Public Health System
Ministry of Health (other Public Health Service providers)
The Ministry of Health and Population (MOHP) operates through a functional structure, through an administrative and a technical workforce across four levels namely, Central, Health Directorates (at governorate level), Health Districts, and Health care Providers. The MOHP central organizational structure is an extensive structure headed by the Minister.
It employs almost 5 000[16] people, including professional and supporting staff, who are in charge of main central functions such as planning, supervision, program management and maintenance.
Mission, roles and functions
The health care system in Egypt is quite complex with a large number of public entities involved in management, financing and the provision of care. The Ministry of Health is responsible for overall health and population policy including the provision of public health services as well as being the major provider of the inpatient-based curative system. The Ministry of Higher Education is responsible for medical education as well as service delivery and the Health Insurance Organization (HIO) is both an insurer/financier and provider of care to employees, students, widows, pensioners and the newborn (covering about 45% of the Egypt’s population).
Governance and organigram
Health policies and strategies often are not supported by evidence and regulatory mechanisms are not well developed. The health system remains highly centralized despite efforts being made to decentralize to governorate and district levels. Coordination within the Ministry of Health and with other related agencies and ministries remains weak.
The MOHP services delivery units are organized along differing lines. These lines may be geographical (i.e. rural and urban), structural (i.e. health units, health centers, hospitals), functional (i.e. maternal child health centers), or programmatic (i.e. immunization, diarrheal disease centers). Currently, there is no nationwide referral system in the MOHP delivery system; rather, there are a number of pilot referral systems in some districts belonging to various health projects. The MOHP service delivery units are organized along different lines. These may be geographic (i.e. rural and urban), structural (e.g. health units, health centers, hospitals), functional (e.g. maternal child health centers) or programmatic (e.g. immunization, diarrheal disease control). Following is a description of the MOHP public health programs (whereas a detailed description of the MOHP service delivery network is included in the later on section MOHP public health programs).
Private Health System
Health Insurances present in the Country
The private health insurance industry has not yet come into its own in Egypt, which means that the majority of Egyptians access care through facilities operated by government ministries or insurance schemes. Those Egyptians that can afford it gladly prefer to make out-of-pocket payments for medical services. Indeed, it would not be at all unusual to go into a clinic for an elective procedure (such as lasik eye surgery) with a stack of cash.Under the current regulatory environment, private health insurance does not represent an attractive business opportunity for enterprisers. In fact it is quite hard to make money on private health insurance in Egypt. Premiums are regulated and too low in comparison to the costs. Another constraint is that an insurance law guarantees employees the right to refuse to participate in a co-payment mechanism.
The largest company offering health insurance in Egypt – Al Shark – continues to lose money under these policies. Although health insurance is only a small part of the company’s portfolio, it causes a disproportionate amount of problems, and might ultimately force Al Shark to withdraw from the health insurance business altogether.
A private health insurance program “Medicare” was introduced a few years ago by the “Nile Badrawi” Hospital. The program has most of its beneficiaries from the upper-middle and upper classes; it charges reasonable premiums and has a co-payment ingredient. In addition, a European private insurance firm has recently been allowed to operate in Egypt. Egyptians of upper-income level basically purchase the insurance. The firm’s operations are handled through a Cairo office and its services are provided through Egyptian private sector providers.
Bilateral/UN Agencies, international NGOs and other relevant stakeholders
Bilateral and multilateral agreements between the Ministry of Health and other governmental institutions and the donor community including UN agencies are reviewed by the parties prior to their signing to ensure their compliance to national policy and the long-term national health strategic plan. The agreements are reviewed and approved by the parliament. Within the Ministry of Health, the Department of Projects coordinates all health and population projects and aid flows to the Ministry with a view towards preventing overlap and duplication and ensuring more effective mobilization and utilization of resources. The Department maintains a projects map that reflects the availability of funds supporting the long-term strategic plan and identifies funding gaps which are brought to the attention of the donor community.
Despite the efforts to align international cooperation with the national health agenda, there remains inadequate coordination between the substantial number of programs funded by bilateral or multilateral donors/development agencies and existing national programs funded by the government. To address these concerns and to better harmonize international cooperation, a Donors’ Advisory Group was established to serve as a coordinating body between the Government of Egypt and the donors to the various sectors. A subgroup of the Donors’ Advisory Group serves as a coordinating body between the Ministry of Health and donors that are active in the field of health. This subgroup coordinates relations between the donors and the Ministry of Health and among the donors themselves. It also supports the Ministry of Health in developing a strategic plan to demonstrate gaps in external support and to coordinate action to fill the gaps identified. The subgroup’s effectiveness, as seen by some of its members, has been limited by confusion over the principles of its establishment, unclear terms of reference and a lack of leadership attributed in part to a rotating chair.
