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.
