Introduction
Globally, the forms of governance and public administration differ distinctively, and especially when one considers the state of growth and development between different nations. From the international perspective, there exists a difference in the manner in which nations across the borders, control and administrate the functions of the public health systems (Gericke, 2005). With the prevailing economic challenges and instabilities between nations, the public administrations on the matters of public health systems often differ across the underdeveloped, developing, and the developed nations (Gericke, 2005). Most probably, how the European nations control their public health systems, differ from the way the developing nations within the Sub Sahara Africa and Asia, handle their public health systems (Gericke, 2005). In light of the above issues, this essay seeks to examine the major similarities and differences between the public health systems of England and Egypt, and especially on the issues that relate to centralization, decentralization, and the monitoring of agents that provide health services.
Centralization and Decentralization
Centralization is a governance process in which the processes of coordinating and controlling the activities of a government or an organization remain monitored by particular people in designated national places (Gericke, 2005). In pertinence to the public health administration, centralization is the process of running the public health systems in a manner that the functions of controlling, monitoring and planning of the public health systems are within certain administrative systems (Saltman, Bankauskaite, & Vrangbaek, 2009). In the public health administration, centralization stands for the public health systems, where the government or the state employees and the leaders are responsible for monitoring, coordinating, and evaluating the activities and functions of the public health systems, including having the authority on the fiscal decisions (Saltman, Bankauskaite, & Vrangbaek, 2009). Although the centralization process has the basic systems of functioning, how nations across the world carry out centralization of their public health systems differ from one country to another.
Decentralization as an administrative process is how a government or an organization coordinates and monitors its activities through several sectors and departments within the local governments and the local authorities (Saltman, Bankauskaite, & Vrangbaek, 2009). To the public health administration, Saltman, Bankauskaite, and Vrangbaek (2009), state that decentralization of the public health systems is the process by which the central government gives the local governments and authorities the overall mandate to oversee the activities and functions of the local health units. In this form of governing the public health systems, the local government and their employees have the controlling capacity and authority over the fiscal decisions (Saltman, Bankauskaite, & Vrangbaek, 2009). Decentralized public health systems run within the local governments and local authorities, where specific the local government oversees the functions of the public health systems and monitors the involvement of the public health officials.
Decentralization of England’s Public Health Systems
Compared to the Egyptian public health system, the public health system of England has been serving on a decentralized form of public health administration. Given the financial stability of the British government, the ability to reform and establish independent platforms that monitor and govern the public health systems has enabled the British government to establish decentralized public health systems (Bartelli, 2012). The public health system of British is overtly in a decentralized form, with most of its functions controlled by the local governments and the local authorities. Within the public health system of the British government, several aspects of decentralization are available to distinguish between the administrative form of England and Egypt (Bartelli, 2012). The British government has put several measures that support the process of decentralizing public health systems. The discussions below will create further comparisons between the British and the Egyptian public health systems.
Administrative Decentralization: Decentralized Policymaking in Britain
The government of the United Kingdom has systematically devolved the management of public health systems. Compared to their counterparts in Egypt, the British government has devolved the public health systems and empowered the local leaders to make crucial policies and regulations that support the growth and development of the public health systems (Saltman, Bankauskaite, & Vrangbaek, 2009). In England, there are smaller administrative units in the local governments that are responsible for policymaking and project monitoring within the local administrative offices. Contrary to the Britain public health systems, the Egyptian public health administration depends on the health care decisions made from the national government levels, where officials from the central government sit and formulate policies (Gericke, 2005). The British government has subunits and sectors of the public health systems that work in a devolved manner to establish health care centres, recommend on the various funding processes, and oversee the functioning of the local hospitals, and the distribution of public health facilities.
When it comes to issues that pertain to policymaking in the public health sector, Egypt operates on a centralized public health administrative system. According to Gericke (2005), since the public health system of Egypt serve under the state-based centralized administrations and structures, most of the decision-making and policymaking activities happen around the upper sections of the central government of Egypt. Leaders within the Ministry of Health Affairs and especially those under the governorate level are responsible for overseeing the functions and responsibilities of their younger officials, who are either within district departments or within the local administrative units (Gericke, 2005). The leaders in the lower and local administrative units report through the hierarchical order and wait for the decisions and policies enacted within the governorate levels and other higher departments of the central government. Each level of the public health sector reports to its respective upper level, where it receives its health practice resources and instructions.
