Addressing the Persistent Urban-Rural Health Divide in Egypt: Twenty Years Later

Over the past two decades, Egypt has made significant strides in improving health outcomes, as evidenced by the reduction in fertility rates, maternal and child mortality, and increased access to healthcare services. However, a substantial urban-rural divide persists, impacting the overall health equity in the country.

This article highlights key disparities between urban and rural areas based on the 1998 Egypt Demographic Health Survey (EDHS) and the 2021 Family Health Survey, and outlines strategic recommendations for decision-makers to address these challenges. It shows that improvement in urban areas in many case equals that in rural areas thus maintaining the urban-rural divide. To make an impact on this divide, more investments and efforts need to be devoted to decrease the gap.? A one-size-fit-all strategy will only maintain the gap as the health indicators continue to improve.

Key Findings

1. Fertility Rates: Although fertility rates have declined, rural areas continue to have higher TFRs indicating the need for enhanced family planning services and education in rural regions.

·?????? 1998 EDHS: The Total Fertility Rate (TFR) was 3.5 children per woman nationally, with urban areas at 2.9 and rural areas at 4.2.

·?????? 2021 Family Health Survey: The TFR decreased to 2.8 children per woman nationally, with urban areas at 2.4 and rural areas at 3.2.

2. Infant and Child Mortality: Despite national improvements, rural areas still experience higher infant and child mortality rates. Targeted interventions are required to improve healthcare access and quality in rural regions.

·?????? 1998 EDHS: Nationally, the Infant Mortality Rate (IMR) was 54 per 1,000 live births, with urban areas at 40 and rural areas at 66. The Under-5 Mortality Rate (U5MR) was 70 per 1,000 live births, with urban areas at 55 and rural areas at 86.

·?????? 2021 Family Health Survey: The IMR decreased to 22.4 per 1,000 live births nationally, with urban areas at 18 and rural areas at 27. The U5MR decreased to 27.8 per 1,000 live births nationally, with urban areas at 23 and rural areas at 32.

3. Maternal Mortality: The reduction in maternal mortality is commendable, but the higher rates in rural areas highlight the need for improved maternal healthcare services, including access to skilled birth attendants and emergency obstetric care.

·?????? 1998 EDHS: The Maternal Mortality Ratio (MMR) was 174 per 100,000 live births nationally, with urban areas at 130 and rural areas at 200.

·?????? 2021 Family Health Survey: The MMR decreased to 37 per 100,000 live births nationally, with urban areas at 25 and rural areas at 48.

4. Access to Healthcare Services: Continued investment in healthcare infrastructure in rural areas is essential to ensure equitable access to services.

·?????? 1998 EDHS: Urban areas had better access to healthcare services, with 80% of women receiving antenatal care from a skilled provider compared to 60% in rural areas. Vaccination rates were also higher in urban areas, with 89% of children fully vaccinated compared to 72% in rural areas.

·?????? 2021 Family Health Survey: While access has improved nationally, with 94% of women receiving antenatal care from a skilled provider in urban areas and 82% in rural areas, significant disparities remain. Vaccination rates increased to 95% in urban areas and 85% in rural areas.

5. Contraceptive Use: While the gap in contraceptive use has narrowed, further efforts are needed to increase access and education around family planning in rural areas.

·?????? 1998 EDHS: Nationally, the contraceptive prevalence rate among married women was 56%, with urban areas at 62% and rural areas at 51%.

·?????? 2021 Family Health Survey: The contraceptive prevalence rate increased to 59% nationally, with urban areas at 64% and rural areas at 56%.

Strategic Recommendations

1.?????? Move from One-Size-Fit-All Strategy to Targeted Investments and Interventions in Lagging rural regions

·?????? Enhance Family Planning and Reproductive Health Services: Expand the availability and accessibility of family planning services in rural areas. This includes community-based education programs and mobile health clinics to reach underserved populations.

·?????? Invest in Rural Healthcare Infrastructure: Allocate resources to build and upgrade healthcare facilities in rural areas. This should be coupled with training and deploying more healthcare workers, particularly skilled birth attendants and pediatric care providers.

·?????? Targeted Maternal and Child Health Programs: Implement targeted interventions to reduce maternal and child mortality in rural regions. This could include improving emergency transport services, providing financial incentives for healthcare workers in rural areas, and expanding immunization coverage.

2.?????? Leverage the Universal Health Insurance (UHI) System: Use the ongoing rollout of the UHI system as a platform to address regional disparities. Ensure that rural populations are prioritized in the UHI expansion, with a focus on covering essential health services and reducing out-of-pocket expenditures.

3.?????? Promote Public-Private Partnerships (PPPs): Encourage partnerships between the government and private sector to deliver healthcare services in rural areas. PPPs can help bridge gaps in service delivery and introduce innovative healthcare solutions.

Addressing the urban-rural divide in health outcomes is crucial for achieving health equity in Egypt. By implementing the above recommendations, decision-makers can ensure that all Egyptians, regardless of where they live, have access to high-quality healthcare services. The success of these initiatives will be pivotal in closing the gap and improving the overall health and well-being of the nation.