Health January 31, 2019
Appetite to invest

By Daniel Male - World Healthcare Journal

There is a new dawn for health reform in Egypt, HE Dr Mohamed Maait, Egypt Finance Minister tells WHJ.

With a population of 106m, growing at 2.6 per cent per annum, Egypt faces a continuing need to invest in infrastructure and healthcare services to ensure it is able to meet the needs of its citizens. World Healthcare Journal speaks to Egyptian Minister of Finance, HE Dr Mohamed Maait, about investment and opportunities in the region.

Egypt currently has both public and private healthcare systems. However, these vary dramatically in terms of quality. According to Allianz Care, the Egyptian government spends only 1.5 per cent of annual GDP on healthcare meaning public health services are often of poor quality with outdated equipment, long queues, poor sanitation and workforce issues. These also vary regionally, with urban areas having far more access to these services than rural districts.

Public health insurance is offered by the Health Insurance Organisation (HIO) which was set up in 1964 to provide insurance to all Egyptians. However, currently, the HIO only supports those in employment and those in education. Uptake of public health insurance has been historically low due to the inconsistency of services. Alternatives to public and private services that many Egyptians choose are mosque and church-based clinics which operate independently.

“Life expectancy is increasing but at the same time we have a high level of fertility,”  Dr Maait says. “The population is not aging but we have a growing population. ” This brings numerous health challenges for Egypt to contend with, not dissimilar to those experienced around the world.

With 82 per cent of premature deaths in Egypt attributable to lifestyle factors, there is vast ground for boosting health outcomes through investment in health services as well as prevention and early intervention strategies. However, this only forms part of wider plans to reform healthcare in the country.

“Our concentration today is on three main elements,” explains Dr Maait. “One is Hepatitis C, so we are investing in that. The second is regarding long queues for waiting lists for medical operations; we are investing in cutting this waiting list. And number three is upgrading 50 hospitals around the country to be units of excellence in order to ensure there is a place people can receive very high-quality services. ” 

There is a clear appetite in Egypt to invest in health. This can be seen most prominently through the investment in training new doctors and nurses. According to Mansoor Ahmed from Colliers MENA, Egypt performs well in comparison to the wider region. Egypt has 3.2 doctors and 3.6 nurses per thousand of the population. This is in comparison to 2.5 doctors and 2.9 nurses on average for MENA. However, there is still much work to be done.

According to the Minister, Egypt needs 8 per cent GDP growth annually to support its growing population. But at present, he acknowledges that it is not happening at ‘a quick enough rate,’ resulting in people becoming poorer. So what strategy has been put in place to meet these needs?

“Number one is to ensure that we have enough financing to pay for the cost of caring for the elderly,” says Dr Maait. “Number two is that we need to invest more in preventative measures. ” These both require new systems and frameworks to be implemented and Egypt needs to attract international investment and partnerships to facilitate their development. Currently, 90 per cent of health spending is on salaries with not enough being invested elsewhere across the healthcare sector, something Dr Maait and the government are looking to change.

Dr. Mohamed Maait and Dan Male

Universal Health Coverage

Most prominently in Dr Maait’s strategy is the ‘introduction of universal coverage’ which would provide a mechanism ‘to ensure that there will be efficiency in the system’ and a structure that will stop the system from collapsing. While an extremely ambitious plan, it is not the first time that Egypt has attempted such a policy. Health insurance was initially introduced in 1964 but uptake was extremely low. As the minister reports, uptake has only ever reached 15 per cent after 54 years.

The issue in the past was structural, according to Dr Maait. “We didn’t create the right mechanism because it was only one organisation responsible for financing, providing the services, supervising the quality of the services and for contracting, so one organisation doing everything. ” The solution is to ensure sufficient funds and stable and viable financing by ensuring it has a foundation in ‘actuarial law’ as opposed to being just a ‘political decision. ’ This, says Dr Maait, “includes training for nurses, doctors, and equipment” as well as focusing on ‘human capital development. ’ 

The plan is not just to cover people, but also their families and to give them the choice about where to get treatment, with the government as the main provider. This is a model that is not unusual throughout the world with the USA most notably offering such a system to its citizens. While the potential gains of ensuring a reliable and sustainable health insurance system offering universal cover are great, the delivery is still a substantial feat to be achieved.

"Egypt needs to attract international investment and partnerships" 

Delivering the system

In terms of the health insurance system, Dr Maait is keen to ensure that it is not controlled by government, but instead is formed of three separate entities; a financing agent, public health provider and a regulator. The financing agent will exist as a health insurance company under the prime minister to ensure funding is available to treatments and services within the system. Meanwhile, the public health provider will bring together all hospitals and the regulator will set standards and supervise as an independent entity under the President.

The Egyptian government plans to roll this out over a 15-year timeline, with funding coming equally from public contributions, from the state budget for those who cannot finance themselves and from taxes levied on cigarettes, highways and other streams. Due to delays, the implementation of the system has been pushed back from the intended date of July 2018. As the minister makes clear, the changes are not simply a new health system, but a “health reform for Egypt. ”

Funding and investment

According to Professor Magdy Ishak, Chairman of the Executive Committee and Unpaid Chief Executive of Magdi Yacoub Foundation Egypt, 70 per cent of total spending on healthcare in Egypt comes from the private funding, a portion far higher than in most developed countries. This ‘open field of investment’ makes Egypt highly attractive to investors says Professor Ishak.

Perhaps unsurprisingly, therefore, the reforms outlined by the Minister have been broadly welcomed by the private sector. Responding to the focus on preventative measures, Shady William, Director of Business Development at Samcrete, said: “The private sector has to play a role in bridging the gap between demand and supply. ” While conventional investment falls into two key pathways; infrastructure and services, a contemporary focus on preventative healthcare has the potential to blend this gap even further. This coincides with a shift towards specialist services as opposed to carbon copying general hospitals.

As with many countries reviewing and upgrading their healthcare systems, Egypt has the very real possibility of making key advances in its delivery of healthcare to its expanding population if the funding and investment is made available.

Dr. Mohamed Maait is currently serving as the Minister of Finance. Previously he held the position of Vice Minister of Finance for Public Treasury Affairs & Head of the Economic Justice Unit, First Deputy Minister of Finance in 2015 and Deputy to the Minister of Finance for Pension and Social Insurance (2009 –2013). In addition, he served as First Deputy Minister of Health & Population (2014-2015), Vice Chairman of the Egyptian Financial Supervisory Authority (2013-2015), Chairman of the Egyptian Governmental Actuarial Department (EGAD) at the Ministry of Finance (2010–2013). He also worked as a senior lecturer and has more than 30 years of teaching and researching experience at many universities in Egypt, Sudan, England and Scotland.

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