Administrative Decentralization: Policy Implementation
Decentralization in terms of administration also consists of issues that pertain to policy implementation. The two nations, England and Egypt, have some distinctiveness in the manner in which they implement the projects and decisions that associate with the public health systems. In the British public health systems, administrative decentralization comes in the form of decentralized administrative units that take the responsibility of implementing the major reforms, policies, and decisions that the local governments have agreed upon with the central government (Saltman, Bankauskaite, & Vrangbaek, 2009). In the United Kingdom, the independent subnational departments within the local administrations often rely on the decentralized policy implementation processes and structures to implement the strategies, projects, decisions and plans that the local government and the decentralized units have agreed upon, and have informed the national government (Saltman, Bankauskaite, & Vrangbaek, 2009). The local governments have effective mechanisms for the coordination and implementation of all the necessary processes and decisions made within the local governments.
In the Egyptian public health systems, the implementation of the public health decisions, projects, strategies, and plans is so much different compared to their British counterpart (Gericke, 2005). Egypt has a heavily centralized public health system, and policymaking within the public health systems is normally the work of the State health officials, who work closely with the central government (Gericke, 2005). The central organizational structure is responsible for administering and implementing policies that deal with the planning, supervision, and program management within the public health systems. In policy implementation, the central government deals with the execution of the administrative and finance decisions, curative health services, preventive and basic health services, population and family planning, as well as the ministerial functions that deal with the public health concerns (Gericke, 2005). The specific department responsible for most of these functions is the Egyptian Ministry of Health and Population (MOHP), which is the provider, regulator, and policymaker of the public health systems.
Fiscal Decentralization: Budgetary Planning and Control
One of the important elements of the public health administration in the planning and control of the financial matters, and especially the health care expenditures and the overall budget. The public health systems of the two nations probably rely on funding and financial support from their central governments, where most of the financial decisions and policies for revenue allocation occur (Gericke, 2005). Nonetheless, most of the fiscal activities that relate to the public health administration differ between the two nations. In the heavily centralized Egypt, the Ministry of Health and Population (MOHP), has the overall mandate of budgeting, planning, financing, revenue allocation, and monitoring of other financial functions straight from the ministerial level (Gericke, 2005). In Britain, although the public health systems similarly rely on the donations from the central government, the government has some decentralized structures such as the National Health Service (NHS), which is an independent health unit that is responsible for controlling its budget through the Public Health England (PHE).
Unlike in Egypt where the national government controls the public health budget, the independent executive bodies of the British National Health Service, such as the Clinical Commissioning Groups, control most of their financial matters (Gericke, 2005). In England, the government only controls the public health expenditures through the department of health that coordinates a few projects and services that the central government owns. The independent National Health Service of the United Kingdom is responsible for purchasing, planning, regulation, and other financial matters on behalf of the secretary of the State. In comparison to the Egyptian health system, Gericke (2005), states that the Egyptian State runs the private and government sectors, and the MOHP, has the largest controlling share of making decisions that pertain to budgetary allocation, revenue distribution, and finance planning. However, both nations have the national treasury departments that are under the central governments, and which are responsible for releasing funds to the respective public health administration units.
Contrary to their England counterpart, the issue of the centralization of the public funds is a chronic problem in Egypt. Although the Egyptian government offers the national departments a substantial amount of funds to run the public health administration, there is a problem of proper planning of the funding strategies. According to Gericke (2005, p.1081), “the fragmentation and subsequent lack of coordination of the Egyptian financing system result in strategic behaviour among provider institutions.” The Egyptian government has failed to coordinate the financial activities in the manner in which the stakeholders and the health officials can understand the allocation of funds, the budgetary control, the revenue allocation, and the distribution of equipment that support in the progress of the public health (Gericke, 2005). Aside from the poor arrangement of funding activities, the management of funds seems fragmented within the 29 different public agencies. Such arrangements affect the efficiency of funding and risk management efforts.
