Ministry of Health Proposes Concession Contracts for Public-Private Partnerships: Medical Syndicate Objects, Parliament Approves in Principle

In April 2024, the Egyptian Cabinet introduced a draft law proposing the management of public health facilities by the private sector through concession contracts. This move aimed to boost healthcare investment and increase the private sector's role. Despite facing strong opposition from the medical syndicate and a wave of objections from parliamentary representatives, the law was approved in principle by the Parliament in record time.

The debate surrounding the draft law highlighted confusion about the role of concessions in public-private partnerships (PPPs) for healthcare services, with many mistaking it for the selling or leasing of public health facilities. This misunderstanding led to significant concerns, especially about the exclusion of primary healthcare services, which were considered crucial for national security.

The General Syndicate of Doctors in Egypt strongly opposed the draft law, arguing that the government should focus on encouraging the private sector to build new healthcare facilities rather than taking over existing ones. They raised concerns about the lack of protections for hospital workers, questioned the criteria for selecting hospitals for these partnerships, and feared that foreign investors might undermine local standards. Dr. Osama Abdel-Hay, head of the Syndicate, expressed worries about the potential negative impact on low-income citizens and the stability of health workers' employment.

During the plenary session, Dr. Ashraf Hatem, Chairman of the House Health Committee, presented the committee's report. He emphasized that the draft law aimed to enhance healthcare service quality, efficiency, and equitable distribution by involving the private and civil sectors. The committee highlighted that the law is grounded in Article 18 of the Constitution, which ensures every citizen's right to health and mandates the state to support public health services.

The draft law proposes a regulatory framework for granting concessions to Egyptian or foreign investors to manage and develop health facilities. This initiative is intended to improve healthcare service quality and efficiency through private sector involvement. The law would operate under the provisions of the 2018 Law Regulating Contracts Concluded by Public Entities, with specific conditions tailored to each project.

Key amendments introduced by the Health Committee and the Council of Ministers include:

1. Restrictions on Concessions: Concessions cannot be granted for primary healthcare facilities and services related to national security.

2. Exemptions: The law will not apply to basic healthcare, family health centers and units, or blood and plasma operations, which are governed by Law No. 8 of 2021.

3. Quality Assurance: Provisions ensure that the quality and availability of services to citizens are not diminished, including free preventive and emergency services.

4. Health Insurance Rights: The amendments protect the rights of beneficiaries under the Universal Health Insurance Law.

5. Mandatory Service Provisions: Investors must provide a portion of their services to state-funded beneficiaries at state-determined prices.

6. Employment Protections: Investors must retain at least 25% of the existing workforce, preserving their financial and employment rights.

7. Limits on Foreign Employment: Foreign doctors, nurses, and technicians are capped at 25% of the total workforce, with restricted licenses.

8. Facility Restoration Clause: The Council of Ministers must outline terms for the potential early restoration of health facilities to the state in case of necessity.

Despite these amendments, several parliamentarians voiced strong objections. Representative Mohamed Abdel Aziz condemned the project as a governmental abandonment of social responsibilities, particularly affecting low-income citizens. He criticized the lack of sufficient guarantees for treating vulnerable groups and the delays in implementing comprehensive health insurance.

Some representatives supported the draft, citing its alignment with constitutional mandates and the encouragement of private sector participation. However, other stressed the need for the law to ensure free medical treatment and protect citizens' rights. Parliamentarians opposing the law, argued it signaled the government's failure to manage public hospitals and retreat from constitutional duties. Concerns about the potential impact on existing health insurance systems and the rights and working conditions of health workers were also raised.

Overall, the sentiment among many parliamentarians was a mix of caution and skepticism, emphasizing the need for stronger safeguards and assurances to protect the health and welfare of all citizens.