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The Sorry State of Egypt’s Health Services

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A woman sits on the floor with her son at an Egyptian public hospital in the province of Sharkia, Egypt. Photo Nasser Nouri

The Egyptian government has taken steps to improve the country’s health services, but some officials recognize that provisions are still inadequate. In 2015, former Prime Minister Ibrahim Mahlab visited two state-funded hospitals and was reportedly stunned by the grim conditions.

Photos of other state hospitals posted by doctors on Facebook following his visit show dirty equipment, bloody bandages on the floors, sewage overflowing into the halls and patients surrounded by stray animals.

Even hospital beds are in short supply. In 2012, the World Bank found that Egyapt has only 0.5 beds per 1,000 people. In contrast, Israel has 3.3 and Mexico 1.5. A lack of government spending, insufficient human resources and inequitable access are all to blame. The state spent just 2.2 per cent of its gross domestic product (GDP) on health care in 2014. Turkey, which has a comparable population and a far superior health-care sector, spends between 5 and 6 per cent.

Medical professionals and local NGOs agree that the quality of care is terrible. Many Egyptians consequently rely on costly private clinics. Although 54 per cent of the population is covered by a government health programme, only 8 per cent routinely visit state-funded clinics. In fact, 72 per cent of the population pay for health care out of their own pocket. The poorest 27 per cent, who live below the poverty line, cannot afford to.

Health-care advocates, such as the Egyptian Initiative for Personal Rights (EIPR) and the Doctors Syndicate, have urged the government to spend more on health care. The state claims that doing so would run counter to necessary austerity measures. Six months ago, Egypt secured a loan from the International Monetary Fund (IMF) on the condition that it implement a myriad of financial reforms. Cutting subsidies was one of them. At the same time, the government continues to splash out on high-profile development projects. As the Economist noted, Egypt spent the equivalent of a year’s health budget on the construction of a new capital city.

Yet despite decades of health-care subsidies, the poor have not always benefitted. Upper-class university hospitals receive the lion’s share of subsidies, whereas the poorest medical schools receive just 11 per cent of the annual quota, according to a 2015 academic study published in the Social Sciences journal.

That said, some improvements in public health have been made in recent years. The World Health Organization (WHO) reported that child and maternal mortality rates in Egypt have fallen. The success was attributed to the wider access to immunization and skilled birth assistance.

However, more needs to be done. Malpractice and corruption, for instance, remain major issues. Egypt’s Administrative Prosecution (AP) reviewed 594 cases of corruption in 2014. In most cases, medical staff were reluctant to help new patients who needed emergency treatment. They also frequently refused to show up or complete their shifts. Some doctors, desperate to feed their families, overprescribed or misdiagnosed patients to make extra money. Several young children died after being injected with the wrong vaccine.

The WHO estimates that Egypt gives as many as 281 million injections per year. At least 23 million are suspected to be unsafe, increasing the risk of infection.

Hendrik Bekedam, the WHO’s spokesperson in Egypt, said that although the country has many hospitals, most are operated by poorly trained medical staff. One doctor told al-Monitor that she had seen colleagues perform operations on HIV-positive patients without gloves. Others delivered babies with their bare hands. Medical workers are at a high risk of contracting Hepatitis C, a disease that still affects large swathes of the population.

Furthermore, there is no detailed legislation that criminalizes malpractice. This means that hospitals and staff are generally immune from prosecution.

Critics have lobbied the government to establish a single committee to reform and monitor the health sector. At present, medical care falls under the authority of the Health, Education, Interior and Defence ministries. Private health-care entities also wield considerable power.

Ayman al-Sebaie, a health researcher for the EIPR, told the local English-language news platform Mada Masr that an independent body made up of ministers, civil society actors and private health-care representatives is desperately needed to improve the quality of health services.

Such a committee could also address the grievances of medical professionals. Abysmal state wages, for instance, compel many doctors to open their own private clinics. In fact, wages can be as low as 890 Egyptian pounds per month ($49).

The lack of incentive to work in the public health sector means that subsidized hospitals are neglected. Hospitals in rural areas are worst off because medical professionals prefer to work in urban areas. The disparity is most obvious in Upper Egypt, where only 49 per cent of women in rural areas receive antenatal care, compared to 75 per cent in cities.

Egypt’s rapidly growing population suggests that the health crisis is only going to get worse. The large number of youth will create challenges as they age. The health sector is already inadequate to meet the needs of 93 million people. By 2050, that figure is projected to reach nearly 150 million.

Looming austerity measures pose an immediate threat. Last year 2016, the government significantly raised the price of 2,010 pharmaceutical drugs. More than 600 of these are used to treat chronic diseases.

Mona Mina, secretary general of the Doctors Syndicate, said the country was facing a “terrible choice”: stopping the provision of life-saving medicines or making them unaffordable for most citizens. The sorry state of Egyptian health care, Mina argued, is due to the government’s neglect and the aggressive privatization of the sector since the 1970s.