Well offs in Egypt in support to the bad offs

A review of the Health Sector Reform in Egypt shows that efforts are being exerted to improve the global health status of the Egyptian population. The right of access to quality health services should be the foremost among the rights for every citizen. A new Insurance Law, the legal basis of new the Health Model, is on its way for ratification in parliament.

Amina Khairy - Cairo, Al-Hayat

A survey carried out two years ago in Egypt shows that the population suffers from two main difficulties: low income and poor health care system. Established more that 45 years ago, the Health Care System endures today major problems: responding poorly to the epidemiological profile, ineffective referral system, low quality of services delivered, long waiting time at the doctor’s office, shortage of essentials medicines and, defective with regard the continuity of care…

In 1996, the Egyptian Ministry of Health and Population carried-out an overall reassessment of the healthcare system and recognized the need for a deep sector reform. The main weaknesses of the model in place were identified such as: the low quality of the public health service providers, the week integration of the health programmes (preventative, curative and health promotion), the overuse of specialized care services and finally, the huge gap exiting between type of health services provided and the expectations and needs of the population.

The reform of the health sector
As a result of this assessment, the Government of Egypt undertook a comprehensive reform of the Health Sector. The long-term goal of the new model foresees the separation of the regulatory, provider and purchaser functions. The health service provider (clinics and hospital), the purchaser of health services (health insurance) and the regulator body (Ministry of Health) will be clearly separated. Therefore, the reform encompasses: (1) a reinforcement of the MoH stewardship capacities, (2) an upgrade of the primary health care network provider, and (2) the establishment of an accreditation and licensing programmes to enforce international standards and norms of quality. It is expected that this new model, sustained by the new insurance law, will promote a better social solidarity.

The Egyptian health sector reform is today well engaged: (1) a new legal framework, the new Insurance Law, has been discussed with the stakeholders and is expected to be submitted to the approval of the parliament by the next session. It will definitively consolidate the new health model, (2) the public Primary Health Care provider network is being upgraded upon the Family Health Model. A National Investment Plan and an Accreditation Programme are being developed recondition and upgrade all the primary health care clinics.

In Suez governorate, a new management model with regard to the health service providers and the health insurance is being tested. The lessons learnt with this project appear to be very instructive for the design of the model to be replicated in the other governorates.

Dr. Youssef Boutros Ghali, Egyptian Minister of Finance, had stated that health insurance coverage will become broader and cover additional categories of people, who will have to contribute with a fairly low premium. For instance, non-working spouses, non-permanent workers, students who drop-out of schools as well as other categories of people who have not been previously included in the health insurance scheme will receive coverage under the new law. Better health services, an improved health administration will also be put in place.

The rich supports the poor
Programme Manager at the European Delegation in Egypt in charge of the Health Sector Policy Support Programme, Dr. Pierre Destexhe says that the approval of this law will provide a new impetus to the reform of the health sector. He adds that the Ministry of Health, the Ministry of Finance and the Ministry of Social Solidarity coordinated theirs efforts to design the future model for the health sector in Egypt. Dr. Destexhe is expecting that this new health model will provide an equal access to health services to the whole Egyptian population in accordance with their needs and not with their ability to pay. Dr. Destexhe wants to believe that the poor and poorest will not be victim of exclusion once the new model in place.
Dr. Destexhe noted that the preliminary estimation given by the Egyptian government estimated that the poorest segment of the Egyptian population, around 20% of the total population, will need a full governmental support for their health coverage. Another 20% of the population might require a partial support in accordance with their capability to afford the cost of the new health services.

Dr. Destexhe stressed on the importance of finding proper funding to guarantee the financial sustainability of the new health model providing that the quality of the health services and therefore their cost will increase. The sustainability of the new insurance scheme will be achieved only is enough resources are earmarked to the new system. New sources of revenues will have to be explored and especially to cover the expenses of the poor.

Dr. Destexhe explained that once the new system will be in place, the patients will have to first contact the “family physician”. When needed for diagnosis or treatment purpose, the primary health care medical doctor will refer the patient to a higher level of health care, such as health specialist. Today, most of the patients prefer to address directly the health specialist and by doing such, bypass the general practitioner.

Dr. Destexhe wants to be optimistic about the future development of the health care system in Egypt. Dr. Destexhe goes-on to say that Egypt made great strides in its health care system development during the last years. The remaining challenges are related to legislative issues, to management capacity and skills, and to financial assumptions and fiscal options. The new insurance law and the actuarial scenario are expected to provide solutions to overcome these difficulties. Within a 20 years perspective, the benefits of this new law should be generalized, likes to think Dr. Destexhe.

The European Union and the health sector in Egypt
In 1998, in order to provide assistance to the Egyptian Government in developing the health sector reform, the European Union carried-out the Health Sector Reform Programme. The programme, with a total budget of 110 million Euros, was developed in 5 governorates namely: Alexandria, Suez, Quena, Menoufea and Sohag. It supported the development of the Family Health Model. More than 125 clinics were rehabilitated, equipped and re-built, among which 71 clinics in Sohag, a governorate classified among the poorest of the country. The programme also included a training component to health care providers as well as a long term technical assistance to the sector.

Launched in 2006 with a total budget of 88 million Euros, the ongoing Health Sector Policy Support Programme is the second European Union intervention carried-out to support to the Egyptian health sector reform. The main objective of this second programme is to support develop the primary health care provider network rolling-out of the “Family Health Model”.
The main achievements of this programme are: (1) the endorsement of a National Health Investment Plan allocating 2.18 billion Egyptian pounds for the upgrade of 2.214 Primary Health Care units until 2010 (to date, 1478 health centers were upgraded, 350 are under construction and another 600 are under engineering evaluation), (2) The roll-out of an accreditation programme that enhances the quality of the health services in accordance with internationally approved health care standards.