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Challenges of the universal health coverage a review of 3 wh rs

Challenges of the Universal Health Coverage: An Overview of Three World Reports


Prof. Ahmed-Refat AG Refat
Prof. Occupational and Environmental Medicine. FOM-ZU

SUMMARY
Background: Universal health coverage (UHC) is fast becoming a first order priority of the global health agenda .The concept of UHC is not new. The WHO constitution in 1948 and the Alma-Ata Declaration in 1978 both indirectly stressed UHC as an important tool to achieve “Health for All.”. A resolution at the 58th World Assembly in 2005 encouraged the countries of the world to embed UHC in their health systems, and the World Health Report (2010) proposed improved financing for health care to achieve this goal. Out of the 17 SDGs, that adopted in 2015, the eighth target of goal 3 (target 3.8) insists : Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
This review will presents a group of relevant UHC issues that discussed comprehensively in the following three World Health Reports:
1. HEALTH SYSTEMS FINANCING, The path to universal coverage (WHR 2010)
2. Research for Universal Health Coverage ( WHR 2013)
3. Tracking universal health coverage: (2017 Global Monitoring Report)
The objective of this work is to identify the areas that need extra efforts from Public Health Departments in teaching, research and training of the future doctors for proper implementing of UHC as a promising health policy in Egypt.

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Challenges of the universal health coverage a review of 3 wh rs

  1. 1. ‫السقازيق‬ ‫بطب‬ ‫المجتمع‬ ‫طب‬ ‫لقسم‬ ‫السنوي‬ ‫المؤتمر‬ 29-30‫مارس‬2018 ‫اإلسماعٌلٌة‬ ‫فندق‬‫الفرسان‬ ‫تولٌب‬-‫العربٌة‬ ‫مصر‬ ‫جمهورٌة‬ ‫بعنوان‬ Challenging the Universal Health Insurance Coverage: Public Health Perspectives 31-Mar-18 www.SlideShare.net/AhmedRefat 1
  2. 2. 31-Mar-18 www.SlideShare.net/AhmedRefat 2
  3. 3. 31-Mar-18 www.SlideShare.net/AhmedRefat 3
  4. 4. Challenges of the Universal Health Coverage: A Review of Three World Health Reports ‫من‬ ‫مقدم‬ ‫بحث‬ Dr. Ahmed-Refat AG Refat Prof. FOM-ZU 31-Mar-18 www.SlideShare.net/AhmedRefat 4
  5. 5. 31-Mar-18 www.SlideShare.net/AhmedRefat 5 Challenges of the Universal Health Coverage: An Overview of Three World Reports Prof. Ahmed-Refat AG Refat Prof. Occupational and Environmental Medicine. FOM-ZU SUMMARY Background: Universal health coverage (UHC) is fast becoming a first order priority of the global health agenda .The concept of UHC is not new. The WHO constitution in 1948 and the Alma-Ata Declaration in 1978 both indirectly stressed UHC as an important tool to achieve “Health for All.”. A resolution at the 58th World Assembly in 2005 encouraged the countries of the world to embed UHC in their health systems, and the World Health Report (2010) proposed improved financing for health care to achieve this goal. Out of the 17 SDGs, that adopted in 2015, the eighth target of goal 3 (target 3.8) insists : Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. This review will presents a group of relevant UHC issues that discussed comprehensively in the following three World Health Reports: 1. HEALTH SYSTEMS FINANCING, The path to universal coverage (WHR 2010) 2. Research for Universal Health Coverage ( WHR 2013) 3. Tracking universal health coverage: (2017 Global Monitoring Report) The objective of this work is to identify the areas that need extra efforts from Public Health Departments in teaching, research and training of the future doctors for proper implementing of UHC as a promising health policy in Egypt.
