AmCham held its monthly luncheon on June 12 at the Semiramis InterContinental Hotel with guest speaker Dr. Hatem El Gabaly, minister of health and population.

Following a brief introduction by AmCham president Taher Helmy, El Gabaly began his presentation by providing a brief history of the progress Egypt has made in key health indicators. He noted the average life expectancy for males in the 1960s was 44 years, while today it is 67 years. For women, it was 46 in the 1960s and is now 71. He compared this favorably to the Organization for Economic Cooperation & Development (OECD)’s figures for average life expectancy, which are 75 for males and 81 for females.

He also noted significant improvements in the infant mortality rate – a benchmark indicator of a developing nation’s progress on the road to development. In 1960, Egypt had 186 infant mortalities per 1,000 live births and child mortality was 104 per 1,000 live births. Today, these rates have gone down to 33 and 39 respectively.

El Gabaly noted that in underdeveloped countries infectious diseases are a big health problem, but as a nation’s populace moves towards a more affluent life, the ratio of infectious diseases to non-infectious “lifestyle” diseases falls. “If you look at developing nations, 50 percent of the diseases are lifestyle diseases, but if you look at the western world and developed countries, it’s about 86 percent. In Egypt now, it’s about 78 percent and infectious diseases are about 16 percent, which is really, I think, the biggest achievement that the health system in Egypt has been able to provide in the last 50 years.”

Despite the improvements, the minister noted that the current health care system is plagued by many problems, including: the lack of real health coverage and a safety net for low-income individuals, poor access to health care, inequitable distribution of health services, and insufficient financing.

The quality of health care is another problem, he said. “Of breast cancers in Egypt, 66 percent are diagnosed in stage 3 and 4. If you compare that to the USA, it’s only 9 percent. So the death incidence from breast cancer for Egyptian women is more than 3.5 times that of the US.”

He said one of the problems contributing to the low quality of care is that although doctors are required to work two years after they graduate, “the top doctors are allowed to stay in Cairo, while those who have the lowest scores go to the farthest points of the country. The least trained physicians are sent to the farthest points, so you can imagine what kind of services people in rural areas are getting.”

The minister also noted that because of the lack of confidence of the public in the health system, most people bypass the health insurance system. More than 62 percent of the population pays for health services out of their own pocket. “The tragedy of this is that the poor people are paying more than the rich people,” he said. “Only 29 percent are covered by the government budget, either by the Ministry of Health or the Ministry of Higher Education and so on, 8 percent go to the health insurance organization and the rest [pay] out of pocket.”

After extensively outlining problems of the current health care system, El Gabaly discussed a number of initiatives that are designed to “produce quick results that can be felt in the street within the coming year or two.” In the meantime and in parallel, he noted, structural reforms must also be undertaken.

But not every initiative will be approved. He stressed that it was important that initiatives meet certain criteria before being implemented, namely whether they have a broad impact, are feasible and are urgently needed. One initiative that obviously met these requirements is medical convoys. “We decided to build a department that will focus on providing medical convoys all over the country within one year,” he said. “We will have three convoys in every governorate and run a program by which we train the people, set up the proper ID system for them, build a database and we follow up on the treatment of patients if they are referred by the convoys to a neighboring hospital. We have done three very successful convoys so far in preparation for the full launch of the initiative in the middle of July.”

Re-examining how the budget of the Ministry of Health is utilized and boosting investment is another priority according to the minister. “Right now, 44 percent of our budget goes to salaries, and investment is only a small portion – about £E 1.2 billion this year, down by about £E 200 million. So we’re looking for opportunities outside the box, mainly public-private partnerships and private financing initiatives. But we’re working very hard to improve the utilization of our investment,” he said.

As for structural changes, El Gabaly pointed out that it will take years and the major issues have to be addressed, starting today, including access, financing, provision and system stewardship. He explained the importance of health care packages and mandatory, universal health insurance.

Following his presentation, El Gabaly answered questions from the audience on subjects including preventative health policies, pharmaceuticals pricing and the current state of bird flu control.