tender to choose a contractor undertakes to complete a full work; in terms of delivery of all hardware and software required and installed, including the integration of existing equipment and provide training. The aim is planned to be operational management information system that leads the entire functions and then published in all parts of Latvia. Such as the establishment of a centralized system can handle 500 users at one time it has been identified specific technical requirements.
217. Implementation Completion Report 2004 reported that after the final signing of the contract in 2002, has been contracted to develop a management information system and the start of implementation, and the system is ready technically to receive all health information services paid for by the State. And continued implementation of the system and add new units.
218. been the development of management information system – in spite of it – for periods of significant delay, and it was felt that this great work is not appreciated enough appreciation. First Valmnaqsh delayed advertised for twelve months, due in part to that after the start of the project shortly, the Ministry of Transportation to conduct a review of the information technology activities at the government level entirely. There was also a lack of technical capacity within the Ministry of Social Solidarity, and delays related to international consultants. In order to keep the process of developing the management information system, it was felt should be the advancement of the Ministry of Health a stronger political backing, as well as support for public relations, conduct training, and supervision necessary.
219. relatively smooth implementation of this project and related projects, and other health information-funded management system from the World Bank – led to say a number of success factors critical: management and strong corporate governance, taking management structure of the exact account; and the structure of the contract and procedures for change management; and inputs professional to deepen specialized project experience; and proactive re-design of work processes; and the technical flexibility and sustainability, including the ability to adapt to a changing policy environment.
220. Lebanon. ESPISP began to apply the emergency program to support the implementation of social protection which is funded by the World Bank in 2007. It was among the groups core activities, Renewed National Social Security Fund, which is the largest national health insurance, particularly in the areas automate its claims management systems. The current regulations of the nature and characterized by a hand