  6. 6. (( WHR )) www.who.int/whr 31-Mar-18 www.SlideShare.net/AhmedRefat 6Dr. Ahmed-Refat AG Refat
  7. 7. WHR • 2013 Research for universal health coverage • 2010 - Health systems financing: the path to universal coverage • 2008 - Primary Health Care – Now More Than Ever • 2007 - A safer future: global public health security in the 21st century • 2006 - working together for health • 2005 - make every mother and child count • 2004 - changing history • 2003 - shaping the future • 2002 - reducing risks to health, promoting healthy life • 2001 - mental health: new understanding, new hope • 2000 - health systems: improving performance • 1999 - making a difference • 1998 - life in the 21st century • 1997 - conquering suffering, enriching humanity • 1996 - fighting diseases, fostering development • 1995 - bridging the gaps 31-Mar-18 www.SlideShare.net/AhmedRefat 7Dr. Ahmed-Refat AG Refat
  8. 8. HEALTH SYSTEMS FINANCING The path to universal coverage 2010 31-Mar-18 www.SlideShare.net/AhmedRefat 8
  9. 9. Research for Universal Health Coverage 2013 31-Mar-18 www.SlideShare.net/AhmedRefat 9
  10. 10. Tracking Universal Health Coverage: 2017 Global Monitoring Report 2017 31-Mar-18 www.SlideShare.net/AhmedRefat 10
  11. 11. 31-Mar-18 www.SlideShare.net/AhmedRefat 11Dr. Ahmed-Refat AG Refat
  12. 12. History 31-Mar-18 www.SlideShare.net/AhmedRefat 12Dr. Ahmed-Refat AG Refat
  13. 13. 31-Mar-18 www.SlideShare.net/AhmedRefat 13
  14. 14. 31-Mar-18 www.SlideShare.net/AhmedRefat 14
  15. 15. 13 Targets The 8th UHC 3.8.1 S.C 3.8.2 F.R SDG#3 31-Mar-18 www.SlideShare.net/AhmedRefat 15
  16. 16. UHC at the core of SDGs • The UHC target 3.8 lies at the core of the other 12 health targets, • and the health goal SDG#3 itself is closely interlinked with the other 16 SDGs, 31-Mar-18 www.SlideShare.net/AhmedRefat 16Dr. Ahmed-Refat AG Refat
  17. 17. 31-Mar-18 www.SlideShare.net/AhmedRefat 17
  18. 18. UHC Ensuring that everyone can obtain essential health services at high quality without suffering financial hardship. .‫ٌتعرض‬ ‫أن‬ ‫دون‬ ‫إلٌها‬ ‫ٌحتاج‬ ً‫الت‬ ‫الجٌدة‬ ‫الصحٌة‬ ‫الخدمات‬ ‫على‬ ‫فرد‬ ‫كل‬ ‫ٌحصل‬ ‫أن‬ ‫الخدمات‬ ‫هذه‬ ‫تكالٌف‬ ‫تحمل‬ ‫جراء‬ ‫من‬ ‫مالٌة‬ ‫ضائقة‬ ً‫ف‬ ‫الوقوع‬ ‫لمخاطر‬ 31-Mar-18 www.SlideShare.net/AhmedRefat 18
  19. 19. Two Dimensions of UHC • Target 3.8.1 • Captures the coverage dimension of UHC (that everyone should receive the health services they need); • Target 3.8.2 • Captures the financial protection dimension of UHC (use of health services should not lead to financial hardship) 31-Mar-18 www.SlideShare.net/AhmedRefat 19Dr. Ahmed-Refat AG Refat
  20. 20. Custodian Agencies for UHC WHO is the designated custodian agency for both SDG 3.8 indicators, With the UNICEF, UNFPA* & UN DESA** for 3.8.1 and the World Bank for 3.8.2. * UN Population Fund ** UN Depart.of Economic and Social Affairs 31-Mar-18 www.SlideShare.net/AhmedRefat 20Dr. Ahmed-Refat AG Refat
  21. 21. The First Report 31-Mar-18 www.SlideShare.net/AhmedRefat 21Dr. Ahmed-Refat AG Refat
