On December 6, 2015, Egypt’s population officially reached 90m, according to a clock maintained by the government’s Central Agency for Public Mobilisation and Statistics. In a press release announcing the milestone, the statistics organisation’s president, Abu Bakr El Gendy, argued that the ever-expanding populace has exacerbated the many development challenges facing Egypt.
This dynamic is evident in the health sector, where a number of recently introduced programmes and policies – aimed at improving both access to care and service quality – have not come to fruition. Egypt’s volatile political environment is partly to blame. Numerous changes to the country’s leadership in recent years have made it difficult for the Ministry of Health and Population (MoHP) and related entities to push new policies through the government. However, the sheer size of the population is perhaps the sector’s biggest challenge moving forward. According to a late 2014 policy brief by the US-based Population Reference Bureau (PRB), “Egypt’s rapid population growth is putting pressure on the country’s economy and environment and is threatening the health and well-being of its people.”
In 2014-15 the MoHP made moves to address this issue head-on by introducing a raft of new policies. Most recently, in mid-November 2015 the minister of health, Ahmed Emad El Din Rady, announced that the country’s new social medical insurance law had been finalised by the MoHP and would be implemented after review by other relevant state entities. The new programme, which has been in development since at least 2013, is expected to have a far-reaching impact in terms of both availability and quality of care, particularly for lower-income Egyptians. “There will never be a thriving health care system in Egypt without comprehensive and real medical insurance,” said Minister El Din Rady during the televised announcement. Assuming the new policy is implemented fully and on schedule, the public health care system in Egypt is set to improve dramatically in the coming years.
Paradoxically, the steady enhancement of health outcomes over the past few decades has been a key contributor to the nation’s rising population burden. According to World Bank data, life expectancy grew from 48 years in 1960 to 71 years in 2012, while the infant mortality rate declined from 113 per 1000 births in 1980 to around 18 per 1000 births in 2012. Meanwhile, from 1994 through 2014, Egypt’s population expanded by 46%, according to the PRB, from 60m to 88m people. This growth spurt has not yet abated. The country’s 2014 fertility rate of 2.87 children per woman was well above the global average of 2.45, according to the Tahrir Institute for Middle East Policy, a Cairo-based non-profit organisation.
Health expenditure, meanwhile, has risen slightly, but has not kept pace with population growth. As such, in 2013-14, the most recent year for which data is available, the country’s total expenditure on health was equivalent to 1.23% of GDP, down somewhat from 1.26% in 2011-12 and 1.29% in 2009-10, according to the Multiples Group, a Dubai-based investment bank with operations in Cairo.
Total per capita health expenditure, meanwhile, has risen from less than $50 in 1995 to around $282 in 2014, according to Multiples Group. Though this represents a significant long-term improvement, the latter figure remains substantially lower than most other countries in the world today .
In 2014 only around half of Egypt’s total population was served by the country’s public health care system, according to government and World Bank data. Around 72% of all health care costs were paid for out-of-pocket by patients and their families. These figures can be attributed to a lack of capacity in the public health care system has risen as a result of the expanding population, supply has stayed basically the same, leading to steadily declining health care provision rates on a per capita basis. World Health Organisation (WHO) data shows that as of 2013 the country had five hospital beds per 10,000 residents, down significantly from 17.3 beds in 2010. Similarly, from 2010 to 2012 Egypt saw significant declines in the number of medical staff. During this three-year period the number of physicians dropped from 28 per 10,000 population to around eight; the number of trained nurses and midwives fell from around 35 to just under 14; and the number of pharmacists declined from around 16 to just over 2.
In mid-January 2014 a new constitution was approved by popular referendum, replacing the nation’s previous 2012 constitution. Article 18 of the new document guarantees the right to health and access to quality health care, in addition to mandating that the government allocate a minimum of 3% of GDP to health care expenditure. The stipulation, which marks the first time a minimum health care spend was named in an Egyptian constitution, has been widely commended by observers on the ground and around the world. At the launch of a white paper released by the MoHP in conjunction with the WHO in August 2014, Henk Bekedam, the WHO representative in Egypt, praised the document for acknowledging that many of the problems currently facing Egypt’s health care industry are the result of low health care expenditure on the part of the government. “The constitution, though, gives hope, as it defines the target for government health spending to be at least 3% of GDP,” Bekedam went on. “This would double current public health spending.”
The jointly authored white paper, which is entitled “Framing National Health Policy”, aims to translate the broad spending requirements and rights guarantees laid out in the constitution into an actionable and sustainable development plan. The document organises the challenges into four interrelated target areas. First is health financing, which the state aims to correct with the introduction of the social medical insurance law, plus a number of other new initiatives. To address the second issue, health information systems, the state is working with the WHO to revamp its health data collection, compilation and reporting standards. Plans to reform the health sector workforce – the third target area – are currently in development, with efforts under way to improve regulation, skill mix, pay, availability and management of human resources. Finally, in a bid to address the fourth target – health services – the WHO is ramping up its efforts to provide technical support across a range of areas, from laboratory facilities and bio-risk management to family health services.
The MoHP’s recently finalised social medical insurance law is a major step forward in improving the country’s health financing situation. According to the government’s State Information Service, around half of the country’s population is covered by basic government medical insurance, while 30% have private health coverage and an additional 20% have no coverage at all. However, in his November 2015 announcement, Minister El Din Rady cited a significantly higher figure. “Between 40% and 42% of Egyptians are in need of this medical insurance coverage,” he said, as reported by local media. “The state will cover their treatment expenses through this law.”
Alongside the new insurance policy, in late 2015 the MoHP announced several related initiatives. The ministry is in the process of establishing a new quality control authority, which will regulate and rank the nation’s hospitals and clinics on the basis of a range of metrics, including staff training and pay, infrastructure, efficiency and equipment quality. Only the top-ranking facilities are expected to be included in the new insurance scheme network. Other policy changes relate to compensation for infections in public health facilities and the pharmaceuticals sector.