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The 20/20 Health Care Project in Egypt

Posted on Jan 30, 2013 by Ailee Slater ()

It is rare to open a newspaper these days and not find a story about upheaval in Egypt - revolution, elections, the deadly riots occurring just this month. However, one area of change in recent years that receives little media attention is healthcare reform in Egypt.

One of Egypt's most pressing struggles is lack of data, meaning that no one knows the effectiveness of current health policies, or how future resources ought to be distributed. There is likewise little data on personnel productivity, and so over and under staffing is a common problem at public hospitals. Without efficient ways of performing studies and analyzing the data collected, there is simply no way to improve the nation's healthcare system as a whole. During the past decade however, Egypt has made great strides toward developing better healthcare.

In 2012, the U.S. program 20/20 finished six years working together with the Egyptian Ministry of Health to improve methods of collecting information, and training administrative staff. 20/20 is a flagship project from USAID, the United States Agency for International Development. The goal of the USAID 20/20 program is to strengthen healthcare systems worldwide. Working with nations such as Mali, Nigeria and Egypt, 20/20 has come together with local groups to implement projects involving new technology, tackling infectious diseases and improving administrative oversight. Additionally, 20/20 has helped these nations to train new medical professionals, and to hire new teachers for medical training facilities.

One major part of 20/20's work in Egypt was a $10 million project to help the Ministry of Health (MOH) assess budgeting and health care needs. The project worked with local health groups in Cairo to collect better data, in particular data regarding staff productivity and how many staff are necessary to tackle the workload in different hospitals. With better abilities in research and analysis, the MOH should be able to create a healthcare system with more productive health providers and better employee resources. This work with staff and data collection is especially important considering the healthcare disparities in different parts of the country; with more knowledge about personnel productivity, medical providers can be placed where they are most needed. A great example of the positive impact 20/20 has had in Egypt is the Egypt National Health Accounts (NHA) Report released in 2011. This NHA Report is only the second of its kind to conduct such a wide-ranging collection of health data and publish the results with the Ministry of Health online.

The report is a perfect illustration of the fact that better data can lead to more usable policy recommendations, as well as more specific health reform goals. The NHA Report managed to track and analyze the biggest problems facing Egypt's healthcare system. The report found that too much health care spending is coming from the private rather than the public sector, and that this out-of-pocket spending is a drain on low income Egyptian citizens especially. At the moment, Egypt spends a smaller proportion of its GDP on healthcare than most other nations in the region. What's more, even with government spending to create and maintain public hospitals, many people still choose to visit a private clinic and pay out-of-pocket for that privilege. The NHA Report found that long waiting times were usually responsible for that decision. Disparities in the care of women and men was another important finding of the NHA Report. This, along with inequality in the healthcare of the poor, was found to be harming Egyptian healthcare reformers' struggle to create a fair and equal healthcare system. The report noted that women living in rural areas were especially disadvantaged by the current system, due to a lack of nearby healthcare resources and misunderstandings about the need for identification when accessing public health services.

Data collected with the NHA Report also found a lack of access to health insurance. Although more and more households have been using insurance since the 1900s, the number of insured Egyptians is still far below the norm for the region. Most people with insurance use the national Health Insurance Organization of Egypt, however this organization was found (like many parts of Egypt's public healthcare) to be in need of improvements in terms of administrative practices, better auditing and better collection of data. Once again, the NHA Report showed that in the case of insurance, women and the poor were at a disadvantage; many women were not covered by insurance due to not having a job, and low income families with no insurance were put at a major financial disadvantage in situations of sudden medical emergency.

This NHA Report has used its sound collection of data to help the Ministry of Health provide important policy recommendations. The MOH first of all recommends that the Egyptian government consider an urgent investment in public health; this money may firstly be used to make public hospitals better so that money will flow back into these institutions rather than into private clinics. Furthermore, the MOH recommends finding ways to get more people on insurance in order to better national health and avoid the pitfalls of inequality among those who are uninsured.

Of course, the Report also recommends that more money be spent on improving data collection and creating more analytic reports. With better studies on demographics and needs, the hope is that Egypt can improve its national healthcare through proper allocation of resources and smarter government spending. Indeed, it is rather shocking to read that at the moment, the Ministry has barely any way of tracking how much money is spent per month on any given health program or hospital. With more focus on data collection tools, the Ministry of Health should be able to develop a better understanding of where money has gone, how well those projects have progressed, and where finances ought to be directed in the future.

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