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Will Cigarette Taxes Bring Egyptian Healthcare to Salvation?

15 December, 2016
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The Egyptian Doctors’ Syndicate supported the parliament's Health Committee proposal to dedicate 40 piasters from the general tax on cigarettes to the General Authority for Health Insurance in mid-November. This proposal is scheduled to be presented before the parliament's Planning and Budget Committee, so that it would reach the next General Assembly.

The syndicate also added that the cigarette tax, imposed in favor of the healthcare system, was backed by both Presidential Decree No. 12 of 2015 and the Ministry of Finance's decision No. 120 of 2015. However, it was never implemented.

The minister of finance first gave word that all of the taxes will be given to the Ministry of Health to finance the healthcare system, but then decided to dedicate only EGP 1.5 billion out of a sum of more than EGP 5 billion, the healthcare director at the Egyptian Initiative for Personal Rights (EIPR), Alaa Ghanaam, told BECAUSE.

Turning away from the politics, we spoke to healthcare experts from different sectors to understand what the main problems are and how to overcome them.  

“Since there’s a great deficiency in the budget, healthcare is worthy of the entire batch rather than just a portion,” the EIPR healthcare director argued.

Ghanaam, together with his team at EIPR, identified seven challenges that healthcare faces in Egypt. Funding is the most pivotal challenge, which the rest of the challenges are dependent on.

According to EIPR’s calculations, healthcare is funded by two factors. 30% of the funds come from the government and the remaining 70% comes from the public’s expenses. Other challenges are about the service, its management, the structure and organization of healthcare, and the development and distribution of human resources.

In a SWOT analysis conducted by the World Health Organization (WHO) about the healthcare system, they summarized its weaknesses in the following points: 

  • High share of out-of-pocket spending on health that has increased in recent years.

  • Highly centralized administrative structures with rigid resource management and flow of funds.

  • Fragmented health system with fragmented regulatory, health financing and providers’ structures.

  • Uneven and inefficient allocation of resources between primary, secondary and tertiary care with skew towards secondary and higher levels.

  • Low quality and inadequate use of public health sector services.

  • Unclear policies and weak regulation of the network of private providers.

  • Poor workforce strategies with lack of harmonization between medical education and practice, lack of appropriate incentives to qualified workforce leading to demotivation, migration and extensive dual practice.

  • Lack of harmonization, integration, communication, sharing and use of data and information with questionable and high fragmentation.

  • Fragmented and non-inclusive surveillance system, particularly with regards to noncommunicable diseases.

  • Inadequate intersectoral coordination, collaboration and integration with no effective governance structure to cater for it.

Part of the problem is that the healthcare system in Egypt plays several roles at the same time. It funds, offers services and manages it without enough quality. The new idea proposed by the EIPR for the next healthcare system will divide these roles so that there will be an independent body for funding the health organization – just like France – and another body to offer the service and a third to act as a surveillance body over the services offered and Ministry of Health.
 
Moreover, doctors working within public hospitals as part of the healthcare system will not be allowed to work elsewhere, not even in private clinics, but in return they will be given a proper salary with a contract.
 
EIPR’s new system will also introduce Egyptians to digital and hard copies of their medical files. “This file will serve both the doctors and the patients. The doctor will be able to explore the patient’s medical history so that he will not have to start all over again – wasting both time and resources,” Ghannam explained.
 
While WHO does not actually propose new laws to the government’s legislative bodies, they "provide technical support to law formulation process or content such as earlier support to modifying traffic law, development of technical nursing education bylaws, and current support to the development of the new health insurance law,” WHO’s national professional officer, Magdy Bakr, told BECAUSE.  
 
In the same analysis mentioned before, WHO pointed out a number of priorities for the government to bear in mind in 2016-2017: 
  • Stepwise implementation of the new universal SHI with its mandated reform of the whole health system

  • Improve access to quality health services for primary, secondary and higher levels of care and strengthen human resources for health, especially at the peripheral level

  • Scale up the family health model as a means for providing integrated PHC with focus on upgrading its human resources component, particularly measures to overcome shortage of family physicians

  • Institutionalization of the health information system with development of a data warehouse, health sector monitoring framework, and information system to manage universal SHI

  • Implementation of national plan of action for the prevention, care and treatment of viral hepatitis as well as focus on key preventive and public health programmes, patient safety including blood and injection safety

  • Strengthen institutional and management capacity and services for noncommunicable disease and nutrition with emphasis on use of modern technology in communicating health education and promotion

  • Develop and implement effective governance, regulatory and institutional arrangements in pharmaceutical sector to improve access and rationalize use of quality medicines and health technology

  • Set and implement measures to ensure financial risk protection, improve efficiency and put in place tools for cost containment

The Egyptian healthcare system is an archaic one. It was established in 1964. It was confined to the public sector only, and didn’t reach other sectors like peasants, unemployed housewives and until now doesn’t reach street vendors, taxi drivers and day laborers. It gradually extended to theoretically cover 57% of the public. However, it covers only 12% in real practice, due to weak funding resources. The 57% of the public covered need about EGP 6 billion annually, according to Ghannam.
Tags Health care Egyptian Initiative for Personal Right cigarettes