  22. 22. HEALTH SYSTEMS FINANCING The path to universal coverage 1st 31-Mar-18 www.SlideShare.net/AhmedRefat 22Dr. Ahmed-Refat AG Refat
  23. 23. UHC Cube 31-Mar-18 www.SlideShare.net/AhmedRefat 23Dr. Ahmed-Refat AG Refat
  24. 24. WHR 2010 ‫الصحية‬ ‫النظم‬ ‫تمويل‬ 31-Mar-18 www.SlideShare.net/AhmedRefat 24Dr. Ahmed-Refat AG Refat
  25. 25. Spending on Health Measures of Financial Protection Catastrophic Spending on Health • SDG 3.8.2. 31-Mar-18 www.SlideShare.net/AhmedRefat 25Dr. Ahmed-Refat AG Refat
  26. 26. Out-of-Pocket & Direct Payments 31-Mar-18 www.SlideShare.net/AhmedRefat 26
  27. 27. More health for the money 31-Mar-18 www.SlideShare.net/AhmedRefat 27Dr. Ahmed-Refat AG Refat
  28. 28. More health for the money Using resources wisely Efficiency 31-Mar-18 www.SlideShare.net/AhmedRefat 28Dr. Ahmed-Refat AG Refat
  29. 29. More health for the money Health-care systems haemorrhage money Using resources wisely 31-Mar-18 www.SlideShare.net/AhmedRefat 29Dr. Ahmed-Refat AG Refat
  30. 30. Inefficiency •It was estimate that 20–40% of all health spending is wasted through inefficiency. 31-Mar-18 www.SlideShare.net/AhmedRefat 30Dr. Ahmed-Refat AG Refat
  31. 31. Hemorrhage of Money Health-care systems haemorrhage money. More than half of the US$ 2 trillion-plus that the United States of America spends on health each year is wasted; 31-Mar-18 www.SlideShare.net/AhmedRefat 31
  32. 32. Hemorrhage of Money Health-care systems haemorrhage money. the annual global health expenditure of about US$ 5.3 trillion, about 6%, ($ 300 billion) , is lost to mistakes or corruption alone .31-Mar-18 www.SlideShare.net/AhmedRefat 32
  33. 33. Eliminate un necessary spending on medicines •Medicines account for 20–30% of global health spending 31-Mar-18 www.SlideShare.net/AhmedRefat 33Dr. Ahmed-Refat AG Refat
  34. 34. 31-Mar-18 www.SlideShare.net/AhmedRefat 34 Ten leading Sources of Health System Inefficiency Dr. Ahmed-Refat AG Refat
  35. 35. Ten leading sources of inefficiency Medicines: 1. underuse of generics and higher than necessary prices for medicines 2. use of substandard medicines 3. inappropriate and ineffective use 31-Mar-18 www.SlideShare.net/AhmedRefat 35Dr. Ahmed-Refat AG Refat
  36. 36. Ten leading sources of inefficiency 1. Medicines: underuse of generics and higher than necessary prices for medicines 2. Medicines: use of substandard and counterfeit medicines 3. Medicines: inappropriate and ineffective use 4. Health-care products and services: overuse/misuse of equipment, investigations and procedures 5. Health workers: inappropriate or costly staff mix, unmotivated workers 6. Health-care services: inappropriate hospital admissions and length of stay 7. Health-care services: inappropriate hospital size (low use of infrastructure)31-Mar-18 www.SlideShare.net/AhmedRefat 36
