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Background The Ministry of Health and Population (MOHP)-Family Planning Sector (FPS) has a strong management information system (MIS) that allows the flow of data from MOHP-FP clinics, health districts, and governorates up to the central level. Yet, family planning (FP) quarterly reports issued at the central level are presented as database/spreadsheet software documents. These data are not used to provide indicators or information that aid in decision-making or the tracking of FP services over time. The objective of the study is to organize data in the database, develop key performance indicators, and design FP reports and policy briefs. Methods The study is operations research that is driven by published data derived from MOHP-FP sector-head, and 2014 service statistics quarterly hardcopy reports. The information was entered into an excel program, and 15 key performance indicators (KPIs) were calculated and used to rank Egypt’s 27 governorates. We developed an annual FP report form, settled tables, and colored graphs that are liable to rank the governorates from best to least favorable. Results The quarterly data sheets issued by the MOHP-FP sector were organized for the quarters, and one annual sheet was developed with the organization of Egypt’s Governorates into 4 specific regions, with each governorate having a fixed position in all reports. The key performance indicators were as follows: percent of clients aged 35 and up; percent of clients with fewer than three children; proportion of current FP users by method; percent of clients reported as first-time clients; percent of clients defined as new clients (non-FP users and FP discontinuers); and contraceptive coverage rate, i.e., percent coverage of married women of reproductive age with dispensed FP methods expressed as couple years. Conclusion MOHP-FP sector service statistics data could be used for the development of fifteen key performance indicators. Having those indicators at governorate, district, and central levels in quarterly and annual reports and their communication with decision-makers at all levels and their tracking overtime will guide them to timely decision-making for improving performance in FP services at all levels.

Background School Health insurance (SHI) is working in Egypt since 2003. However, there were no impact indicators that inform policy makers about health status of school children. Therefore, the school health project was conducted by Arab Medical Union (AMU) Medical Syndicate in cooperation with Ministry of Education (MOE), Ministry of Health and Population (MOHP) and Public Health Department, Cairo University to conduct comprehensive medical services to primary school children and to assess the impact of the SHI and the efficiency of AMU project to promote health of children. Methods In‐depth interview with policy makers in MOHP, MOE, SHI and secondary analysis of AMU documents. A systematic random sample of 7000 students (7–10 years) was selected which formed 10% of the examined children in AMU project and proportionally distributed in 355 schools in seven Districts in Fayoum Governorate. Results SHI was ineffective in providing preventive services to school children. The AMU project was efficient in covering 82% of the targeted students with clinical, preventive and referral services with estimated cost per student were 54.8LE. Clinical findings showed anaemia the major problem (84%), dental (33%), hair/scalp (9%) and visual errors (6%). Conclusion The current Primary Health Care facilities needs to improve the quality preventive and curative health services provided to school children. Also, providing health services through medical conveys was of high cost and unsustainable.

Background: In Egypt, primary healthcare workers (PHCWs) often work in challenging situations and in relative isolation from the health system and specialists' experiences. Supervision is currently applied by PHCWs to present practice, control and upgrade knowledge and skills. Objectives: To assess the current supervision system in the Ministry of Health and Population (MOHP) at the central, governorate, district, and primary healthcare (PHC) facility levels. Methods: The research setting is the MOHP-PHC head quarter (HQ) and five governorates. Design: Cross-sectional analytical observational health system research qualitative and quantitative study of Egyptian health service and operations. Sampling: The multistage sampling technique was used to select districts (n ¼ 25) units (n ¼ 250), physicians (n ¼ 250), and nurses (n ¼ 250) from five randomly selected governorates that represent four Egypt regions. Data collection: Focus group discussions (FGDs) and selfadministered questionnaires. Results: Response rate to questionnaires were in total 73% (67% for physicians and 80% for nurses). FGDs demonstrated that PHC has an effective supervision system at central, governorate, and district levels. The effective supervision allowed overcoming barriers related to the shortage in PHCWs needed to cover 5364 PHC units in addition to mobile clinics. Supervisors use a standardized

BACKGROUND: The study is of practical importance for policy makers and family planning (FP) program managers as the profile of FP method-mix with a shift from a mechanical method as intrauterine devices (IUD) to hormonal methods such as oral contraceptives (OCs) and injectables predicts a critical situation for maternal and child health and reflects shortcomings in FP service delivery program. AIM: The purpose of the current study was to identify reasons for the progressive shift from IUD to OCs in Egypt. METHODS: The study is an-operations research conducted at four levels of the Ministry of Health and Population/FP (MOHP/FP) service delivery: Central (headquarter, HQ), governorate, district, and service delivery points. It included five of MOHP/United Nations Fund for Population Activities-Contraceptive Security Project governorates that represent, urban governorates, Lower Egypt, and Upper Egypt. Both qualitative data in-depth interviews with MOHP/HQ staff, Two Focus Group Discussions with FP Health Directorates staff and nurses in the five governorates, and quantitative data through a self-administered questionnaire for 607 service providers (SP). RESULTS: There was a consensus on the actual shift from IUD to OCs use. Reasons were the absence of incentives for healthcare providers for IUD insertion services (64%) and improper training of physicians (45%), and the availability of OCs all time. CONCLUSION: The three articulating issues that lead to shifting from IUD to OCs are: Unsatisfactory training and incentive systems for SPs and the clients’ choice of OCs for independent use/autonomy, and availability of OCs all the times at a reasonable cost in both the public and private sectors.

