الفهرس 
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Abstract
The purpose of this part of the final report is to
Int rodoce toe backgr o.:m<1.,. concept.s , •md proced ures ’of the
ECffij{ Urban Health Sector Assessment Project. and to
present II sU!I1OO.ry of findings, conclusions and
reCOll1!llendlilo,ns.
The Urban Heal th secror Assessment (lllSA - the Study) was
conducted by the Health Services Research Group of the
~perjlllental Center for Traini.ng Evaluation of Social
Programs (OCTOR). II research COOlsuHatiton group located in
the Inst l ture of Natioo”l Planning. in Egypt. The Stud)’ is
part of t’ile Egyptian Ministry of I!ealth’s Urban Health
Deliver)’ Project (lim&’- the Project), funded by USAlD in
Cairo.
ThelJIDp is desi$lled to modify ami upgrade Cairo ’5 existing
maternal and Child health and family planning services
delivery system. Specifically, the Project responds to the
health needs of low-im:,ome groups, particularly women of
chj]d bening age MO children under six years of age. The
~ISA study is intended to provide information useful to the
lJ-IDP in its planniJl\g/services 1l11prol’ement component. ’The
Study ••·•as funded by USAID in February. 198’0. Project
illJPlelllentHion began in May of that year, and was completa’l
in OCtober. 1982. Phase n. including design of methods.
data collection & anal)’s is & report preparat ion was of less
than one year’s duration.
The original rationale for the study, as stated ill the
USAJD Project Paper. was’ t.o fulfull ”the need for
undert.aking a hedth sector assessment for the greater
CBJiro area to provide a more scienti fic base for planning
the health service deli very system ••.•• (and) to help
rationalite heal til services wi thin these areas.” It was
also intended to introduce and eventually institutionalize
health servfces research as one llIeans of imprQvjng health
services delivery in Egypt.
The purpose of the 2.S year llISA study was to provide
information useful to the UlHDP and the Min.istry of Health
in its planning/service illlprollement component. The ltlSA
Study was conducted in two phases in three zones of Cairo:
Helvan South and ~est Cairo. (See l-laps 1, 2• .3 tor study
areas. ) Phase J of the study, conducted in fiebt.m , .•a••s a
• z -
pi lot test of bot” research lllethods and an OI’l1.anlzational
approach to conducting socha comprehensive hC<llth needs
as sessmerrt study in EgYl~t. Phase 11 was designed based on
ltnQwlcdge gained in HeJwan.
1hc prilllilry research question, focusiN! on maternal<tlld
child health, was:
”Who goes to what health care SOUTce, for ”,1’I;l.t ·teason, to
receive what service, at ••bat <::ost1” .
1Ms question was used as the basis for design of the study
methods and data collection instnments. It was derived
from the objectives of the WSA stl)dy, as stated in the
contract scope of ’’’lark, ”nd frQlll the results of Phase· I.
’The study objectives, aad their relationship to the metlloos
used io iIIlplernenting the project. are shown in Table 1.1-
In PhasE: J, a nlJnber of both traditional ana innovat i•e•..
data collection and Foil sea rch management methods .•e..r.e
desj !J,I1ed and tested. The intent W~$ to develop metnods and
data that could ulti.m;;tely be used by the Ninistry of
Health in planning health care policy ana progT<IJII$.
’Iberefore, the methods had to be replicable, and of
reJa.twely 10’i<l cost and short duration. Deta iIed records
were kept of the implet~lmtatioo process, in order to assess
the feasibility, utility, and appropriateness of the
metkods used, 111.05’e records provide an illoV:!Iloable set of”
data for use by the Mi~jst~ of Health and AID in planning
nealth services research projects in El::ypt. (Refer to the
project documents HSA/SR/Ol through HSA/SR/l~.)
Furthermore, 81gn if icant; data were collected on these
aspects of 1He in i1elwan that Could relate to health care
systems del’very and utilization of Maternal snd Child
Health (~’CH) serv ices in that area. Additional important
find i ngs also included health care needs Md treatment
behavior of the population, service deli very patterns, and
accessibility. (see: especially documents HSA/SRJO:5, (14 and
11 fordeUils of Phase I in Helwan.)
SUbsequent to data col Iect ion and analysis for Helwan. an
extensive review was Inade of the methods and stud)’
()r~anhation. and the research design for South ,lind !II’est
Cllro ”’3S devet oped based 0)1, tho exper iences in Helwan.
The target group (mothers of ddld-bea;rin~ a1e, and
children of six yeats and younger) rem3il’led the same, as
did assessment of the health care delhN~ry system pertinent
to the target group. l1owever, the methodoLogy was revised
in two lllajor ways:
1. fA contour approach was adapted for the two geographic
areas sefected for study in ”Phase II: lind
2.. The eleven task force groups were rcpl<lced by a single
multidisciplinary team.
See Part 1I Methodology far an overview of Ph.ase I
approaches and for Phase n methods lind approaches.
FOCI ,of Interest the study had several interrelated foci of interest:
I) providers fheafth workers} who deliver health services
in the formal lliJld Informal systems;
2) clients lIIho, use the services provided through the
fomal and in.formal health services delivery systems~
3) the community at large, including bealth services
users and non-users livini in the particular
sccto-econcenc, sccic-cul tura l , and urban-envi ronmental
setting under study; and
4) the hl!81th services and technologies available in each
of the f••ci lit.ies under study.
Bach of the groups and individuals provides or lilt UizeS· the
health care 5yst.em according to their background
chaTact.e’fistics (e.g., socto-econcedc and demographic
facrers), and the environmental conditions in which they
live and/or work. cne basic research question is: what
are the characteristics and conditions of the target
groups , and how do they affect health service
deliver-y!utilh.ation? Th.C potential and actual client.s and
providers are pIIrt of an interactive system whose study am
yield infordation that can be ~sed to improve health
services delivery such that the health needs of the target
group are met. The~. study was used to collect and
anal~e data regarding:
Socio-ec;:onomic., deracgraphic and attitudinal
characteristics to construct a profile ,of th,8 target
population (clients) and the proltiders