Embedding a clinical governance framework within Egypt's health insurance system

Since the enactment of the universal health insurance law in 2018, Egypt has undertaken major health system reforms. In 2021, the Egypt Healthcare Authority introduced a clinical governance framework to improve the quality and safety of health care services.

To describe the implementation, early outcomes and lessons learned from introducing a clinical governance framework in Egypt between 2021 and 2024.

We implemented the clinical governance framework in 29 hospitals and 301 family health units across 6 governorates, serving approximately 5 million beneficiaries. Activities included training and on-site technical support. Key performance indicators were monitored and analysed to assess implementation outcomes.

A total of 494 treatment protocols were developed across 28 medical specialties and more than 5000 physicians were trained to apply the protocols. There was an increase in the detection and timely correction of adverse events in the majority of cases. In Port Said Governorate, 82% of medication errors were detected and corrected in 2023, 84% in Ismailia Governorate and 70% in South Sinai Governorate. In 2024, the percentage of medication errors decreased by 27% in Port Said Governorate and 11% in Luxor Governorate. Hand hygiene compliance increased to 85% in 2024 from 78% in 2023, and surgical site infections decreased to 0.83 from 5 per 100 surgeries.

Despite certain challenges the introduction of a clinical governance framework contributed to improved safety and clinical outcomes in selected facilities. Political commitment and integration within existing structures were crucial to success.