  37. 37. Ten leading sources of inefficiency 1. Medicines: underuse of generics and higher than necessary prices for medicines 2. Medicines: use of substandard and counterfeit medicines 3. Medicines: inappropriate and ineffective use 4. Health-care products and services: overuse or supply of equipment, investigations and procedures 5. Health workers: inappropriate or costly staff mix, unmotivated workers 6. Health-care services: inappropriate hospital admissions and length of stay 7. Health-care services: inappropriate hospital size (low use of infrastructure) 8. Health-care services: medical errors and suboptimal quality of care 9. Health system leakages: waste, corruption and fraud 10. Health interventions: inefficient mix/ inappropriate level of strategies 31-Mar-18 www.SlideShare.net/AhmedRefat 37Dr. Ahmed-Refat AG Refat
  38. 38. Switching to Generics costs to patients could be reduced by an average of 60% by switching from originator brands to the lowest priced generic equivalents31-Mar-18 www.SlideShare.net/AhmedRefat 38
  39. 39. Motivate people Health workers are at the core of a health system and typically account for about half of all health spending in a country 31-Mar-18 www.SlideShare.net/AhmedRefat 39Dr. Ahmed-Refat AG Refat
  40. 40. Improve hospital efficiency – size and length of stay 31-Mar-18 www.SlideShare.net/AhmedRefat 40Dr. Ahmed-Refat AG Refat
  41. 41. Medical Error Costs • Get care right the first time Medical error costs money & suffering. • One in 10 patients in developed countries is harmed while receiving hospital care. 31-Mar-18 www.SlideShare.net/AhmedRefat 41Dr. Ahmed-Refat AG Refat
  42. 42. WHO CHOICE 31-Mar-18 www.SlideShare.net/AhmedRefat 42
  43. 43. Assess which services are needed WHO-CHOICE (CHOosing Interventions that are Cost Effective) :provided guidance on the cost– effectiveness of a wide range of interventions in different settings 31-Mar-18 www.SlideShare.net/AhmedRefat 43Dr. Ahmed-Refat AG Refat
  44. 44. The Second Report 31-Mar-18 www.SlideShare.net/AhmedRefat 44
  45. 45. Tracking Universal Health Coverage: 2017 Global Monitoring Report 2nd 31-Mar-18 www.SlideShare.net/AhmedRefat 45
  46. 46. SDG # 3 Target 8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. 31-Mar-18 www.SlideShare.net/AhmedRefat 46
  47. 47. Service Coverage • The proportion of people in need of a service that receive it, regardless of quality 31-Mar-18 www.SlideShare.net/AhmedRefat 47Dr. Ahmed-Refat AG Refat
  48. 48. Service Coverage access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all 31-Mar-18 www.SlideShare.net/AhmedRefat 48Dr. Ahmed-Refat AG Refat
  49. 49. Effective Service Coverage •The proportion of people in need of services who receive services of sufficient quality to obtain potential health gains 31-Mar-18 www.SlideShare.net/AhmedRefat 49
  50. 50. Tracer Indicators & UHC Index 31-Mar-18 www.SlideShare.net/AhmedRefat 50Dr. Ahmed-Refat AG Refat
  51. 51. Tracer indicators Subset of indicators that represent overall coverage 31-Mar-18 www.SlideShare.net/AhmedRefat 51
  52. 52. 16 Tracer indicators of essential health services 1. Reproductive, maternal, newborn and child health 2. Infectious diseases 3. Noncommunicable diseases 4. Service capacity and access 4 X 4 = 16 Indicators 31-Mar-18 www.SlideShare.net/AhmedRefat 52