The CCA, seen as a planning tool to support Egypt’s national development priorities, adopts a nationally owned twintrack strategy for UN system assistance. The twin-track strategy supports:
1° projects and programs to help Egyptian citizens improve their quality of life and individual welfare through better social services, including health nutrition and education
2° the government and its institutions to perform their duties more adequately in the pursuit of realizing the millennium development goals and the protection of established human rights norms.
[1] http://apps.who.int/medicinedocs/documents/s17293e/s17293e.pdf
Ministry of Health (other Public Health Service providers)
The Ministry of Health and Population (MOHP) operates through a functional structure, through an administrative and a technical workforce across four levels namely, Central, Health Directorates (at governorate level), Health Districts, and Health care Providers. The MOHP central organizational structure is an extensive structure headed by the Minister.
It employs almost 5 000[16] people, including professional and supporting staff, who are in charge of main central functions such as planning, supervision, program management and maintenance.
Mission, roles and functions
The health care system in Egypt is quite complex with a large number of public entities involved in management, financing and the provision of care. The Ministry of Health is responsible for overall health and population policy including the provision of public health services as well as being the major provider of the inpatient-based curative system. The Ministry of Higher Education is responsible for medical education as well as service delivery and the Health Insurance Organization (HIO) is both an insurer/financier and provider of care to employees, students, widows, pensioners and the newborn (covering about 45% of the Egypt’s population).
Governance and organigram
Health policies and strategies often are not supported by evidence and regulatory mechanisms are not well developed. The health system remains highly centralized despite efforts being made to decentralize to governorate and district levels. Coordination within the Ministry of Health and with other related agencies and ministries remains weak.
The MOHP services delivery units are organized along differing lines. These lines may be geographical (i.e. rural and urban), structural (i.e. health units, health centers, hospitals), functional (i.e. maternal child health centers), or programmatic (i.e. immunization, diarrheal disease centers). Currently, there is no nationwide referral system in the MOHP delivery system; rather, there are a number of pilot referral systems in some districts belonging to various health projects. The MOHP service delivery units are organized along different lines. These may be geographic (i.e. rural and urban), structural (e.g. health units, health centers, hospitals), functional (e.g. maternal child health centers) or programmatic (e.g. immunization, diarrheal disease control). Following is a description of the MOHP public health programs (whereas a detailed description of the MOHP service delivery network is included in the later on section MOHP public health programs).
Private Health System
Health Insurances present in the Country
The private health insurance industry has not yet come into its own in Egypt, which means that the majority of Egyptians access care through facilities operated by government ministries or insurance schemes. Those Egyptians that can afford it gladly prefer to make out-of-pocket payments for medical services. Indeed, it would not be at all unusual to go into a clinic for an elective procedure (such as lasik eye surgery) with a stack of cash.Under the current regulatory environment, private health insurance does not represent an attractive business opportunity for enterprisers. In fact it is quite hard to make money on private health insurance in Egypt. Premiums are regulated and too low in comparison to the costs. Another constraint is that an insurance law guarantees employees the right to refuse to participate in a co-payment mechanism.
The largest company offering health insurance in Egypt – Al Shark – continues to lose money under these policies. Although health insurance is only a small part of the company’s portfolio, it causes a disproportionate amount of problems, and might ultimately force Al Shark to withdraw from the health insurance business altogether.
A private health insurance program “Medicare” was introduced a few years ago by the “Nile Badrawi” Hospital. The program has most of its beneficiaries from the upper-middle and upper classes; it charges reasonable premiums and has a co-payment ingredient. In addition, a European private insurance firm has recently been allowed to operate in Egypt. Egyptians of upper-income level basically purchase the insurance. The firm’s operations are handled through a Cairo office and its services are provided through Egyptian private sector providers.
Bilateral/UN Agencies, international NGOs and other relevant stakeholders
Bilateral and multilateral agreements between the Ministry of Health and other governmental institutions and the donor community including UN agencies are reviewed by the parties prior to their signing to ensure their compliance to national policy and the long-term national health strategic plan. The agreements are reviewed and approved by the parliament. Within the Ministry of Health, the Department of Projects coordinates all health and population projects and aid flows to the Ministry with a view towards preventing overlap and duplication and ensuring more effective mobilization and utilization of resources. The Department maintains a projects map that reflects the availability of funds supporting the long-term strategic plan and identifies funding gaps which are brought to the attention of the donor community.
Despite the efforts to align international cooperation with the national health agenda, there remains inadequate coordination between the substantial number of programs funded by bilateral or multilateral donors/development agencies and existing national programs funded by the government. To address these concerns and to better harmonize international cooperation, a Donors’ Advisory Group was established to serve as a coordinating body between the Government of Egypt and the donors to the various sectors. A subgroup of the Donors’ Advisory Group serves as a coordinating body between the Ministry of Health and donors that are active in the field of health. This subgroup coordinates relations between the donors and the Ministry of Health and among the donors themselves. It also supports the Ministry of Health in developing a strategic plan to demonstrate gaps in external support and to coordinate action to fill the gaps identified. The subgroup’s effectiveness, as seen by some of its members, has been limited by confusion over the principles of its establishment, unclear terms of reference and a lack of leadership attributed in part to a rotating chair.
