importance in the effective management of the project

Bastgragaha for a very long time in processing up for years in some cases, as was the result in action inconsistent decisions and duplication of effort during the evaluation of claims and processing. Emergency program included to support the implementation of social protection to develop an automated system to manage claims aim internal clinics in hospitals claims management. Offering electronic claims from hospitals and then be processed automatically, with proper supervision, and then issued a letter adoption of repayment. And it included the development process to conduct numerous interviews and workshops with the National Social Security Fund staff to determine the workflow procedures as well as the valuation rules of the National Social Security Fund, with extensive participation to the end user is one of the key features of this project, and has been integrated into the evaluation rules in the “engine rules “he automatically applied to each of the claims, and completed the pilot program, which was attended by three hospitals in 2009.
221. drew a number of lessons learned from this program, including: (a) In addition to the formation of a project team to manage the claims, the National Social Security Fund had already contracted with the IT service provider to complete other related work. It was clear that a successful interaction between the teams a very important factor, and that was difficult to achieve at times. It is crucial that the implementation body coordination between all the teams that do business related to each other. And it is of the utmost importance in the effective management of the project as a whole. (B) There have been times when obstructed maintain the project within the specified scope. Technical issues have appeared seemingly separate but linked with each other, it was necessary to be addressed to ensure the system performance of their functions in the end. (C) must implement fully prepared for delivery gradual and final products for the body. It must be of sufficient funds and staff and training is available for the effective transfer of skills and technology enabled.
222. Slovenia. Health sector Slovenian management project started in 2000 to support a large variety of areas, including health policy, and the development of health standards, and health information systems support included the establishment of a national mechanism for the exchange of health information and be a central hub for the exchange of information on health matters between the bodies. Generally it has been evaluated in the project outcomes as satisfactory.
223. It turned out early in the project in relation to specific issues pertaining to the components of information systems that are not likely to accept the stakeholders of the concept of establishing a national mechanism for the exchange of information. It also emerged legal issues had to be addressed. UNU Institute of Public Health, for example, it was the only party allowed to legally review of health care outcomes data, complicating the task of health insurance body on categories of diagnostic classification system management. If the institute did not support an integrated information system full support, has slowed progress on the project. Therefore it was decided to reallocate some funding directed to the development of the field of information technology; to support other aspects of the project, such as the categories of diagnostic classification and quality of care, at a time when consultations will continue with stakeholders on the information system design. Then decide later in the 2003 follow-up to complete the establishment of data management would focus on the establishment of standards and procedures in order to improve data accuracy and to ensure the safety and confidentiality of the center. The centerpiece will be the initial focus is to support the classification categories of diagnostic program. The evaluation team was reached in this regard that where was an important IT project significantly components Vsachris then more time to understand the legal, institutional and political constraints, and then integrate this understanding into the project design process.
224. Summary expertise and international experience. 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 with the development of the project. It should be noted that in the Egyptian context, all of the General Authority for Health Insurance and the Ministry of Health is working closely with each other 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 communication strategy and strong awareness regarding the various stakeholders. There is also a high-level effort to sift through a steering committee for health and social insurance system headed by the Prime Minister. In the end, one of the main sources of the delay is that information systems activities in the system design requirements and the procurement process is not implemented only after the adoption of the project or the date of entry into force. In the case of Health Insurance Systems Development Project, in charge of Egypt’s authorities have begun their work well in advance before the adoption of the project or the validity of its effective date Aftort strong technical systems requirements, and drafted brochures specification standard tenders and conditions, and launched the invitation process for the Request for Proposals already. It also expressed its desire to strengthen these pamphlets with advice provided by the Review Group on strengthening the quality of the technical specifications.

the clinical information system system in hospital

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

Support supervision and implementation strategy

World Bank funds spent so far in preparation for the project:
1. World Bank resources: ~ US $ 450 403
2. Trust Funds: Policy and Human Resources Development ~ US $ 464 331
3. Total: ~ US $ 914 734

Estimated costs for accreditation and supervision:
1. The remaining cost of adoption: 60 thousand US dollars
2. The annual estimated cost of supervision: 200 thousand US dollars

Support supervision and implementation strategy
206. Articles of Association of the World Bank agreement requires that managers and staff bears responsibility for overseeing the implementation of the recipient of the projects and programs that receive funding from the World Bank. The main objective of supervision is to ensure that only the use of funding received in the intended purposes, paying due attention to economy and efficiency in spending, and ensure the achievement of support operations for their development objectives. In light of the complexity of the development of the proposed health insurance systems and attendant high-risk project, the World Bank proposes to apply the enhancer program for the supervision and implementation of the purpose of this project.
207. The following principles will guide this effort:
208. should be a supervising flexible and responsive, and serve as a mechanism for the continuation of the partnership. In this sense, supervision needs to be designed as a process of continuous and able to identify implementation challenges that arise in all aspects of the project and its rapid response interactive. Moreover, the the process that provides a mechanism for dialogue and close cooperation between the government and stakeholders. Thus, in addition to overseeing the functions of regular official semi-annual, Ministry of Health and the General Authority for Health Insurance and the World Bank have agreed to hold regular meetings every two weeks to assess the progress made and the issues that arise, and the areas that necessitate a united effort to ensure a coordinated solutions to common issues. To facilitate this ongoing interaction, the World Bank appointed head of a veteran staff and key members of the team in the field.
209. ensure that the provision of technical precision and approach based on team spirit is crucial given for each of the technical complexity and multiplicity of stakeholders for health insurance information systems that will be developed under the umbrella of the Health Insurance Systems Development Project. To respond effectively to the requirements of implementation; need supervision teams from both sides of the government and the World Bank both to be fitted Pachtsasian have the appropriate technical skills and expertise. This includes, among other things, technical specialists in the following areas: health insurance management systems and health insurance information, and purchase of complex information systems, economic analysis, institutional development, financial management and payments and communications. During the implementation it has shown the need for additional skills in order to deal with the emerging specific requirements.