  53. 53. Tracer indicators : Reproductive, maternal, newborn and child health • 1. Family planning • 2. Pregnancy and delivery care • 3. Child immunization • 4. Child treatment 31-Mar-18 www.SlideShare.net/AhmedRefat 53Dr. Ahmed-Refat AG Refat
  54. 54. Tracer Indicators: Infectious diseases • 1. Tuberculosis treatment • 2. HIV treatment • 3. Malaria prevention • 4. Water and sanitation 31-Mar-18 www.SlideShare.net/AhmedRefat 54Dr. Ahmed-Refat AG Refat
  55. 55. Tracer Indicators: Noncommunicable diseases 1. Prevention of cardiovascular disease 2. Management of diabetes 3. Cancer detection and treatment 4. Tobacco control 31-Mar-18 www.SlideShare.net/AhmedRefat 55Dr. Ahmed-Refat AG Refat
  56. 56. Tracer Indicators: Service capacity and access • 1. Hospital access. • 2. Health worker density • 3. Access to essential medicines • 4. Health security (IHR) 31-Mar-18 www.SlideShare.net/AhmedRefat 56Dr. Ahmed-Refat AG Refat
  57. 57. Service Coverage Index • The UHC service coverage index is a single indicator that is computed based on tracer indicators to monitor coverage of essential health services. 31-Mar-18 www.SlideShare.net/AhmedRefat 57Dr. Ahmed-Refat AG Refat
  58. 58. UHC Service Coverage Index 31-Mar-18 www.SlideShare.net/AhmedRefat 58Dr. Ahmed-Refat AG Refat
  59. 59. At least half of the world’s population does not have full coverage with essential health services… Service Coverage Index 31-Mar-18 www.SlideShare.net/AhmedRefat 59Dr. Ahmed-Refat AG Refat
  60. 60. Service Coverage Index • The UHC service coverage index has a value of 64 (out of 100) globally ( Range 22 - 86 ) 31-Mar-18 www.SlideShare.net/AhmedRefat 60Dr. Ahmed-Refat AG Refat
  61. 61. Moving from the minimum index (22) to the maximum index (86) across countries is associated with 21 additional years of life expectancy after controlling for gross national income per capita and mean years of adult education. Service Coverage Index 31-Mar-18 www.SlideShare.net/AhmedRefat 61Dr. Ahmed-Refat AG Refat
  62. 62. •High UHC-index values are associated with high life expectancy, even after controlling for national income and education. Service Coverage Index 31-Mar-18 www.SlideShare.net/AhmedRefat 62Dr. Ahmed-Refat AG Refat
  63. 63. The UHC index is correlated with under-5 mortality rates (-0.86), life expectancy (0.88), and the Human Development Index (0.91). Service Coverage Index 31-Mar-18 www.SlideShare.net/AhmedRefat 63 Dr. Ahmed-Refat AG Refat
  64. 64. Specific Services 31-Mar-18 www.SlideShare.net/AhmedRefat 64
  65. 65. Specific Services • More than 1 billion people live with uncontrolled hypertension; • More than 200 million women have inadequate coverage for family planning; • and almost 20 million infants fail to start or complete the primary series of DTP-containing vaccine,31-Mar-18 www.SlideShare.net/AhmedRefat 65
  66. 66. SDG # 3 Target 8 Achieve universal health coverage, Financial Risk Protection. 31-Mar-18 www.SlideShare.net/AhmedRefat 66Dr. Ahmed-Refat AG Refat
