The purpose of this page is learning, information dissemination, and scientific debate for those interested in Egypt's public health and its linkages to human development and social justice. In doing so, this page is committed to have a neutral stand and to present all views equally. This blog is based on the work of different experts in their field.

Wednesday, January 25, 2012

Improving Health Outcomes of the Poor – A Social Justice Agenda for Egypt

Health outcomes are usually measured in terms of the ability of health systems to introduce improvements in three areas: (i) health status; (ii) financial protection; and (iii) client satisfaction and dignity.  The challenges related to these health outcomes reflect an attention and priority to be provided to the poor and those potentially who could fall in poverty, an opportunity for adoption of a social justice agenda.

These challenges, which mainly indicate unfairness to the least advantaged group of the society, could be shortly summarized as follows:

In terms of health status, inequity that could be observed in disparities in achieving MDG 4 (child mortality) and MDG 5 (maternal health) across geographic regions and income quintiles.  Inequity is demonstrated by the persistent prevalence of high level of stunting, strongly linked to poverty. With the expected increase of non-communicable diseases and the high prevalence of hepatitis C, the burden of disease is expected to increase on Egyptians, especially the poor and probably would drive more people into poverty.

In terms of financial protection, the inability to protect the Egyptians from the impoverishing effects of health expenditures especially against catastrophic illness is significant.  This is presented by coverage of about half of the population with Social Health Insurance (SHI), inequity to access to Program for the Treatment on Expense of State (PTES), and that three fourths of total health expenditure is out of pocket.

In terms of client Satisfaction and system responsiveness, a nationwide dissatisfaction with the health care system presented by the high utilization rates and number of visits at private sector providers and the very low utilization rates at public health facilities. Further, utilization rates of the poor are the lowest among different income quintiles for all types of health services, although the poor are more likely to utilize public health facilities than the better off groups emphasizing the phenomenon of inequity.

There are other cross cutting developmental challenges that would affect the outcomes of the health sector that are important to consider such as stagnated fertility rates, high level of illiteracy, poor outcomes of the education system, high unemployment rates especially among the youth and in particularly among women, low rates and inequitable sanitation coverage, the rise and potential endemicity of avian flu, lack of proper social safety net to the poor, strong social and cultural factors expected to increase that would affect women empowerment. These would emphasize that parallel attention should be provided equally to the least advantaged in other sectors.

Positioning social justice at the center of the health sector agenda, taking in consideration the slogans that were raised by the January 25th revolution and its context, would present a non-controversial theme to set related goals for the next five-year strategy as part of Egypt’s transition in the health sector.  This theme would be presented as Improving Health Outcomes of the Poor, as the least advantaged group of people in the society.  

A social justice agenda would naturally focus on the poor based on principles of distributive justice, a key principle would be the Difference Principle.  This principle stipulates that social and economic inequalities would be allowed in a community as long as they work to satisfy two conditions: (a) a fair equality of opportunity for all to compete for positions and offices; and (b) they are to be to the greatest benefit of the least advantaged members of society.  Its main moral motivation is to provide equal respect for persons whatever their social or natural status.  In order for that to happen, the least advantaged members of the society will be prioritized by redistributing resources to benefit them from the better off to raise their health status to a level equal to those in higher quintiles of income of the population, and that as a result this would allow them to have equal opportunity to compete for jobs and earn income. As well as it presents a favorable redistribution to those most affected group of the population in terms of poor health outcomes.

Improving the health outcomes of the poor would significantly contribute to improve Egypt's health goals and indicators in total, as the concentration of poor performance of the health system resides in poor areas.  

Setting goals under this theme would then focus on three elements that could be quantified:

(i)     improving the health status of the poor in specific regions (Regions such as Upper Egypt, Lower Egypt, Frontier governorates; or governorates such as Sohag, Assiut, Sharkia; or districts such as urban slums)
(ii)     protecting the population and especially the poor from the impoverishing effects of health expenditure and the near poor from getting poor
(iii)     seeking the poor’s satisfaction of service provision and treating them in a manner that preserves their dignity

If we pursue that route, we should be looking for improvements to be achieved at the health systems level to achieve the theme of improving health outcomes of the poor that would represent a possible continuation to the earlier efforts of reform of the health sector that started in 1996/1997 and hopefully coincides with it but with a more sharpened focus on the poor. This will be the subject of future posts

Until we meet again....