Appendix 12: Documents project file
 The Egyptian Arabic Republic

Health Insurance Systems Development Project

210. Selected documents available to the World Bank and / or the Ministry of Health as follows:
Documents available to the World Bank and the Ministry of Health
• note dated May / May to June 9, 2008 27
• note dated 8 October / October 27, 2008
• note dated 12 May 18 / May 2009
• note dated 24 to October 29 / October 2009 (pre-assessment)
• Assess procurement capabilities, October / October 2009
• Assess the financial management capacity, in October / October 2009
• procurement plan for developing the health insurance systems October 28 / October 2009
• Japan, the Japanese Fund grant for policy development, human resources development, in May / May 29, 2007
Documents available to the Ministry of Health
• Management Information for health insurance and national specifications clinical information system providers system data flow, January 2007
• Technical report on the appropriate services outsourcing (BPO), November 2007
• assess the effects of family health insurance fund in Sohag, in July 2008 guide
• monitoring family health insurance, August / August 2008 Fund System Guide

contribute to the financial sustainability of the system

To contribute to the financial sustainability of the system of social health insurance
193. is unlikely to represent the financial sustainability of the activities of implementation will begin within the Health Insurance Systems Development Project a problem, given the potential for return on investment, as explained above, and close monitoring of the project be undertaken by the company specialized in the verification and validation, which will be contracted to the project.
194. offers Health Insurance Systems Development Support Project is very important for the financial sustainability of the program of social health insurance as a whole, which requires the implementation of a number of measures (a) appropriate subscription rates; (b) comply with contributions (c) The level of commitment by the state to provide the necessary subsidies and any additional transfers from the budget to prevent the accumulation of debt down to bankruptcy at the end (d) clarity about shared responsibilities between the state and complex assessments in connection with the financing of health benefits (e) the new health insurance management’s ability to money management to effectively contain costs with quality assurance. And it will support the technical skills, technologies and systems that will include the development of health insurance systems significantly these measures and then the project will help to achieve sustainability for the entire system.
195. One of the critical aspects important to ensure financial sustainability of the program of social health insurance, where the financial capacity and the budget available is limited to the government, to ensure the priority given to cover goods and services that have the greatest health impact and to protect the populations which prove their inability to afford the cost in Especially. And it will enable the technical skills, technologies and systems that will include the development of health insurance systems, a project of the National Authority for health insurance from the implementation of a more structured review of the basic system of social health insurance for the elements of a package of benefits, medical fees, and rates of subscription.
Fourth: The internal rate of return of the project investments
Nord 196. The following is a summary of the revenue generated in the project; based on the assumptions described above and to set the financial costs of the investment project.
Benefits / costs of the current value of inflows (US $)
Savings due to the anti-manipulation and fraud, and to prevent the misuse of resources, and administrative efficiency gains (see above for details)
Net cash flow after deducting recurring costs: $ 111 million until 2020 (discount rate 10 per cent)
Investment costs as well as recurring costs. It expected to stabilize recurrent costs at the end of the investment period and to grow at a steady rate thereafter – hard depreciation of equipment / machines
Investment: $ 75 million (the discount rate to 10 per cent)
Net present value
Internal rate of return US $ 36 million
48 per cent

197. stop the sensitivity of the revenue estimates on the extent of incompetence and scope of the improvements in the three provinces where the project is implemented. There is no evidence of this, and then there is nothing to indicate that the context is favorable or unfavorable, particularly in these provinces compared to other parts of the country.
198. Assuming that these three pilot provinces together make up one-third of health care spending would total health expenditures to approximate these provinces 2.73 billion US states (the total spending on health care in 2007 in Egypt, 8.2 billion US dollars). It produces a draw dividing the cost of the project amounting to US $ 75 million for health expenses of the experimental points to the provinces, giving almost 2.7 per cent. And swinging the occurrence improve overall efficiency through project investments was 2.7 per cent up on the short-term, which will cover the period of the immediate implementation of the project.

Technical extension of the facility 9: return of investment rate and the net present value
199. The following analysis calculates the net present value of investments based on the assumptions stated above concerning the benefits and estimated revenues associated. Moreover, exchange rate calculations assume a uniform during the implementation period, with revenues likely to be realized after the first year. The assumption of three alternative scenarios based on the speed of outgoing payments and proceeds.
the year

Note: Assuming a discount rate of 10 per cent with a unified exchange rate
200. As is shown in the table above, the net present value is positive after the second year in both scenarios. It is estimated that the rate of financial return of the project will be in the range of 48 per cent in the baseline scenario over the next ten years. This will result in a failure to implement the project – according to the schedule and take full advantage of the benefits – less return; on the contrary, the rapid and effective implementation could lead to a return of more than 100 per cent.
201. The following figure shows the current values ​​of the revenues for each scenario.