By Mohamed Gad

Despite an improvement in Egyptians' health during the past 20 years noted by the World Bank and represented in an increase in life expectancy from 64.5 years to 70.5 years, such an improvement was not achieved with equality.

In its paper titled "A Roadmap to Achieve Social Justice in Health Care in Egypt", the World Bank proposed to the Egyptian government in January a vision to reform the healthcare system and make it more just.

The Egyptian government is currently working on issuing a new legislation to change the current health insurance system.

The bank adopted in its paper the concept of health equality. The concept was elaborated by the World Health Organisation in 2010 as the process of providing people with the quality health services they need free of charge, said Alaa Hamed, senior health specialist in the Middle East and North Africa at the World Bank who contributed to drafting the World Bank’s proposed vision to Egypt.

While 20 percent of Egypt's richest citizens spend 13.5 percent of their income on health services, the least privileged 20 percent of the population spend 21 percent of their income on such services. Hamed said the figures represent "a huge burden on the poor," adding that lifting the burden of health services for the less privileged should be sought when setting health policies.

The controversy stirred by the concept of health equality stems from concern that some social strata might fall into poverty due to health spending, Hamed said.

"Over a 100 million individuals fall into poverty annually due to health spending," he told Aswat Masriya.

The health specialist added that some health indicators show an improvement in Egyptians' health at the macro level, though some geographical areas fail to meet noted improvement.

Decreasing child and mother mortality will allow Egypt to achieve the United Nations Development Programme's millennium goals, however these goals will not be met in Upper Egypt, an area where 93 percent of Egypt's poorest villages are centred, said Hamed.

Decreasing under-five child mortality rate by two-thirds and decreasing maternal mortality ratio by three quarters in 2015 are among the UN's millennium development goals. 

HEALTH GOALS IN 2030

The health vision provided by the World Bank is based on achieving two goals by 2030, Hamed said; providing family health services of a standard quality for all Egyptians, and encompassing all Egyptians within a health insurance system.

Egypt attempted to implement the family health services system in 2003, Hamed said, adding that its implementation was limited to five governorates only. Failing to expand the system turned it into "the weakest link" in Egypt's healthcare system, the health specialist said.

The World Bank is currently providing funds worth $75 million for a project to improve the quality of the family health services system in Egypt's 1000 poorest villages, ongoing until 2017.

Mental health services are among the core services which Egyptians need to expand on providing, Hamed said, adding that there are indicators of an increase in mental illnesses.

"Unipolar depressive disorders and anxiety are among the main causes of disability and death among women aged 15 - 49 while addiction, often a coping mechanism for mental health conditions, is rising among men," the World Bank study read.

Health insurance services should cover "costly illnesses", such as cancer, which threaten to land patients in poverty, Hamed said.

Egypt's health insurance system currently covers 50 million Egyptian citizens, a little over half of the country's population, according to government figures.

AVAILABLE MEANS OF FUNDING

Though the government is aiming to cover all Egyptians with health insurance services, the reality on the ground suggests that the source of 72 percent of the sum of spending on health services is citizens' personal spending, the World Bank reported in its paper.

A comprehensive system should aim to minimise private spending on health as much as possible, Hamed said, to reduce the risk of citizens falling below poverty line due to health spending.

Health insurance systems worldwide are usually funded through subscriptions or taxes, Hamed said.

"The problem in Egypt is that the base of citizens subject to taxation is narrow and the rates of work in the unofficial sector are large," Hamed said.

"Egypt therefore needs to work with a hybrid of those two financial suppliers during the coming 10 to 15 years."

The World Bank stressed in its vision that Egypt must improve its accountability mechanisms for the bodies which provide health services in order to improve the quality of such services.

"The civil society must be involved in [the process] of monitoring the services," Hamed said, stressing the importance of having effective and independent complaint systems.