  67. 67. Spending on Health Out-of- pocket health expenditures 31-Mar-18 www.SlideShare.net/AhmedRefat 67Dr. Ahmed-Refat AG Refat
  68. 68. Spending on Health Out-of- pocket health expenditures ( catastrophic ) when they exceed a given percentage (10% or 25%) of income or consumption . This is the approach adopted in SDG 3.8.2. 31-Mar-18 www.SlideShare.net/AhmedRefat 68Dr. Ahmed-Refat AG Refat
  69. 69. Financial Catastrophe • an estimated 150 million people globally suffer financial catastrophe each year • and 100 million are pushed into poverty because of direct payments for health services. • This indicates a widespread lack of financial risk protection 31-Mar-18 www.SlideShare.net/AhmedRefat 69Dr. Ahmed-Refat AG Refat
  70. 70. UHC Indicators ( Egypt & Some Countries ) 31-Mar-18 www.SlideShare.net/AhmedRefatDr. Ahmed-Refat AG Refat 68 26.2% 3.9%
  71. 71. UHC Index,2015 31-Mar-18 www.SlideShare.net/AhmedRefat 71Dr. Ahmed-Refat AG Refat
  72. 72. Incidence of catastrophic health spending: SDG 3.8.2, latest year 31-Mar-18 www.SlideShare.net/AhmedRefat 72Dr. Ahmed-Refat AG Refat
  73. 73. The Third Report 31-Mar-18 www.SlideShare.net/AhmedRefat 73Dr. Ahmed-Refat AG Refat
  74. 74. Research for Universal Health Coverage 3rd 31-Mar-18 www.SlideShare.net/AhmedRefat 74Dr. Ahmed-Refat AG Refat
  75. 75. EUROPEAN COMMISSION 2015 31-Mar-18 www.SlideShare.net/AhmedRefat 75Dr. Ahmed-Refat AG Refat
  76. 76. • Case-study 1 • Insecticide-treated mosquito nets to reduce childhood mortality …ma • Case-study 3 • Zinc supplements to reduce pneumonia and diarrhoea in young children……rct 31-Mar-18 www.SlideShare.net/AhmedRefat 76
  77. 77. • Case-study 4 Telemedicine to improve the quality of paediatric care…operational rs somalia • Case-study 5 New diagnostics for tuberculosis.. Valid ass 4 cout 31-Mar-18 www.SlideShare.net/AhmedRefat 77
  78. 78. The value of Health Research Exceptional returns 31-Mar-18 www.SlideShare.net/AhmedRefat 78Dr. Ahmed-Refat AG Refat
  79. 79. ‫االستثمار‬‫الصحية‬ ‫البحوث‬ ‫في‬–(‫العائد‬‫المجسي‬) Investing US$ 335 million. yielded about US$ 15.2 billion benefits to society after 10 years ) By valuing QALY &GDP) indicating a yearly return on investment of 46%. ‫سنوي‬ ‫عائد‬46%31-Mar-18 www.SlideShare.net/AhmedRefat 79
  80. 80. •The yearly rate of return in terms of GDP was 30% for all medical research in the UK ‫االستثمار‬‫الصحية‬ ‫البحوث‬ ‫في‬–(‫العائد‬‫المجسي‬) 31-Mar-18 www.SlideShare.net/AhmedRefat 80Dr. Ahmed-Refat AG Refat
  81. 81. • 300% of initial investment in cost savings for health Impact of biomedical research •in USA Impact of investment in research 31-Mar-18 www.SlideShare.net/AhmedRefat 81Dr. Ahmed-Refat AG Refat
  82. 82. Impact of investment in research More than 450 times the initial investment over 10 years • Clinical trials carried out by the National Institute of Health in the USA 31-Mar-18 www.SlideShare.net/AhmedRefat 82Dr. Ahmed-Refat AG Refat
