On the occasion of the Celebration of the International Health Day on 7 April, The Egyptian Supreme Standing Committee for Human Rights (SSCHR) issued a report reviewing state's efforts to uphold the right to health, given the current health global crisis of the coronavirus outbreak.
Ahram Online obtained a copy of the report, which, the organization says, comes within an 'unprecedented challenge due to the COVID-19 outbreak'.
The Technical Secretariat of the Supreme Standing Committee of Human Rights developed on the occasion of International Health Day a report on Egyptian efforts to uphold the right to health at the level of national legislation, policies and indicators. Recently the Committee issued a detailed and specialized report on national efforts to uphold human rights in its response to COVID-19.
On constitutional framework to uphold the right to health, 'The current Egyptian constitution firmly upholds health and relevant rights. The Constitution initially provides for the right of every single citizen to health in Article 18 thereof, which is one of the lengthiest articles, as it details the citizen’s right to integrated health care in compliance with quality standards', the report said.
'The state, by virtue of the same articles, shall ensure preservation, support and capacity building of public health service facilities providing services to the people whilst ensuring the geographical distribution thereof. The State, also, shall allocate a percentage of no less than 3% of GDP for health, to be increased progressively. The constitution incriminates abstention from providing treatment to every human being in emergencies or life-threatening cases notwithstanding the form thereof', it added.
'According to Article 18, the state shall cover a host of other matters, including improving the financial situation of physicians, nurses, and paramedics as they are at the front line of defense against the disease. All health facilities, products and materials shall be subject to the state control as well as health related media. The state encourages the participation of the private and civil society sectors in providing health care', the SSCHR noted.
The report also referred to the constitution's incrimination of any abuse of human physical inviolability or human organs trafficking or running any medical or scientific experiments on humans without their free documented consent as per the rules of medical science (Article 60).
The SSCHR refered to a number of Egyptian constituion articles regulating the right to health as follows:
- The Egyptian constitution addresses donation of tissues and organs and provides that the state should regulate the rules of organ donations and transplantation (Article 61).
- The Constitution ensures the citizens’ right to adequate, safe and healthy housing (Article 78) as well as the right to healthy adequate food and clean water (Article 79). The Constitution enumerates health rights for children including compulsory free immunization, health care and staple nutrition, as well as the rights of children with disabilities to ensure their rehabilitation (Article 80). The State shall, by constitution, ensure the health rights of persons with disabilities and pygmies (Article 81), and to ensure the health rights of senior citizens (Article 8).
As for upholding the right to health within Egypt Vision 2030: 'Health policies acquire special significance in strategic planning as expressed in Egypt Vision 2030 which provides for a number of targets in relation to upholding the right to health as', the report said, citing these targets as follows:
Achieving better, fairer and more equitable health results to boost welfare and economic development.
Achieving comprehensive health coverage for all Egyptians to secure their needs of safe quality health services as and when needed less the financial burden.
Increasing investment in health while guaranteeing the optimization of available resources.
Developing and bolstering public health programmes that enhance and protect health.
Ensuring quality and safety of health services.
Improving the health sector governance to guarantee the effective, responsible and transparent management thereof at all levels.
' Egypt Vision 2030 provides for a number of key performance indicators including: extension of life expectancy until seventy nine years of age; reduction of infant and under-5 mortality rates by 50%; reduction of maternity mortality rate by 60%; narrowing the remarkable gap in health results; ending all forms of malnutrition; reduction of the financial burden emanating from out-of-pocket expenditure by 24%; satisfaction of the fair and equitable accessibility by all citizens to necessary health interventions to 80%; ensuring the availability of basic medicines, and medical equipment; and boosting governmental spending on health to 5% of GDP' , the report said.
' On Comprehensive Health Insuranceو Egypt has made remarkable strides by promulgating the comprehensive Health Insurance Law (Law 2/2018) which covers mandatory insurance of all citizens residing in the country, with the option of extending the same to cover Egyptian expats', it added.
The law obligates the State to provide services of (public health, preventive services, first aid and ambulance services, family planning and other health services necessary to cover all kinds of disasters and epidemics for free as well as occupational injuries).
The law shall be gradually applied to all governorates to ensure fiscal sustainability and actuarial balance. The State shall, by virtue of the law, boost the efficiency of state-owned health facilities gradually before rolling out the system. The philosophy of the new comprehensive Health Insurance system resides in the principle of mandatory coverage and social solidarity whereby the state covers the costs for the less-privileged. The system is based on the separation of finance from service provision. The General Authority for comprehensive Health Insurance is in charge of the system management and finance, whereas the Authority of Health Care provides health and curative care services within and without hospitals.
' The comprehensive Health Insurance Law shall be applied on 6 phases until 2023. The first phase covers (Port Said, Suez, South Sinai, Ismailia, Luxor and Aswan) with the cost of EGP1.8 billion. This is the current phase launched by HE President Abdul Fattah Al-Sisi on November 26th, 2019 in Port Said Governorate as a step to lay the foundations for integrated health system covering 100% of Egyptians as per the latest international criteria. The number of beneficiaries of the first phase until March 17th, 2020 reached 2,700,000', the report noted.