The CCA, seen as a planning tool to support Egypt’s national development priorities, adopts a nationally owned twintrack strategy for UN system assistance. The twin-track strategy supports:
1° projects and programs to help Egyptian citizens improve their quality of life and individual welfare through better social services, including health nutrition and education
2° the government and its institutions to perform their duties more adequately in the pursuit of realizing the millennium development goals and the protection of established human rights norms.
[1] http://apps.who.int/medicinedocs/documents/s17293e/s17293e.pdf
Comparison Between Health Expenditures in Algeria and in Egypt
Health Priorities and Strategic National Public Health Programs
Even though, Egypt's healthcare system has been making progress, in some areas it has been ineffectively run and in many cases neglected. Despite so much international monetary assistance, on top of government programs and organizations implemented to improve the system, Egypt's quality of healthcare would generally be considered poor.
Although public hospitals and clinics are distributed relatively evenly throughout the country, their services are generally inadequate because of the shortage of doctors and nurses (20 doctors per 10 000 people while Cuba has 55 doctors per 10 000 people) and the general lack of modern equipment. In rural and urban areas patients using the government facilities can expect a lengthy journey and a long wait to see a physician. Dissatisfaction with public hospitals and clinics has forced some low-income patients to attempt to seek treatment at expensive private clinics at even greater personal expense.
Privately run hospitals on the other hand tend to be concentrated in the cities, very expensive, and cater to the middle and higher income earners who can afford the prices.
The Egyptian healthcare system still faces some basic hygiene and sanitation issues. Over 30% of the total population does not have access to safe water for drinking and food preparation. About 17,000 children die each year because of diarrhea due to the bad water quality. Public sanitation plants have been unable to keep up with the growing population, only one third of the homes are connected to the sewage system and only 50% of the homes have any plumbing to speak of. Educating the population about the dangers of using stagnant water, which provides an ideal environment for parasites, can control the spread of diseases such as Tuberculosis, Schistosomiasis, Malaria, and Trachoma.
The principal national health policy orientation and priorities have been articulated through the government’s health sector reform program and Healthy Egyptians 2010. The health sector reform program, initiated in 1997 and due to continue through 2018, reflects five guiding principles:
Even though, Egypt's healthcare system has been making progress, in some areas it has been ineffectively run and in many cases neglected. Despite so much international monetary assistance, on top of government programs and organizations implemented to improve the system, Egypt's quality of healthcare would generally be considered poor.
Although public hospitals and clinics are distributed relatively evenly throughout the country, their services are generally inadequate because of the shortage of doctors and nurses (20 doctors per 10 000 people while Cuba has 55 doctors per 10 000 people) and the general lack of modern equipment. In rural and urban areas patients using the government facilities can expect a lengthy journey and a long wait to see a physician. Dissatisfaction with public hospitals and clinics has forced some low-income patients to attempt to seek treatment at expensive private clinics at even greater personal expense.
Privately run hospitals on the other hand tend to be concentrated in the cities, very expensive, and cater to the middle and higher income earners who can afford the prices.
The Egyptian healthcare system still faces some basic hygiene and sanitation issues. Over 30% of the total population does not have access to safe water for drinking and food preparation. About 17,000 children die each year because of diarrhea due to the bad water quality. Public sanitation plants have been unable to keep up with the growing population, only one third of the homes are connected to the sewage system and only 50% of the homes have any plumbing to speak of. Educating the population about the dangers of using stagnant water, which provides an ideal environment for parasites, can control the spread of diseases such as Tuberculosis, Schistosomiasis, Malaria, and Trachoma.
The principal national health policy orientation and priorities have been articulated through the government’s health sector reform program and Healthy Egyptians 2010. The health sector reform program, initiated in 1997 and due to continue through 2018, reflects five guiding principles:
- Universality: covering the entire population with a basic package of priority services. Every person in the country will have the same access to and benefits from basic health care.
- Quality: improving and assuring the standards of health care and facilities, enhancing diagnostic and clinical effectiveness, and updating medical and nursing education and training. Professional and ethical treatment, public satisfaction and trust should characterize the health care system.
- Equity: financing for health care services is based on ability to pay, while the provision of services is based on need. All regions of the country and people of all income levels will have a fair share in the health system.
- Efficiency: allocating and mobilizing human and infrastructure resources for health care based on population needs and cost-effectiveness. The government and citizens will obtain the best health value for money.
- Sustainability: ensuring the continuity, self-sufficiency and lasting establishment of the health care system reforms, and services for the health and well-being of future generations.
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