  83. 83. • 37-39% Estimate of the impact of biomedical research in the biomedical sector in mental health and cardiovascula diseases in UK on reducton of mortality/morbility and on GDP Impact of investment in research 31-Mar-18 www.SlideShare.net/AhmedRefat 83Dr. Ahmed-Refat AG Refat
  84. 84. In Australia, finding that every 1 dollar invested in Australian health research and development yielded, on average, $ 2.17 in health benefits. ‫االستثمار‬‫الصحية‬ ‫البحوث‬ ‫في‬–(‫العائد‬‫المجسي‬) 31-Mar-18 www.SlideShare.net/AhmedRefat 84Dr. Ahmed-Refat AG Refat
  85. 85. 31-Mar-18 www.SlideShare.net/AhmedRefat 85
  86. 86. •At least half of the world’s population still do not have full coverage of essential health services. • . 31-Mar-18 www.SlideShare.net/AhmedRefat 86
  87. 87. •About 100 million people are still being pushed into “extreme poverty” (living on $ 1.90 or less a day) because they have to pay for health care. 31-Mar-18 www.SlideShare.net/AhmedRefat 87
  88. 88. •Over 800 million people (almost 12 % of the world’s population) spent at least 10 % of their household budgets to pay for health care. 31-Mar-18 www.SlideShare.net/AhmedRefat 88
  89. 89. Egypt
  90. 90. Egypt •‫عام‬ ً‫ف‬١٨٢٨‫م‬.‫افتتحت‬‫مصرٌة‬ ‫طبٌة‬ ‫مدرسة‬ ‫أول‬ •ً‫ف‬‫عهد‬ً‫عل‬ ‫دمحم‬‫انشئ‬“‫المجلس‬‫العام‬‫للصحة‬« ‫و‬‫هو‬‫مؤسسة‬ ‫أول‬‫صحٌة‬،‫الحدٌثة‬ ‫مصر‬ ً‫ف‬ ‫حكومٌة‬ ‫الصحة‬ ‫لوزارة‬ ‫نواة‬ ‫اعتباره‬ ‫وٌمكن‬. •‫عام‬ ً‫وف‬١٩٣٦‫م‬.‫إنشاء‬ ‫تم‬"‫وزارة‬‫الصحة‬» •‫عام‬ ً‫وف‬١٩٢٥‫م‬.‫تم‬‫حكومٌة‬ ‫جامعة‬ ‫أول‬ ‫إنشاء‬‫ومن‬ ‫بٌن‬‫كلٌة‬ ‫هناك‬ ‫كانت‬ ‫البداٌة‬ ً‫ف‬ ‫تأسٌسها‬ ‫تم‬ ‫كلٌات‬ ‫أربع‬ ‫للطب‬. 31-Mar-18 www.SlideShare.net/AhmedRefat 90Dr. Ahmed-Refat AG Refat
  91. 91. Egypt •‫بعد‬ ‫ما‬ ‫حقبة‬‫ثورة‬٢٣‫ٌولٌو‬١٩٥٢‫م‬. •‫تم‬‫تطوير‬،‫الصحية‬ ‫الرعاية‬ ‫نظام‬‫في‬‫رئيسيين؛‬ ‫اتجاهين‬ •‫األول‬‫هو‬‫التوسع‬ً‫الرأس‬‫المستشفيات‬ ‫وبناء‬ ‫التحديث‬ ‫خالل‬ ‫من‬ ،‫الخدمة‬ ‫تقديم‬ ‫لمنافذ‬ ‫التقني‬ ‫والتطوير‬ •ً‫الثان‬ ‫واالتجاه‬ً‫األفق‬ ‫التوسع‬ ‫هو‬‫خارج‬ ‫الخدمات‬ ‫مد‬ ‫خالل‬ ‫من‬ ،‫الريف‬ ‫إلى‬ ‫ووصولها‬ ‫الحضرية‬ ‫والمناطق‬ ‫المدن‬ ‫نطاق‬ •‫وكان‬‫تأسيس‬ ‫خطة‬ ‫الفترة‬ ‫تلك‬ ‫في‬ ‫الصحية‬ ‫المنجزات‬ ‫أهم‬ ‫بين‬ ‫من‬ ‫متكامل‬ ‫نموذج‬‫للتنمٌة‬‫المجتمعٌة‬‫من‬ ‫الصحٌة‬ ‫الوحدات‬ ‫تعمل‬ ‫الرٌفٌة‬ ‫خالله‬.‫الخطة‬ ‫هذه‬ ‫تنفيذ‬ ‫في‬ ‫البدء‬ ‫تم‬ ‫وقد‬‫في‬‫الخمسٌنٌات‬‫اسم‬ ‫تحت‬ "‫المجمعة‬ ‫الوحدات‬"‫قبل‬‫عدٌدة‬ ‫سنوات‬‫من‬‫إعالن‬"‫ألما‬‫آتا‬" (Health For All + Health in all + D (. 31-Mar-18 www.SlideShare.net/AhmedRefat 91Dr. Ahmed-Refat AG Refat
  92. 92. Number of Doctors per 1 000 people WHO Threshold (22.8) 31-Mar-18 www.SlideShare.net/AhmedRefat 92Dr. Ahmed-Refat AG Refat
  93. 93. Cited References 1. http://www.who.int/universal_health_covera ge/en/ 2. http://www.who.int/whr/2010/en/ 3. http://www.who.int/whr/2013/report/en/ 4. http://documents.worldbank.org/curated/en /640121513095868125/pdf/122029-WP- REVISED-PUBLIC.pdf 5. http://www.ghwatch.org/sites/www.ghwatc h.org/files/Health%20Report.pdf 31-Mar-18 www.SlideShare.net/AhmedRefat 93Dr. Ahmed-Refat AG Refat
  94. 94. ‫شكرا‬

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