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The health facility should have a system to maintain the accuracy and validity of data and reporting, complete and accurate medical records, with a system for reviewing medical records, and a system to ensure that all records are confidential.

The facility has a system to monitor and improve the quality of care; the facility should have a committee or team assigned who studies MBA for improving the quality of care at the facility, with an assigned QI coordinator whose role is to conduct QI related work. The facility should have an annual QI plan with Priorities for improvement, Implementation plan with timeframe, assigned responsibilities for implementation including process improvement teams and committees and operating budget included.  There should be a system to develop, adopt, and disseminate clinical practice guidelines for priority clinical areas and procedures provided at the facility. There should be a system to develop, adopt, and disseminate clinical practice guidelines for priority clinical areas and procedures provided at the facility. There should also be a system to review the use of drugs and/or antibiotics. Staff should also receive regular trainings on QI.

The MBA facility should have a prevention program; an effective dissemination program to educate its staff about disease and accident prevention, and screening for illnesses such as diabetes, hypertension, asthma, accidents among children, cancer. The facility should have effective communication to make its patients aware of what they can do to prevent and reduce illnesses. It is essential to maintain Continuity of care; through arrangements with public health, educational and social service organizations and ensuring that patients are seen by the same family doctor over a certain period of time.

Another important aspect in MBA is the referral system, the facility should have a well-defined system for referrals, with a written referral policy that is communicated to all providers together with a list of referral facilities and/or specialists available and known by physicians. All providers should use the referral forms to hospital and specialists and keep good record of the number of referral cases.

Any health facility should have a clear mission statement developed and agreed upon by staff, a clear organizational structure with clear lines of authority, A full time director assigned to manage the facility with a clear written job description. The facility director should have appropriate training in health management and participates in continuous education programs. There should be written job descriptions for all positions in the facility which are clearly communicated to all staff. There should be a clear system/process for coordination and communication between the director and the staff.  There should also be a fair system of assessment for employees’ performance. There has to be an adequate number of staff and distribution by specialty.  An orientation program for new comers should be in place, together with a system for continuous education for current staff through trainings in different key areas: At least 80% of providers trained in clinical practice guidelines, At least 60% of providers trained in IMCI, At least 60% of providers trained in Family Planning, At least 80% of staff trained in infection control and At least 80% of staff trained in interpersonal skills and client satisfaction.

Based on the above national standards of health services, Cairo currently has two sets of public primary health care facilities; accredited and non-accredited. The accredited facilities are the ones partially (75%-85%) applying the national standards mentioned above, while the non-accredited are still not applying the national standards as indicated by the Egyptian Ministry of Health and Population. Since all accredited clinics are only partially complying with the national standards, an accreditation period varies from one and half to two years, after which accreditation is expired and needs to be renewed.

Performance evaluation is a standard process undertaken in all governmental jobs and needs an MBA qualifications. The annual performance evaluation process is just a routine process that does not have in reality a direct effect on the promotions or career enhancement for employees (although it should). It is not conducted in a dialogue form, wherein the supervisor evaluates the staff, then the staff comments and discusses with the supervisor, on the contrary the supervisor fills in the evaluation form, sends it to the second level supervisor, then to the health directorate and then the staff gets a copy after it is finalized. According to health workers, the only use for performance evaluation form is if someone wants to apply for a certain study or apply for a managerial position, but other than that it does not affect the monthly appraisal or increase the possibility of promotion of staff member. Promotions are prepared by schedules from the Ministry of Health and in groups not individual.  Usually the performance evaluation is filled for all employees indicating “excellent” performance with very rare exceptions.