Political Decentralization: Political Frameworks and Public Health
When comparing the public health system of England and Egypt, it is important to examine how the political frameworks work, and how the governments have centralized or decentralized the public health systems politically (Bartelli, 2012). Political decentralization can refer to how a government makes a set of constitutional reforms and amendments to devolve political authorities to the sub-national departments (Bartelli, 2012). England generally works on a decentralized political framework and the government has subunits of administration that operate through the political structures. The mayors and the governors have an indirect impact on the political-administrative connection because they form the set of institutions formulate, organize, and implement the collective objectives and goals set out by the central and local administrative units (Bartelli, 2012). The British mayor has the powers and responsibilities that relate to the issues of allocating public land or public properties for the development of the public health systems.
The England cities are under the leadership of mayors, who are the principle leaders or the Chief Executive Officers, who run important administrative and fiscal activities of the nation (Bartelli, 2012). The mayors are responsible for administering and preparing the annual expenses of the cities, the budgets, and financial plans. Such involvement of the mayors has a direct impact on the revenue allocation for the local governments. Things are a little bit different in Egypt as the structuring of the national government and the local governments differs from that of the British government. In Egypt, the utmost priority of the government in terms of the political arrangements in the public health department lies within the structures of the Ministry of Health and populations (MOHP), which is a subunit of the central government (Gericke, 2005). In the Egyptian political framework, all the important matters of public health administration are under the Ministry of Health and Populations (MOHP).
The only manner in which the Egyptian public health administration resembles that of England is the way the Egyptian government allows the democratic selection of the top government officials, who are paramount in policymaking (Bartelli, 2010). Although democratization is slow in Egypt due to the socialite leadership, the present Egyptian government is working towards the restructuring of the government units to accommodate the plans of decentralizing the central authority into the devolved systems (Gericke, 2005). The public workers in the department of health have made efforts to establish independent political units that support the shift from the central authority towards the devolved public health systems. In terms participating in the activities of the local authorities, Gericke (2005) postulates that Egypt has begun to establish local frameworks that support the involvement of the public health officials in the matters that relate to the selection of their representative members to participate in the discussion of local public health concerns.
Political Decentralization: Choice of Leaders and Command Chain
The public health administrations of the two nations rely heavily on the stability of the political frameworks that directly affect the provision of public health. Choice of leaders, therefore, influences the provision of public health and the running of authorities that directly affect the operations of the public health system (Gericke, 2005). In the United Kingdom, the political frameworks that support the progress and development of public health systems have a connection with the National Health Service. The independent National Health Service makes important political contributions because the involvement of the health and wellbeing boards and the Public Health England (PHE) is very significant (Saltman, Bankauskaite, & Vrangbaek, 2009). The Health and Wellbeing Boards (HWBs), which are part of the local government authorities, often assemble the departments of the NHS, the local health systems, and the public health administration, to plan on how to satisfy the local health demands and how to help air the voices of the patients.
The Health and Wellbeing Boards (HWBs), comprises of the locally elected representatives, the Health-Watch representatives, the local representatives of CCG (Clinical Commissioning Groups), directors of the Adult Social Services (LGA), and the directors of public health (Saltman, Bankauskaite, & Vrangbaek, 2009). These groups of individuals, who sit on the HWBs, are influential in making the important political decisions that support the wellbeing of the public health systems. The Britain political system is incomparable to that of Egypt. The heavily centralized Egypt has a different political structure that gives the central government great autonomy over the public and local health systems (Gericke, 2005). Most of the political structures that support the development of the public health systems of Egypt are under the frameworks of the central government, where the overall command occurs. Various departments and ministries under the central government are responsible for selecting leaders, who implement and control the policies and regulations of the public health service.
