Performance of the health sector in Egypt: policies and challenges
In addition to providing diagnostic, therapeutic and rehabilitative services, the concept of health care extended to include the concept of maintaining public health within the framework of human development for society. Health care depends on specific bases, such as Its availability to the citizen near his place of living and work with a certain quality, and his ability to obtain it and bear its costs in relation to his income.
The right of citizens to obtain appropriate health care must depend on their needs and not on their ability to pay the costs of this care, and therefore future strategies must be developed, taking into account population growth, the capabilities of the citizen and the state to achieve goals that cannot be waived for the citizen regardless of his financial ability.
This paper aims to identify the health policy in Egypt, strategies for its implementation, health sector indicators and the state’s efforts in the field of health care, and finally to present a set of proposals to activate health strategies in Egypt, through the following points:
First: Features of Egypt’s health policy
Second: Indicators on Egypt’s health sector
Third: The State’s efforts in the area of health care
Fourth: Suggestions for activating health strategies in Egypt
The paper’s results were as follows:
1- The total value of public spending on the health sector in the budget for the fiscal year 2021/2022 amounted to about 108.8 billion pounds, an increase rate of 15.3 billion pounds (or about 16%) over the allocations for the health sector in the fiscal year 2020/2021, which amounted to about 93.5 billion pounds.
2-The total number of the health insurance beneficiaries is 57 million citizens until 2020. The number of health facilities affiliated to the public and private sectors in Egypt is estimated to be about 2,034 in 2020, and the cost of developing the infrastructure and medical equipment in 18 model university hospitals, including departments and emergency hospitals, amounted to 2.7 billion pounds.
3- The cost of treating 2.9 million patients at the state’s expense at home during 2020 is estimated at about 8.9 billion pounds. The total cost spent on the presidential initiative to eradicate C virus and non-communicable diseases amounted to 3.8 billion pounds.
First: Features of the health policy in Egypt
Health in the 2014 constitution has a comprehensive perspective and is not limited to the health sector. In many of its other articles, it deals with the roles of various sectors outside the health sector in promoting the health of the population. It also shows the necessity of addressing health issues with a multi-sectoral approach as the main driver in the process of preparing health policy in Egypt.
The health policy in Egypt is based on:
- Coordination of policies between institutions and agencies of the health sector and other sectors whose functions and activities are related to public health.
- Strengthening basic health care services and providing them in disadvantaged areas to meet the basic needs of all segments of society, especially mothers and children.
- Expand the base of participation in the increasing costs of medical care.
4- Encouraging local production to meet the citizens’ needs of medicine, serums, family planning methods, and medical and laboratory supplies.
5- Developing information systems to support decision-making, preparing health plans and programs, following up on their implementation, and distributing available resources to governorates according to their needs.
6-Developing health human resources in all its categories, both quantitatively and qualitatively, and ensuring their good use and fair distribution to keep pace with successive scientific and technical developments and ensure quality performance.
Health strategies in Egypt depend on several main axes:
- Emphasizing the right of the Egyptian citizen to health and social care as a right guaranteed to him by the constitution.
- Commitment to national and international charters within a framework of humanitarian cooperation to serve children, women and the family
3-Positive participation in achieving the objectives of the state’s social and economic development plan
4- Emphasizing that health spending is an investment with a large income and that it is necessary to increase the share of the health sector in the state’s general budget to meet the basic health needs of the Egyptian citizen.
5-Emphasis on the fairness of specialized medical health services in the regions of Egypt, and the provision of basic health services to deprived areas, in order to facilitate the citizen and implement the directions of the state in the next stage.
The general strategy for the health sector is:
- Coordination and integration between ministries whose activities are related to public health to ensure raising the health level of the community.
- Raising the level of primary health care services preventively, curatively, and educationally, and achieving horizontal expansion in the provision of integrated services, especially in urban sprawl areas.
3-Increasing financial resources for the provision and development of health services, and directing available resources through international agreements to support preventive services and address priority health problems.
- Developing curative and urgent services, including specialized accurate services, and providing them at the regional level.
- Expanding health insurance services to cover new categories and developing service delivery systems.
- Expanding geographically the system of medical institutions to recover all or part of the expenses of the medical service.
7-Encouraging the role of civil and voluntary institutions and the private sector to complete some aspects of health plans.
- Raising community awareness of its positive role in maintaining the health of its members.
- Increasing interest in applied scientific research to benefit from its results in developing the health service, such as: health systems research, applied research and operations research to identify and analyze service performance problems, choose the most appropriate solutions, and evaluate their efficiency and effectiveness.
10 – Expanding the use of survey methods and indicators of disease prediction, especially among vulnerable groups, and quickly take the necessary measures to control them.
11- Improving the method of planning the development of manpower working in the health sector and linking the educational process to the needs of society
Second: Indicators on the health sector in Egypt
The health system in Egypt is characterized as one of the complex systems where there are multiple providers of health services, and is also characterized by multiple sources of funding, management and service.
The latest statistics of the Information and Decision Support Center of the Council of Ministers indicate that the total value of public spending on the health sector in the budget for the fiscal year 2021/2022 amounted to about 108.8 billion pounds, an increase of 15.3 billion pounds (or about 16%) over the allocations of the health sector in the fiscal year 2020/2021, which amounted to about 93.5 billion pounds, and the total number of beneficiaries of health insurance is 57 million citizens until 2020.
