Challenges And Progress In Egypt’s Healthcare System: A 2023 Update

October 23, 2023


One of the biggest problems facing Egyptians has always been the quality of healthcare services. Given the country’s low-middle income status (based on World Bank classifications) and a population nearing 110 million, the government has long struggled to ensure top-tier, affordable healthcare.

A 2019 report by the Demographic and Health Survey Program (DHSP), published by USAID, said Egypt’s healthcare system “faces not only the burden of combating illnesses associated with poverty and lack of education, but it must also respond to emerging diseases and illnesses associated with modern, urban life.”

To improve healthcare services and increase medical investment, the Ministry of Health and Population (MOHP) has increased spending by 15% in fiscal year 2023-2024 compared to the previous year. Additionally, the ministry is collaborating with other countries to advance the sector and launching new national health campaigns.

Labyrinthine system

The government is the “major provider of primary preventive and curative care in Egypt,” the DHSP report noted, with “about 5,000 health facilities and more than 80,000 beds nationwide.”

State-owned providers receive financial support from the national budget, and their medical and administrative staff are “subject to the rules and regulations that govern all civil service organizations.” That is most evident in salaries, which adhere to Egypt’s Civil Service Employment Law. According to the DHSP report, that is common in “lower- and middle-income countries.”

Those medical providers can have “economic departments” where patients pay a nominal fee. Regardless of the proceeds, the support those hospitals and centers receive from the Ministry of Finance isn’t affected.

Government-owned hospitals are classified based on size. Integrated Hospitals (20 to 60 beds) are the smallest, providing primary care and specialized services in rural areas. District Hospitals (100 to 200 beds) serve larger areas with populations of 10,000 to 50,000. The biggest are General Hospitals located in the capitals of each governorate.

The health ministry also owns facilities specializing in treating eye infections, psychiatric problems, chest conditions, fevers, heart disorders, tumors, and gynecology and obstetrics.

Other ministries also own and operate hospitals that cater to their own employees. The list includes the ministries of interior, transport, religious affairs and defense, among others. Meanwhile, most state-owned universities have medical facilities regulated by the Ministry of Higher Education.

The other type of medical service providers are quasi-government facilities (parastatal). They are partly owned by either the Health Ministry’s Health Insurance Organization (HIO), Curative Care Organization, or Teaching Hospitals and Institutes Organization. That gives them a “controlling share of decision-making” in the facilities they co-own. Like government hospitals, parastatal providers charge patients nominal fees.

They are different from 100% state-owned facilities “from an operational and … financial perspective, … governed by [their] own set of rules,” said the DHSP report, with “separate budgets and more autonomy in daily operations.”

Revenue streams differ based on which government agency co-owns them. For example, those the HIO owns get payments from the Social Insurance Organization, Pensioners Insurance Organization, and Student Health Insurance Program, as well as co-payments from civil servants.

Privately owned facilities include for-profit establishments such as medical centers and hospitals. There also are NGO-funded medical service providers, such as religiously affiliated clinics and charitable organizations, which are licensed and regulated by the Ministry of Social Solidarity.

Initiatives and reforms

The government has multiple programs that support specific needs, such as reproductive health and family planning, diarrheal and acute respiratory diseases, an expanded program for immunizations, and maternal health.

In July 2020, the government announced the umbrella 100 Million Healthy Lives Initiative. “The initiative [aims to] upgrade the health system in Egypt … achieving the … Egypt Vision 2030,” said the State Information Service

In October 2021, the health ministry announced the Elderly Continuing Care Program, which treats the physical, mental, and emotional impacts of age-related illnesses for eligible patients.

The program, part of the 100 Million Healthy Lives Initiative, has helped 552,000 elderly citizens through August in 832 medical centers in 21 governorates.

In 2022, the health ministry launched a new universal healthcare system that gives full medical coverage to all Egyptian workers. It also legally obliges them to contribute to their unemployed spouses’ and children’s coverage.

Private medical centers and practitioners can opt to join that universal system, under which they would receive nominal fees from patients. The government covers the rest of their costs. The DHSP report said the goal for the ministry is to “phase out its role as a provider of health and medical services.”

In June, Prime Minister Mostafa Madbouly launched the 100 Days Health Initiative, which sends medical teams to inaccessible areas to examine and treat residents for free.

Two months later, President Abdel Fattah el-Sisi launched the 1,000 Golden Days to Develop the Egyptian Family, part of the 100 Million Healthy Lives initiative. The program focuses on the development of the physical, emotional, and mental health of newborns through their first 1,000 days. It also offers similar support to parents to ensure a healthy environment for the whole family.

The first phase will run through June 2024, rolling out to 10 governorates. The second phase will end in December 2025, covering the remainder of Egypt’s municipalities.

Another avenue MOHP is working on is cooperation with other countries to improve the quality and reach of health services to residents.

Throughout 2023, ministry officials have met with representatives from Italy to discuss programs to improve nursing in Egypt; with Spanish counterparts regarding knowledge transfer opportunities in the field of ophthalmology; and with Portuguese officials regarding knowledge transfer opportunities to identify and treat tumors, particularly breast tumors.

Health ministry officials also met with their French counterparts to discuss developing and upgrading Egypt’s Universal Healthcare System. They also met with the World Health Organization and EBRD to improve the ministry’s healthcare services, particularly maternal and mental health.

To promote medical investments, the health ministry officials met with Qatari, South Korean, and Czech officials to discuss FDI opportunities and sign MoUs to build healthcare facilities and factories that produce medical equipment. In February, a ministry press release said three MoUs with Qatari investors were signed “to offer healthcare services.”

During the 58th Meeting of Arab Health Ministers in March, Health and Population Minister Khaled Abdel Ghaffar called for establishing an “Arab Medicine Agency” to create a “more sustainable medicinal ecosystem” that unifies health standards among Arab nations.

The agency would aim to create new markets to export medicine and promote medical equipment manufacturing. It also would focus on improving the quality of nursing and helping the Arab world deal with pandemics by working together to develop vaccines and medicines and unifying procedures to prevent the spread of disease.

At the event, Abdel Ghaffar said such cooperation “would ensure the region achieves its health security goals, which will reflect positively on Arab economies and societies.”