Egypt is moving forward with plans to upgrade public health care services following the approval of a $530m loan from the World Bank, which will also support the rollout of a universal health insurance plan.
Announced in late June, the loan will go towards the five-year, $992m Transforming Egypt's Healthcare System Project, also launched in June, which aims to upgrade some 600 primary health care facilities and 27 hospitals.
A significant portion of the funding seeks to improve prevention and treatment of hepatitis C and non-communicable diseases (NCDs), two of the most prominent health concerns in the country.
In 2015 the World Health Organisation (WHO) estimated that around 7% of the population aged between 15 and 59 were infected with hepatitis C – the highest rate in the world – and that the disease was responsible for some 40,000 deaths in 2016.
However, a programme established in 2014 providing treatment to sufferers at low costs has seen more than 1m people treated, with a cure rate of 95% in many areas. The World Bank funding seeks to further reduce the cost of treatment, with the aim of reaching a greater proportion of the population.
To combat the impact of NCDs, which account for 82% of all deaths and 67% of premature deaths, according to the WHO, some of the funding will be allocated to the World Bank-backed National Multisectoral Action Plan for Prevention and Control of NCDs 2017-22, which aims to reduce incidence of NCDs through education and preventive measures.
The planned upgrade to medical facilities comes as the government looks to boost coverage with the rollout of its new universal health coverage plan.
The programme, whose first stage was launched on July 6, will be rolled out incrementally up to 2032. Enrolment is obligatory, and the plan will be funded by a combination of employee and employer contributions, and taxes on some goods, such as cigarettes, and high-emission industries.
While industry officials agree that the plan could significantly improve access and quality of care – at present, an estimated 30-40% of the population is without health coverage – and bring down high costs associated with private treatment, some have raised concerns over the cost of co-payments.
Under the scheme, employers and employees will be subject to a combined contribution of 4-5% from the employer and 1% from the employee. While this is similar to existing health insurance plans, earners with families will also be required to pay a premium of 3% for a non-working spouse and 1% for each dependent child, according to local market research firm Pharos, which could exert pressure on household incomes. Persons with no or very low incomes will be completely covered by the state.
Despite the upgrade of health care infrastructure associated with the World Bank funding, there are also concerns that the expansion of insured persons – which would also apply to those currently using private insurance – could place a strain on existing health care services.
Egypt had 1.6 hospital beds per 1000 people in 2014, according to WHO data, below the MENA average of 1.9, and the country’s rate of 0.8 physicians per 1000 people was similarly below the regional average of 1.7.
The expansion of health coverage and the need to expand existing services could therefore offer more opportunities for private sector investment.
Indeed, given the shortfall of existing supply – real estate consultancy Colliers International estimates the country will need an extra 6000 doctors annually for the next decade, along with an additional 35,000 hospital beds over the period – industry figures agree the private sector has an important role to play in boosting overall capacity and improving health care standards.
The new insurance programme was also designed with a view to private sector participation. Hospitals and health care facilities owned by private operators will be able to participate in the new universal health care programme if they meet certain criterion set out by the government.
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