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Egyptian Health System

Case Studies

In Egypt, we managed a project team on a contract held by PLS in Denmark. The project was funded by the African Development Bank. The project was focussed on developing a health master plan for each of three governorates under the Ministry of Health and Population.

With the support of academics from the University of Cairo and El Shaams University, we obtained maps of each of the three governorates from the Egyptian Army. These were not detailed enough for us to develop the Geographical Information System (GIS) that would be essential for the production of the master plans. In addition, the governorates in Nag Hammadi, and Qena were under military supervision and access to them was controlled strictly. The third governorate, Suez, was not so strictly controlled. Additionally, this would prove to be problematic later on when we organised focus groups to undertake research, and later still when we needed to check our findings.

The team were encouraged to use their network of military and medical school contacts in order to discover ways to get the team on the ground. The difficulty was that we needed to carry out field studies, and to meet local village elders and community leaders. Without local knowledge any master plan would lack credibility as it would not be evidence based.

Stuart Morgan, the team leader, was given clearance by the military to visit restricted areas and to meet with local village elders and community leaders. His reputation as an amateur photographer did not go unnoticed, and his military escorts even encouraged him to take photographs whilst on site. They failed to notice that the photographs were not so much of the archaeological sites, but of topographical features, such as roads, and drainage ditches, and health related facilities. It was an excellent way too, to establish a network of community leaders. This would prove to be useful elsewhere in the project. One of the discoveries during these field visits was that the military maps were hopelessly inaccurate. Many villages were not in the locations indicated on the maps and roads had been reconstructed and redirected since the maps were drawn up. The photographs provided just the evidence that was needed by the Ministry of Health and Population.

A local female doctor, who spoke Arabic and English was recruited to run focus groups of women living in the areas of interest. The attendance of a male village elder in each focus group was unavoidable. However, because of the earlier field trips and the skill of the focus group leader we generated much valuable information.
The project over-ran by four weeks as a result of difficulties getting military clearance to visit the governorates. However, three excellent highly detailed master plans were developed and funding to build new primary health care centres and district hospitals was enabled.

The knowledge and skills adopted in this project proved invaluable when carrying out subsequently a similar exercise for the World Bank in Tajikistan.

Subsequent to the first project in Egypt, we were contracted by the British Council to develop a human resources strategy and implementation plan for the Ministry of Health and Population. This second project in Egypt was funded by the European Union.

Subsequent to the first project in Tajikistan, we were contracted on behalf of the European Union to review the health service development programme, and to identify and formulate a second health service development programme. This project required close co-operation on a daily basis with the Deputy Minister of Finance, the Minister of Health and the EC Delegation. This was a highly politically sensitive project.