Audit of Suez Canal area medical education and health services development, USAID/Egypt project no. 263-0136

Audit report covers the period 3/80-5/85 and is based on document review and interviews with USAID/E, Egyptian, and Boston University (BU) contractor personnel. The project"s unique medical education program of placing university medical students in MOH health clinics - which has been replicated at Menoufia University - as well as renovation of the clinics has improved health care in three of the five designated governorates. The North and South Sinai governorates have not yet been covered, however, because SCU/FOM resources were inadequate and because the bedouin environment of the two governorates required a different approach than the industrial, agricultural, and commercial environments of Suez, Ismailia, and Port Said, respectively. Instead of developing a comprehensive plan to supplement clinic-based training with other Egyptian and U.S. training, BU has prepared short-term plans which heavily favor SCU staff and do not specifically meet the health needs of the Sinai governorates. BU also failed to help the FOM develop an organizational design and a detailed management plan by 7/85; this, however, was due to legal restrictions unanticipated by project planners. As a result, the FOM has continued to operate under a management system not particularly suited to the project"s needs. Despite the grant agreement prohibition, BU used project funds to make $126,136 in incentive payments to FOM staff who participated in the Group Practice Plan. These payments, for which the Government of Egypt (GOE) was responsible, were made on the basis of an understanding with A.I.D. officials but without written approval from USAID/E. Finally, USAID/E did not account for or receive reports on expected GOE contributions totaling $55.4 million. As a result, USAID/E may have financed certain costs that were supposed to be covered by the GOE. Recommendations aimed at solving these problems are included.