Towards a fairer and accountable Egyptian health care system
In an event, organized on March 1-3, 2013 in the beautiful city of Sharm El-Sheikh in Egypt, debating the theme of “health insurance for the poor”, one of the distinguished presenters, Dr. Cristian Baeza, stated the following “ a segregated system for the poor proved to be a poor system”. Later in his presentation, he followed by stating “universal means the entire population, but paying particular attention to the poor is critical as they are historically postponed and not prioritized”. Cristian was presenting lessons learned from countries from Latin America on their experiences in expanding universal health insurance coverage. The question begged itself, “What does this mean for Egypt?”
Before the January 25th revolution, national health policy was applied universally with no particular priority set for improving health outcomes of the poor. Allocations of budgetary funds for the health sector followed Ministry of Finance budget lines with no priority set for lagging regions or for those falling behind across population groups. With expected upcoming reforms to Egypt’s subsidy system, poverty rates would increase by several percentage points warranting putting in place a pro-poor health policy for protection of the poor and the vulnerable.
Traditionally, Egypt’s budget allocations are fragmented among a number of competing publicly-funded programs that hinder Egypt’s ability to pool risks and compromises Egypt’s path towards achieving universal health coverage. The results of the health care system reflect evidence of unfairness. In terms of health status, the nationwide progress made in reducing mortality among women, infants and children is not evenly distributed resulting in growing disparities in achieving MDG 4 (child mortality) and MDG 5 (maternal health) across geographic regions and income quintiles. In terms of financial protection, the inability to protect the Egyptians from the impoverishing effects of health expenditures, especially against catastrophic illness is significant: (i) the ongoing Social Health Insurance (SHI) excludes the poor as well as those who are in the informal sector, self-employed farmers or rural residents; and (ii) access to the Program for the Treatment on Expense of State (PTES) is also inequitable. All resulted in three fourth of total health expenditure being spent out of pocket. In terms of client satisfaction and system responsiveness, service utilization by the poorest quintile of the population is the lowest for all types of health services, although the poor are more likely to utilize public health facilities than the better-off groups. These are all consequences of the lack of a specific pro-poor health policy.
Following the revolution for the last two years, governments and ministers of health were struggling to find ways to translate social justice into health programs that could reach the poor. We’ve witnessed an active civil society movement organizing events and seminars, writing blogs and facebook threads going deep into discussing the nature of these programs and presenting serious proposals. On the governmental side, A social health insurance law is in the making promising to cover the cost of premiums for the poor, however, with uncertainty about its sources of funding. Already, a Law for expanding health insurance coverage of female-headed households has been issued; however, with a low turnout of beneficiaries showing up for enrollment. A social justice budget was proposed to inject more funds in ongoing programs perceived to be underfunded such as Free Health Care, Program for the Treatment on the Expense of State, or for subsidized drugs and milk formula, and possibly fund school feeding programs. However, the question remains: are these good examples of pro-poor programs? Would they lead to a fairer health care system?
Recognizing the need for developing health policies and programs that promotes fairness and accountability in Egypt is essential and a first step. A following and needed second step is to examine the ongoing health programs through a lens that can judge if these policies and programs are pro-poor or not. A third step will be to develop a health policy that keeps and consolidate those programs which are not only pro-poor but also efficient and effective, and ensuring that they are an integral part of the overall health care system.