Monitoring of Agents that Provide Health Services
The national governments of England and Egypt have merged efforts with several other governmental and private institutions to provide health services to their people. Although the central governments of the two nations have direct influences on the arrangement and planning of the public health systems, the delivery of health care is a sensitive matter that requires the involvement of other internal and external agents (Bartelli, 2012). However, due to centralization and decentralization arrangements between the two nations, the actions of monitoring these public health service providers often differ. In both nations, the agents that provide health services include the Health Insurance Organizations, Private Voluntary Organizations, the Nongovernmental organizations, and several other institutions and sub-institutions (Bartelli, 2012). Most predominantly, the central government of Egypt is responsible for monitoring the agents of providing health services, whereas the local authorities of the British government are responsible for monitoring the agents that provide health services.
Monitoring of health service agents in England: Governmental Sectors
England has several public, sub-national and private authorities that work within the national government and the local authorities to oversee the functioning and progress of the health service providers (Saltman, Bankauskaite, & Vrangbaek, 2009). The government legal frameworks and structures have a critical contribution to the monitoring and evaluation of the public health service provides. In the United Kingdom, the process of ensuring accountability of the agents that provide public health in England is complex, although a great connection exists between the state officials, the local authorities, and the independent bodies that regulate the administration and functioning of the public health departments (Saltman, Bankauskaite, & Vrangbaek, 2009). England has provided local structures and public structures that monitor and evaluate the activities of the health service providers. From the top, four major departments of the central government enjoy some unlimited sovereignty. The NHS England, the Public Health England, the Trust Development Authority and the Health Education England, are some of the main entities of the central government.
In England, the monitoring of the agents of public health that provide public health services is the responsibility of all the organizations found within the public departments and within the local authorities (Saltman, Bankauskaite, & Vrangbaek, 2009). Below the four major units of control, there are subunits such as the commissioning support unit, the clinical commissioning groups, the health-watch local, and the local authorities. The four subsections that exist in each devolved system have the responsibility of overseeing the agents of public health within the departments of Secondary Care, Community Services, Mental Health Services, the Rehabilitation Services, and the Local Public Health Services (Saltman, Bankauskaite, & Vrangbaek, 2009). Each of the agencies is responsible for delivering the public health services by the set regulations and the conditions that the top officials of the departments have agreed. The chain of command runs from the top of the department of health, which mostly comprises of the locally appointed representatives, to the lower health care agencies.
The decentralization of the British public health department is eminent through the monitoring of the lowest subunits such as the primary care agencies, the specialized services agencies, the offender healthcare agencies, the armed forces healthcare agencies, and the agencies that deal with the immunization and screening of young children (Saltman, Bankauskaite, & Vrangbaek, 2009). Although the central government takes part in the monitoring and evaluation of the agencies of public health services, their involvement is normally indirect through the four representatives of the HWBs. Monitoring of the public health service providers in England also involves four major sub-national departments that oversee, report, and recommend on the way forward (Saltman, Bankauskaite, & Vrangbaek, 2009). The four sub-national units include the Trust Development Authority, the Health-Watch England, the Monitor department, and the Care Quality Commission. These subgroups monitor the progress of the health service agents in terms of following the practice guidelines, legal principles, working within the desired budgets, and proper reporting of health care concerns.
The involvement of the British central government in the matters that pertain to the monitoring of the agents that provide public health services is normally indirect, and through the structures of the National Hospital Services (Saltman, Bankauskaite, & Vrangbaek, 2009). Through the Secretary of State for Health, who bears the responsibility of monitoring the progress of the departments of health, the central government of England oversees the work of the public health agents (Saltman, Bankauskaite, & Vrangbaek, 2009). Below the frameworks of the central government are some of the officials that work closely with the state as well as the local authorities, in ensuring that the agents of providing public health services are accountable. Below the State Secretary of State for Health are the Chief Medical Officer, the National Medical Director, the Chief Nursing Officer, and the Chief Professional Officers (Saltman, Bankauskaite, & Vrangbaek, 2009). They formulate policies and regulations that impact and control the actions of the public health service agents.
