Published on Arab Voices

Pro-poor health coverage expands in Egypt

 Amira Nour & Sarah Fouad After the Arab Spring, Egypt’s health sector went through a shaky transition  as seven consecutive Egyptian Ministers of Health struggled to make the sector live up to the revolution’s ideal of a  health sector that would serve to uphold human dignity and social justice. Pre-revolution reforms to the sector had focused on expanding access to essential services in family health and to health insurance coverage. The political environment and the sector’s limited capacity had not, however, made it possible for these pilot schemes to be scaled up properly, with a pro-poor focus.
Following the January 2011 revolution, Egypt’s parliament pursued the ideal of creating a fairer health system by passing two laws designed to expand health insurance to include female-headed households and children under five years old. In 2013, a third law gave the same coverage to farmers; under it, they were all to become beneficiaries of Egypt’s Health Insurance Organization (HIO). But by attracting a disproportionate number of patients in need of expensive medical treatment—without a proper health enrollment scheme in place to collect premiums from people in good health to subsidize people who were sick—these laws had the unintended effect of increasing the HIO’s deficit.
In 2014, the Government of Egypt asked the World Bank for technical and financial assistance to expand its pro-poor health coverage. By engaging the health sector’s stakeholders, the Bank facilitated the development of a paper, the “ Roadmap to Achieving Social Justice in the Healthcare Sector”, which has provided a methodology that can be used to diagnose areas of inequality in health status, financial protection, and in the responsiveness of the country’s health system.
The paper recommends a few interventions to address problems in the health sector that contribute to social injustice. The government has adopted a more progressive path in the health sector based on these interventions, prioritizing the expansion of access to public health care services and financial protection for disadvantaged populations—a bottom-up approach to universal health coverage.
In 2015, Egypt’s government increased its health sector budget by USD 400 million  in order to reach the target set by the country’s constitution of spending the equivalent of 3% of Egypt’s GDP on health care by 2017. The increase in the budget was for establishing the Program for Healthcare for the Poor. This program subsidizes the cost of health care for people who are beneficiaries of the Social Pension Assistance Program, starting with beneficiaries living in Upper Egypt, a largely underdeveloped region.
With a USD 75 million loan from the World Bank, the government has started improving the quality of primary health care in the poorest 1,000 villages in Upper Egypt to make sure their health care facilities are operational and have physicians, nurses, and medicine. Based on independent verification by the UN children’s agency, UNICEF, the loan is getting results, with a demonstrable readiness for improvements in health service delivery and an increase in issuing certificates of accreditation to the program.
The project supports the strengthening of mechanisms for public feedback in the forms of: grievance redress, third party monitoring, and client satisfaction. It also supports health sector transparency by enabling the Ministry of Health to disclose the performance of each health facility on the web. Once the program has achieved its results, Egypt’s Ministry of Finance is due to continue funding these.
In early 2016, the program reported that 4 million people had enrolled with it; it says its target is to reach 7.2 million people in 2017. In terms of uptake, it has seen people make an average of 5.4 visits a  year to primary health care facilities in Upper Egypt, compared to a national rate of 1.1 visits a year. This pro-poor coverage approach—in which complementary interventions are made on the sides of both demand and supply—will develop into a mature, pro-poor health system as Egypt’s experience of it grows and lessons are learned.
After the revolution, Egypt’s policymakers had a unique opportunity to tackle the constraints that had prevented earlier efforts to make progress towards pro-poor health care coverage. Without the revolution, Egypt may have still been at the stage of trying out new approaches to health care, instead of the fairer and more accountable health system it has embarked upon building now.


Alaa Hamed

Senior Health Specialist

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