On Public Spending on Health, the State budget for the fiscal year 2019/2020 shows that health expenditures total EGP 73,062 billion with an increase of EGP 11 billion compared to the last fiscal year.
The report said that health spending covers hospitals and outpatient clinics, specialized hospital services, medical centres services, maternity centres, public health services, research and development in health affairs, public hospitals, university hospitals, the General Authority for Hospitals and Educational Institutes, the Pharmaceutical Control and Research Authority, the Ophthalmology Research Institute and the National Council for Addiction Control.
As for treatment at the state expense, the public spending on treating less-privileged citizens at the expense of the state reached EGP 6,622 million compared to EGP5,637 million as per the balance sheet of last year with an increase of EGP985 million. The foregoing figures show that the State has doubled its expenses compared to five years ago.
On Allocations for purchasing medicine and medical equipment: The allocations made during fiscal year 2019/2020 reached EGP 9,113 million, representing 12% of the budget for the purchase of goods and services', the report mentioned.
Regarding the subsidization of children medicine and milk: The allocations for these items amount to EGP 1,500 million. This subsidization is the amount of cost difference borne by the state resulting from the importation and sale of insulin, children’s milk and potassium iodides for prices less than the economic cost thereof.
On Health Insurance Subsidy, an amount of EGP 2,092,000,000isearmarked for health insurance programmes for the various categories as per the financial statement of the state budget for the fiscal year 2019/2020. The subsidy amount shall be distributed over 6 programmes as follows:
Health insurance subsidy for students in the amount of EGP 351,000,000 allocated in the budget for 23,400,000 students, in the annual amount of EGP15 per student.
Health insurance subsidy for single mothers in the amount of EGP 166,000,000 for 830,000 single mothers, in the amount of EGP 200 per single mother.
Health insurance subsidy for children below school age in the amount of EGP 227,000,000 covering 15,170,000 children, in the amount of EGP 15 annually per child.
Health insurance subsidy for less-privileged citizens (comprehensive Health Insurance system) in the amount of EGP 252,000,000.
Health insurance subsidy for less-privileged beneficiaries of social insurance pension in the amount of one billion Egyptian pounds.
Health insurance subsidy for farmers in the amount of EGP 100,000,000 covering 500,000 individuals in the amount of EGP 200 annually per capita.
On National Health Indicators, the report mentioned the state efforts as follows:
The number of state-owned hospitals increased from 643 in 2011 to 691 in 2018. Meanwhile the number of private hospitals increased from 926 in 2011 to 1157 in 2018. This increase is nationwide to ensure access by all citizens to health care. The number of insured citizens increased from 50,194,000 in 2014 to 55,581,000 in 2018.
The number of patients treated at the state expense:
The number of patients treated at the state expense domestically and abroad increased to 2,632,000 in 2018 with a cost of EGP 8.4 billion. Certain measures are taken to ensure speedy curative service provision at the state expense thus shrinking the period lapsing between application and decision issuance to 48 hours in cases of emergency and 72 hours for other cases.
Number of ambulances:
The number of ambulances increased in 2018 to 2912 and the number of emergency centers increased to 1464. The number of university hospitals increased by 2.3% in 2018 compared to 2017 by 89 hospitals. Physicians numbers increased in 2018 to become 126,197, whereas the number of nurses reached 217,105. Blood transfusion services are developed to reach 24 centres in all governorates. The foregoing assets and resources are deployed nationwide to ensure inclusive service provision covering, inter alia, rural and urban areas, males and females, and low-income brackets.
Mandatory routine vaccination:
2.6 million children receive mandatory routine vaccines annually with coverage exceeding 96%. Egypt managed to eradicate certain diseases as the WHO announced Egypt’s success in completely eradicating polio as no new cases have been detected since 2003. 40 million vaccinations are administered annually against polio, rubella and mumps. A program was developed to support natural breast feeding during the first six months to ensure safe nutrition for infants. A mandatory test is run for would-be spouses to ensure the absence of any diseases. Would-be spouse test offices totaled 481 nationwide in 2018.
Reduction in under-5 mortality rate:
Intensive governmental efforts led to a decrease in child mortality rate under age 5 from 42.1 thousand in 2015 to 36.7 thousand in 2018. The number of under 5 mortalities decreased from 20.3 thousand in 2015 to 20 thousand in 2018. Universal mortality rate fell from 8.6% in 2006 to 3.2% in 2018.
Within the context of health awareness and education, outreach initiatives are developed to educate people on pregnancy and follow-up with specialized doctors. Eventually, the number of births supervised by skilled specialists increased from 80.7% in 2007 to 92.7% in 2011. A health education campaign was launched targeting medical cadres, local leaders, and the populace especially in areas with high rates of endemic diseases. The civil society is active in the area of health outreach. The number of notarized NGOs in 2019 reached 211 in Greater Cairo.
