Pay for Performance for Improved Health in Egypt

P4P in EgyptSameh El-Saharty, Mohamed Elhayatmy, Kimberly Switlick Prose, and Rena Eichler

In 1997, the Egyptian Ministry of Health and Population (MOHP) embarked upon a reform program to restructure and reengineer the health sector with the goal of increasing health insurance coverage and access to high-quality health services, and improving health outcomes. As part of the reform, a Family Health Model for service delivery in primary health care facilities was introduced in three pilot governorates (and later rolled out in two additional governorates), and in 2001, pay for performance (P4P) was incorporated into the reform program in all five governorates. Through P4P, health care providers receive a financial incentive, which is distributed to facility staff when they reach certain targets.

Initial results suggest that the reform program helped to achieve improvements in the quality of care, and increased satisfaction levels among both health care providers and beneficiaries. The MOHP therefore scaled up the Family Health Model for service delivery but the scale-up of the successful performance-based financing model is stalled because of financial uncertainty. The two reforms are interdependent and it is unlikely that the scale-up of the model will have the same level of impact without the associated financial incentives.

(Available on the Health Systems 20/20 <;  website)