This year saw the roll-out of Egypt’s ambitious system of universal health insurance (UHI) in Ismailia, Luxor, and North Sinai, reports Reem Leila. The three governorates followed Port Said, where a UHI pilot project was implemented in 2019. The first phase of UHI implementation is also slated to include the governorates of South Sinai, Aswan, and Suez and, according to Minister of Finance Mohamed Maait, who chairs the UHI Authority, should be completed by the end of the current fiscal year.
UHI is the flagship project of the New Republic, the foundations of which were laid by President Abdel-Fattah Al-Sisi, Maait said in October. Priority in implementing the system is being given to Egypt’s poorest governorates. Rolling out the system across the whole of Egypt will take 10 years, with Cairo included in the sixth and final phase, and when complete the UHI will ensure all citizens, regardless of income or location, have access to quality healthcare.
Egypt’s 2014 constitution placed health services at the heart of the development agenda, mandating a minimum budget allocation of three per cent of GDP. Though it was originally envisaged that a nationwide roll-out would take 15 years, the system, says Maait, is now on track to become fully operational within a decade.
The overall cost of the first phase of the rollout, according to Khaled Abdel-Ghaffar, the minister of higher education and scientific research and acting health minister, is LE51.2 billion, which covers improvements to health facility infrastructure, medical and non-medical equipment, and three months’ operating and administrative costs.
In addition to primary healthcare, UHI will cover more than 3,000 medical services, including surgery, analysis, radiology, tumour treatment, organ transplants, prosthetic devices, visual and audio aids, dental treatment, therapeutic foods, and other supplements.
A 2015 World Bank paper, “A roadmap to achieve social justice in healthcare in Egypt”, identified the expansion of priority services and population coverage, and the reduction of out-of-pocket expenditure, as key to implementing universal health coverage.
During the course of the Covid-19 pandemic, patients in areas where UHI has been rolled out have been able to access remote consultations, including information on how to prevent infections and advice on how best to isolate, and the elderly and those with chronic conditions can have medications delivered to their door free of charge.
The World Bank paper said the expansion of family health services to all Egyptian citizens by 2030, with a focus on disadvantaged populations, was central to realising universal health coverage, and stipulated that such services should cover maternal and child health, reproductive health, family planning, the prevention, screening, and treatment of noncommunicable diseases, mental health, and nutrition.
Expanding mandatory social health insurance to all citizens by 2030, with an initial focus on disadvantaged populations, will ensure that Egyptians receive financial protections in an equitable manner, the World Bank concluded, and “that no Egyptian will be pushed into or kept in poverty by paying for healthcare”.
UHI is overseen by three regulatory authorities supervised by the Ministry of Finance and the Central Auditing Organisation. The General Authority for Accreditation and Health Control sets quality standards, accredits healthcare providers, and regulates compliance; the General Authority for Healthcare oversees the provision of services, and the UHI Authority distributes funds.
Employees contribute to the system to the tune of one per cent of their salary, with employers required to pay three per cent. The government steps in to cover the payments of anyone unable to pay contributions, including widows and those with special needs, both of whom are exempted from insurance payments. The system will also receive 0.25 per cent corporate tax revenue, a portion of the duty levied on cigarettes, and some of the income generated by toll tickets and driving licence renewal fees.
Medical staff, nurses, administrators, quality and infection controllers, and second-line administrators, are already receiving training in advance of the planned national roll-out of UHI.
*A version of this article appears in print in the 23 December, 2021 edition of Al-Ahram Weekly