The National Campaign for the Eradication of Hepatitis C Virus and Early Detection of Non-Communicable Diseases:
In September 2018 President Al-Sisi launched an initiative to eradicate Hepatitis C and early detection of non-communicable diseases under the slogan “100 million health”. Under this initiative all state sectors, spearheaded by the Ministry of Health and Population, should provide full support to that initiative for the early detection of Hepatitis C and non-communicable diseases. The initiative was administered on three successive phases for 7 months starting October 1st, 2018 until end of April 2019 nationwide in all twenty seven governorates. 56 million citizens were tested in the context of that initiative, detecting 2,200,000 positive cases.
Hepatitis C treatment was disbursed to 900,000 citizens. The total cost of the 100 million health initiative reached USD 260,000,000, 130,000,000 treatments and 130,000,000 tests. The WHO, and its representative in Egypt, has repeatedly commended the efforts of the Egyptian state in addressing Hepatitis C thanks to political commitment at the highest level in the state to control the disease. The WHO also stressed that it will continue to provide the support necessary to reach the desired goals.
Screening and Treating Refugees and Foreigners “Egypt’s Guests”:
Egypt launched a new phase officially on May 1st, 2019 until September 30th, 2019 in the context of the 100 Million Health Initiative (however the same was actually extended until August 31st, 2019). The new phase screens and treats foreigners and refugees from Hepatitis C. This presidential initiative targets screening children arrivals under 12 years until 18 years and adults over 18 years old. Screening is administered in 309 screening points nationwide. 67,498 refugees and foreign residents were examined and positive cases were treated gratuitously. The first refugee who tested positive for hepatitis C received free treatment one week after test commencement. Almost 182 positive cases received free treatment after the first incident.
In this context, the UN High Commission for Refugees and the WHO commended the new phase of the 100 Million Health Initiative covering all foreign residents in Egypt, which speaks to the leading role of Egypt in serving humanity.
Egyptian Women are the Health of Egypt Initiative for early detection of breast cancer: 115,000 women were tested until July 2019. The initiative targets 30 million women.
100 Million Health Initiative for early detection of anemia, stunting, obesity and malnutrition of school students which targets 11.5 million students in 22,000 schools.
Control of Harmful Traditional Practices (including FGM):
The National Committee Against FGM is established in 2019 and is co-headed by the National Council for Women and the National Council for Motherhood and Childhood to synergize efforts to eradicate FGM. The State has, in collaboration with the civil society, launched several initiatives including the initiatives of “White Coat” and “Let’s Protect Her” to educate on the gravity of FGM and its health adverse effects. Law 78/2016 was enacted to amend the Penal Code whereby FGM is considered felony and even attempted FGM is punishable, and no reconciliation or settlement may be reached in this case in particular. In case the FGM process is completed and causes the death or permanent disability of the victim penalty shall be aggravated. The National Strategy Against FGM (2016-2020) aims to decrease FGM rates by enforcing relevant laws and ministerial decisions to prevent the same and punish practitioners. The strategy also aims to enforce relevant legislation and educate society on the risks involved in FGM and that it is religiously groundless, in addition to tightening control and aggravating penalty for doctors who engage in FGM.
Control of Drugs, Psychotropics, smoking and harmful material:
A Fund is established for the treatment and control of addiction and drug-use pursuant to thePresidential Decision 46/1991. The Fund made several initiatives for education on risks of substance abuseand the social integration of cured cases such as “Life is Rosier without Smoking” to educate children on the adverse effects of smoking and “Don’t Try” Initiative to educate summer vacationists and beach-goers in coastal governorates on the gravity of addiction; as well as “Egypt free of addiction” Initiative to help addicts get rid of substance abuse impacts as well as “Listen to Me” Initiative raising awareness about the harmful effects of smoking and substance-use and to rectify misconceptions about substance abuse.
In this context awareness raising programmes are developed on the dangers of substance abuse in 8500 schools targeting 1.5 million students with a 50% increase compared to last year. 66 training camps are provided for students targeting 2500 volunteers. Outreach is developed for factory workers under the slogan “Make no Mistake” targeting 7500 workers. Moreover, 200 awareness initiatives are organized for drivers under the slogan “Have a safe trip” in 22 governorates for 20,000 drivers, whereby it becomes obligatory for drivers to take the drug tests as a sine-quo-none for license issuance and renewal. 34 workshops are held at corrective institutions and 60 preventive theatre shows are presented in most vulnerable locations such as “Al-Asmarat, GheitelEnab, and Al-Mahrousa” and in main squares and arenas. The Friday mass service speech is standardized in coordination with the Ministry of Awqaf to educate people on the dangers of drugs in addition to the information campaign “You are stronger than drugs” which reached 40,000,000 views in two months.