Is Egypt Committed to Private Sector Engagement in Health: An Overview of its Policy Statements

Egypt's Universal Health Insurance Law and associated policy documents outline an attempt to present a framework for private sector engagement in the health sector, reflecting the extent Egypt is committed to enhancing healthcare delivery through different forms of public-private partnerships. The level of Egypt's commitment could be documented across several key areas, including constitutional provisions, strategic frameworks, specific legislation.?

However, this commitment does not converge towards a unified and integrated approach for private sector engagement, focusing on service delivery ignoring many much needed for engagement. The policy statements supporting private sector engagement ranged from that of the overall health sector to universal health insurance coverage. Further, the language of support is leaning towards putting more emphasis on supporting Egypt’s healthcare service delivery through its public sector as the primary source of health care while allowing a space for the private sector to participate. In some cases, the statements are contradictory in terms of defining the role of the private sector especially that related to the delivery of primary health care services.

We have selected a few policy documents to demonstrate Egypt's level of commitment.

Health Articles in the Constitution.

In principle, Egypt's constitution explicitly supports private sector participation in healthcare. Article 18 encourages the involvement of both private and public sectors in providing health care services, while Article 36 promotes the private sector's social responsibility in serving the national economy and society. However, Article 18 emphasizes the state's role in maintaining and enhancing public health facilities, ensuring their efficiency and equitable distribution, and subjecting all health-related activities to state oversight.

Government Ownership Policy Document

The government’s ownership policy underscores a more restrictive approach, aiming to maintain or increase current governmental investments in the health sector while simultaneously allowing for private sector participation.

Strategic Directions Framework for Health 2023-2030

The Ministry of Health and Population (MoHP) report, "Strategic Directions Framework for Health in Egypt 2023-2030," outlines the government's strategic goals, with a primary focus on achieving universal health coverage. The document went into more details outlining key strategies to include:

- Strengthening the new Universal Health Insurance System (UHIS) by promoting competition and choice among public and private service providers.

- Enhancing the quality of healthcare services across all levels in both public and private sectors.

- Promoting public-private partnerships (PPP) to improve healthcare accessibility and efficiency.

- Collaborating with the private sector to enhance the production and quality of health products, including local pharmaceutical manufacturing.

- Strengthening health system governance by reviewing and updating health-related laws and regulations.

Conclusions of the National Dialogue

The national committee was concerned with accelerating the expansion of the Universal Health Insurance System and recommended to horizontally expand primary health care nationwide This expansion, targeted within 3 to 5 years, emphasizes the state's role in upgrading health facilities while enhancing private sector and civil society participation, thus fostering a comprehensive healthcare network.

Government Health Plan 2024-2026

The 2024 health plan includes incentives for health sector investors, facilitating their access to special benefits in the modern healthcare sector. It encourages the private sector to expand initiatives like "hospital at home" and hospital-to-hospital care paths to reduce hospitalization rates, showcasing the government's stance in integrating private sector solutions to enhance healthcare delivery in a rather limited scope.

Egypt’s Universal Health Insurance Law

The Universal Health Insurance Law establishes a more inclusive approach for private sector engagement. Article 10 allows the Universal Health Insurance Authority to purchase health services from both public and private entities at standardized prices. Article 16 enables private hospitals to provide services once they meet accreditation standards, and Article 36 requires all health facilities to obtain accreditation within three years, ensuring compliance with quality standards. Collectively, these measures aim to improve service delivery and health outcomes through a regulated and integrated private sector. However, there are other articles that were not clear on the relationship between Egypt's public provider, the Egypt Healthcare Authority, and private sector providers.

PPP Concession Law

The PPP law specifies regulations for private sector engagement in establishing and operating health facilities. Operators are responsible for maintaining facilities and equipment, ensuring compliance with health laws, and employing experienced personnel. The commitment period ranges from three to fifteen years, after which facilities and equipment are transferred back to the state in good condition. Operators must also provide a portion of health services at state-determined prices and continue employing a significant percentage of the facility’s staff, safeguarding their financial and employment rights. However, the law prohibited the involvement of operators in the delivery of primary health care services.

In conclusion, Egypt's policy statements demonstrate an attempt to commit to integrate the private sector into the national healthcare system that would require additional efforts to make this commitment stronger and clearer. By balancing public and private sector roles, the country could aim to enhance healthcare accessibility, quality, and efficiency, ultimately achieving its goal of universal health coverage.