Monitoring of the Nongovernment Agents in England
Concerning how England and Egypt monitor their nongovernmental organizations, their practices differ. Apart from the established government structures, the National Health Service of England collaborates with other private organizations that are also accountable in their service provision responsibilities (Saltman, Bankauskaite, & Vrangbaek, 2009). Developed through the Health and Social Care Act 2012, the 211 Clinical Commissioning Groups (CCGs) have an important role in the monitoring of how the agents undertake their responsibilities in the public health sector (Saltman, Bankauskaite, & Vrangbaek, 2009). These commissioning groups are powerful subunits in the public health department because they are capable of monitoring the voluntary and private sectors. The private insurance companies, the professional health organizations, the nongovernmental organizations, and other health care providers are under the structures of the local authorities. The local structures govern the distribution of services, the allocation of finances, and the functioning of the sub-national sectors.
In matters that concern the use of funds and the allocation of funds by the nongovernmental organizations, the decentralized systems of the British government have allowed important procedures of monitoring to take place within the local establishments (Saltman, Bankauskaite, & Vrangbaek, 2009). According to the National Health Service, Monitor is the finance regulating body that controls the foundation trusts to ensure that the NHS Foundation Trusts are operating in the desired manner, the private organization are stable and cooperating, and the public service agents are operating with quality and efficiency (Saltman, Bankauskaite, & Vrangbaek, 2009. The Monitor department often analyzes the working capabilities of the agents, their commitment to the provision of health services and their efficiency in service provision.
Monitoring of Agents that Provide Health Services in Egypt
Monitoring of public health providers is almost the same in Egypt, although it is under the centralized systems. Although the MOHP is responsible for monitoring, evaluating, financing, budgeting, planning and resource allocation, the government local subunits highly contribute to the monitoring of the agents that provide public health services (Gericke, 2005). The Egyptian government has major frameworks such as the Health Insurance Organization (HIO), the Curative Care Organizations (CCO), and the General Organization of Teaching Hospitals and Institutes (THO), which are responsible for monitoring the public service providers within the local frameworks (Gericke, 2005). Even though the national government and the systems of the central government are responsible for monitoring the major activities of the public health service providers, the three sub-independent departments are active in the monitoring and evaluation processes (Gericke, 2005). Through the established local frameworks and public system, the three departments often coordinate some important activities that associate with the monitoring of the health agents.
Several departments of the Egyptian national government have their frameworks developed into the local governments to monitor, evaluate, and analyze the operations of the agents that provide the public health services (Gericke, 2005). The public regulatory agencies under the umbrella of the MOHP have the powers to executive duties of the central government that pertain to the public health services. Since the structure of the health systems operates on a vertical arrangement, most of the orders come from the central government under the responsible ministries, to the local governments (Gericke, 2005). The service providers registered under the MOHP, often work under the frameworks of the central government of Egypt.
The central government has rooted its structures all through, from the national department of health under the MOHP, into the regional authorities. The agents of health such as the private insurance companies, the health service unions, the professional organizations, and the non-governmental organizations are answerable to the systems established by the central government (Gericke, 2005). The performance of the hospitals, the pharmaceutical companies, and other medical institutions are under the nationally led institutions such as the provincial health departments and the district health sectors. Such arrangements affect the effective communication of the health care concerns that the agents have reported, affects the equal distribution of health resources, the allocation of revenue to the agents, and distribution of medical equipment W(Gericke, 2005). The control and monitoring of the health care agents from the central government units affects the efficiency of the healthcare service provision, the communication of health care problems, and the channelling of the solutions from the central government.
Conclusion
When it comes to matters that concern the management of public health systems within the nations, there are clear margins in the manner in which the developed nations operate, and how the developing and the middle-income nations operate. Egypt is one of the gradually growing middle-income nations of Africa that have a perennial problem of centralizing the public health administration. When compared to England, the form of public health administration seems centralized and the decisions concerning the control, monitoring, financing, budgeting, and revenue allocation lies within the mandate of the central government. In England, the government has delegated most of the primary functions of the public health department to the locally formed frameworks that work closely with the local authorities to ensure that the devolved health activities are working as per the expectations of the government. In comparison, the England health department seems more organized in terms of delivering health services to needy people within the local regions.
References
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Saltman, R., Bankauskaite, V., & Vrangbaek, K. (2009). Decentralization in
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