Health as an Instrument for Comprehensive Development

H.E. Dr. Ismail Sallam, Minister of Health & Population, addressed AmCham Egypt's monthly luncheon on May 7 on the topic of "health as an instrument for comprehensive development." Dr. Sallam emphasized the centrality of health care - particularly holistic, preventive health care - in all aspects of social and economic development. "Hospitals and treatment of illnesses are only 20 percent of health care," he said. The real challenges, and the top priorities of the ministry, are "prevention and promotion."

Likening health to the foundation of a house, the minister pointed out that "without health, people are unable to work, to listen, to communicate."

Health care produces a tremendous return on initial investments. "Nothing [else] can produce as much," Sallam said, asserting that LE 1 invested in health can produce a return of LE 30 after 10 years. "The holistic approach is the only way to deliver health," he added.

Moreover, health is crucial to social stability. "When we talk of economic reform or Open Door policies, we must remember that the most important considerations for any society are stability and security," Sallam said. "The worst problems arise when there is a lack of balance between [health care] and reform."

The ministry's basic approach is "elimination of disparities," including those between rich and poor, rural and urban, Upper Egypt and Cairo. The ministry is also careful to consider people with special needs.

Touching on gender issues, the minister noted that the most basic problems are found in rural areas. The ministry has set up 1,000 women's health clinics, which not only provide health care, but also deal with educational and social issues, including reproductive health. "In fact, the clinics are for everyone, but the main issue is to get women advancing," Sallam said. As women have become involved in the clinics' women's clubs, their husbands have begun listening to them and turning to them for advice, he said.

Sallam also discussed the ministry's efforts to reduce waiting times for public health care. "We used to have the poor in a queue for years," he said. "Now the ministry has taken a direct approach to ensure that the basic needs of poor people are met. The screening process has been simplified. Anyone who accepts standing in a queue for a government hospital is poor."

According to the minister, who is himself a heart surgeon, there is currently no waiting list for cardiovascular surgery, and the ministry has greatly improved the cost-effectiveness of its programs in this field.

Sallam said that health services in remote parts of the country have also been greatly improved, with 460 mobile clinics run by private groups providing care all over Egypt.

The ministry has completed 2,700 clinics for primary health care in the last five years. "Around Africa, efforts to deal with Aids and malaria have been hindered not by lack of money but because there has been no vehicle for programs in the community," the minister said. "And this is because there has been no primary health care."

The ministry is currently tacking the problem of registration. "In the next three years, a comprehensive system of registration will emerge," Sallam said. "There will be a number for every house and a file for every family."

The minister also cited the example of Healthy Egyptians 2010, a program based on a successful U.S. model, Healthy People 2000. In order to utilize resources most effectively, the program - which the ministry is implementing in cooperation with the U.S. Department of Health - specifically targets anti-smoking campaigns, safe motherhood and childhood, and accident/emergency care.

The ministry is counting on help from the private sector and NGOs. With 85 percent of the population living on incomes of around $1,500 per year, most Egyptians "can't afford private hospitals," he said. "We shall seek to see these people insured - with a role for the private sector, and less of a burden on the public sector."

NGOs could also take over the burden of some of the government's work. The health ministry agreed, for example, to allow a group of Egyptian doctors from the United States to run a wing of a government hospital.

"The future is for the private sector," Sallam said. However, he warned against hasty privatization as an end in itself. "People say privatization is a target," he noted. "But I must deliver health wherever there is no delivery."

The ministry has, however, already had some success in developing "centers of excellence" for health care, where employees receive fair pay, depending on their work. "For example, we recognize that doing 20 operations is different from doing 100 operations," Sallam explained. "Some are now earning LE 20,000 per month. We're happy to be clearing the waiting lists and seeing better utilization and occupancy rates."

Finally, the minister turned to pharmaceutical policy. "The health ministry is trying to do some tuning," he said. "Pharmaceutical strategy can't be seen alone. It is part of health strategy." As in other areas, the ministry considers insurance an urgent necessity to cover the costs of pharmaceuticals. "We have to make sure that underprivileged groups also get their pharmaceuticals," Sallam said.

Defending the health ministry's record on regulating drugs, Sallam said that conflicts between local producers and multinationals had been greatly exaggerated in the press. "We are supporting our pharmaceutical industry," he acknowledged. But while there is some competition between multinationals and the Egyptian industry, "we're not in conflict. The Ministry of Health is there to regulate issues between the two."

The ministry's role, Sallam explained, is to "ensure sustainability." If companies were allowed to produce pharmaceuticals on a purely free-market basis, "essential drugs would otherwise be unavailable or intermittently available."

This pharmaceutical policy is consistent with the ministry's overall approach. "We'd like to have free-market interaction, but we must protect the social balance," Sallam said. "Pricing is done fairly, but with social components in mind." These social components," he added, "are the most important part for the stability and sustainability of any economic program."

In the question and answer session that followed, the minister elaborated on how the health ministry coordinates with the industry in the process of research. "The process of approving new drugs is transparent," he stressed, explaining that pricing is based on benchmarking against other countries.

Multinational companies, however, have not invested in research in Egypt. "How much research have you done in Egypt? Nothing," Sallam said. Multinationals are essential for progress, he said. "We are just asking that we all work together, even with the local industry."

On the sensitive issue of intellectual-property rights, "we must ensure that intellectual property will help us," Sallam said. If protection of multinationals' patent rights appears to be "affecting patients' interests or the local industry's interests," he warned, "this will affect people's views."

In order to solve the problem, he concluded, "all of us have to work together to pass an intellectual-property law in the safest way."

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