The number of health facilities affiliated to the public and private sectors in Egypt was estimated in 2020 to be about 2,034, and the cost of developing the infrastructure and medical equipment in 18 model university hospitals, including emergency departments and hospitals, amounted to 2.7 billion pounds. The cost of treating 2.9 million patients at the state’s expense at home during the year 2020 is estimated at about 8.9 billion pounds. The total cost spent on the presidential initiative to eradicate C virus and non-communicable diseases amounted to 3.8 billion pounds.
The rate of doctors is 2.8 per 1000 population in Egypt,which is better than what is available in MENA and GCC countries, while the nursing rate of 2.3 per 1000 population in Egypt is equal to that of the MENA region. However, with regard to the family rate 1.3 per 1000 population, Egypt differs significantly from some MENA countries, especially the Gulf Cooperation Council (GCC), which requires a large amount of investment to keep pace with regional standards. In general, Egypt not only needs to invest in healthcare infrastructure, but also needs to provide comprehensive health care based on technology to improve the quality of health care in the country so that it can compete with other countries at the regional and international levels.
The health care market in Egypt is largely dominated by the government and semi-governmental sector, which includes specialized medical centers in the public sector, government agencies and other entities, such as railways, universities, etc.,include 72% of beds although the private sector represents a proportion 63% of the total hospitals, and thus the largest player in the field, but it suffers from severe disintegration with the availability of only 31 beds for each private hospital, compared to 96 beds for each government hospital and 209 beds for each semi-governmental hospital. This provides great opportunities to achieve integration with the private sector through mergers and acquisitions.
The healthcare sector in Egypt – especially the private healthcare sector – provides many profitable opportunities for developers, investors and operators. However, the sector faces many challenges, such as rising capital costs and an emigration of qualified doctors and paramedical staff.
Third: State efforts in the field of health care
In its vision for sustainable development, known as “Egypt Vision 2030″, the country was keen to ensure the quality of the provided health services, and that all Egyptians enjoy a healthy, sound and secure life, through the application of an integrated health system characterized by availability, quality, and non-discrimination, and capability of improving health indicators by achieving comprehensive health coverage for all Arab and African citizens, including Arab and African women.
The comprehensive health insurance law was issued in 2018, aiming to provide all citizens with access to high-quality health care services. Accordingly, the state worked to establish three independent bodies to manage the comprehensive social health insurance system, whereby the system’s financing, service provision, and quality control were separated.
Following the Comprehensive Health Insurance Law, Law No. 151 of 2019 was issued regarding the “establishment of the Egyptian Authority for Unified Procurement and Medical Supply, the Department of Medical Technology and the Egyptian Medicines Authority.”
In July 2020, a draft of the Prime Minister’s decision regarding licensing the Egyptian Authority for the Unified Procurement and Medical Supply and the Department of Medical Technology was approved to establish a joint-stock company under the name of “Egyptian Company for Medical Investments”, with the purpose of supporting the activities of the Egyptian Authority and helping it in implementing its competence. These include transporting and distributing medical preparations managed by the Egyptian Authority, in addition to managing the system of strategic warehouses established by the Authority in partnership with state agencies and entities.
The state has taken a new step in terms of comprehensive health insurance to develop the health system and meet the medical needs of citizens in an integrated manner and at the highest level
The first phase of the “comprehensive health insurance” in all the governorates to which it is specified registered more than 5 million citizens, and about 51 hospitals and more than 310 health units and medical centers were established and developed, and more than 90 health facilities were approved. Since the launch of the system, the cost of developing the infrastructure and information in the health insurance system has so far reached more than 51 billion pounds, and more than 6 million health services have been provided, and more than 82,000 advanced surgeries have been provided in the governorates of the first phase.
The number of health insurance beneficiaries reached 57 million in 2020, compared to 50.5 million in 2014.
Accordingly, the state launched a number of family planning and reproductive health convoys in 7 governorates, as part of the “Our Days Are Better” initiative to provide family planning services and means to beneficiaries in disadvantaged villages and areas, in addition to the initiative to eliminate waiting lists under the slogan “100 Million Health” initiative, which aims To completely eliminate waiting lists for critical operations and surgeries, the estimated cost of the initiative amounted to about 6.2 billion pounds.
As well as the presidential initiative to eradicate hepatitis C and non-communicable diseases, which was launched in September 2018 and targets about 50 million Egyptian citizens. The prominent results of the initiative include checking up more than 60 m citizens whom were infected until June 2021, and the cost of the initiative amounted to about 3.8 billion pounds, in addition to the “Dignified Life” initiative, through which the state provided health services to citizens through medical convoys for the services of the elderly, children, and people with special needs free of charge in remote and areas deprived of health services at republic level.
The Egyptian state has adopted a phased plan to deal with the Corona pandemic, and the investment plan of the Ministry of Health and Population has strengthened increasing the capacity of hospitals to confront the emerging Corona virus. The state has exerted efforts to develop and equip central laboratories in the various governorates of the Republic; the most prominent of them are: Equipping 60 laboratories with all the necessary equipment and supplies to test the virus in all governorates. With regard to vaccination operations against the virus, the state has made distinguished efforts in this field.
As a result of the Egyptian efforts in the health sector, Egypt obtained an advanced evaluation at the level of the Middle East region in the Joint External Evaluation (IHR-JEE) of the International Health Regulations, which was carried out by a committee of international experts. It praised Egypt’s expertise and capabilities in the areas of public health necessary to implement the International Health Regulations.
Fourth: Suggestions for activating health strategies in Egypt
1-Achieving better and equitable health outcomes
2- Protecting and promoting health, ensuring access to basic health services for all, while protecting against the financial risks arising from spending on health.
3- Strengthening the role of the government in providing public health services.