Background: Egypt's Ministry of Health and Population (MOHP) has 5364 Family Medicine Facilities (FMF) encompassing family folders (FF) with detailed medical information about family members. However, there is no health information system at the facility level to provide community morbidity statistics, especially about chronic communicable and noncommunicable diseases (NCD). Objectives: Develop statistical module centering on the risk factors associated with chronic diseases among families encompassed in family center folders. Methods: The study was done in a Family Medicine Center (FMC) in Giza. A sample of 2169 FFs forming 54% of the total available FFs in this center was selected by systematic random sampling technique. A software excel program was designed to include 8 sheets to integrate the data registered in 16 forms distributed in 32 pages with subsequent analysis of these data on chronic diseases. Results: The collected data were about 10477 individuals in 2169 FFs. The proportions of individuals diagnosed with chronic diseases were as follows: 51.9% diagnosed with diabetes mellitus, 26.2% with hypertension, 6% with cardiac diseases, 3.7% with renal diseases, 3.4% with psychological disorders, 2.1% with epilepsy, 1.3% with neurological disorders, 1.2% with liver diseases, 1.1% with blood diseases, 0.9% with asthma, 0.3% with bone diseases, 0.2% with skin diseases, and 1.8% with tuberculosis. There were statistically significant differences (p< 0.01) between the proportion of cases in terms of crowding index, age, sex, education, work status, and habits. Conclusion: The study provided a module of 8 forms including data from 32 pages of the family folders. This module allows the statistical analysis of the risk factors associated with chronic diseases among families registered in the FMF. Scaling up of this module across FMFs could guide service providers to support the at-risk families.

Background:  Infant and child mortality are indicators of population wellbeing. Although, Child mortality rates are declining in Egypt, national averages mask regional disparities. For that, identification and quantification of factors contributing to mortality, at the local level, through ecological correlation studies could provide a guide to more focused public health interventions for reducing mortality. The study aims to improve child health and decrease child mortality rate through recognizing ecological/environmental factors predicting child mortality among municipalities in Giza governorate. Methodology: Ecological, cross sectional study, adopting the municipalities (n=215) as unit of analysis, was conducted to examine associations between child mortality and some human development indicators. Results: High negative significant correlation between U5MR and   access to water (r=-0.966) was found. Access to sanitation and access to electricity are negatively correlated with U5MR with r=-0.955 and - 0.905 respectively. The results with IMR were similar to that with U5MR. An increase in one percentage access of household to safe water predict 1.05and 0.78 fewer U5MR and IMR (R2=0.97 and 0.98; P≤0.001) respectively. U5MR and IMR decrease, significantly, by 0.82 and 0.61deaths, respectively, with increase access to sanitation by 1%. Conclusion: Access to safe water and sanitation are strong predictors of U5MR and IMR. Increase coverage of households by safe water has the largest impact in reduction of children mortality rate. For that, the study recommends advocacy to ensure coverage of household with safe water and sanitation system.

Background: Exposure of women to socioeconomic risks, as becoming the head of the family, could influence their life quality. Therefore, assessment of women's needs in families headed by women (FHW)to achieve equity regarding health-related quality of life (HRQoL) is pivotal for stakeholders involved in women's programs. Objective: to identify the predictors of HRQoL of young women heading their families versus young wives in families headed by men (FHM). Methods: A community-based cross-sectional study compared the HRQoL for two groups of women (age is 25-49 years); 200women heading their families (group 1) and 200 wives in FHM (group 2). The study was conducted in a randomly selected shiakha (El-Atrees Shiakha) in El-Saida Zeinab district in Cairo, Egypt using structured interview questionnaire form. Results: Women heading their families who had significantly (p< 0.05) lower mean HRQoL score compared to wives in FHM were those ≥35 years old, non-educated and those with history of early marriage (mean HRQoL scores ± standard deviations were 3.5±0.6, 3.5±0.56, 3.4±0.6 respectively).Conclusion: women having socioeconomic risks related to 'non-education, young age at marriage and working in unstable jobs" were more vulnerable to suffer from low HRQoL upon exposure to the socioeconomic crises of becoming the head of the family.