THE DREAM of MAKING THE CHANGE

QUIALITY HEALTH CARE FOR THE UNPRIVILLGED BECAME REALITY

 

 

As I look back at the time I took office as Minster of Health, I recall things seeming gloomy then as I got more oriented with our ailing health system. This, however, never took away my determination to realize the dream of instituting a new healthcare system that would provide unprivileged with access to quality health services, and alleviate disparities inequalities in access across gender, socioeconomic or geographical divides.

As I took office in 1996 I soon realized that Egypt’s health problems are enormous. I inherited an aging medical infrastructure badly in need of radical reform. Egypt was under threat of multiple disease epidemics. Primary healthcare was anything but effective, as 11 million Egyptians were did not have access to healthcare services. The healthcare establishment was operating under severe conditions, as its personnel were underpaid and had no access to training opportunities. Many women were deprived of healthcare and reproductive care, not to mention the prevalence of the cruel practices of female genital mutilation (FGM). Additionally, maternal mortality rate were extremely high, particularly in Upper Egypt.

In addressing these challenges, the first step that had to be taken was the creation of a coherent health reform vision that serves all Egyptians. Together with the ministry staff and experts, I developed a information management system that enhanced the ministry’s planning, monitoring and evaluation. The ministry also established an effective human resources development program, which offered existing staff training opportunities and worked on the recruitment of qualified personnel. The program also featured an advanced performance-based system for evaluation and incentive setting, as well as a system of accreditation and certification. To overcome the serious budgetary constraints we faced, the ministry created new international and domestic channels for health care financing. New management and financial approaches were introduced to health institutes to promote independence, create economic autonomy and allow for cost recovery. Soon thereafter, the ministry created a board for medical ethics. It also promoted various research initiatives, and helped to introduce of new therapeutic and technical modalities.

On the political front, I succeeded in setting this healthcare reform strategy to attain a major priority on the national agenda. I increased the annual public health budget by 10-15%. The ministry established an efficiently distributed network of facilities for primary health care, public health, and laboratories, especially in remote and areas previously deprived of access to healthcare. It also instituted a proper disease surveillance and monitoring - system and developed professional human resources programs and certification. This contributed greatly to the Ministry’s success in containing many epidemics that had threatened the health of many Egyptians, including cholera, typhoid, meningitis and summer diarrhea. The subsequent period also featured marked reduction in, if not complete elimination of, most infectious as whooping cough, diphtheria and endemic diseases, such as lieshmeniasis, anchylestoma, and bilharzias.

Only a few years later, almost 100% of the Egyptian population had access to healthcare services after we Ministry dispatched mobile clinics throughout the country, including remote areas.  Immunization coverage, moreover, increased from 79% in 1995 to 98% in 2002. The period between 1995 and 2000 also featured an increase in life expectancy and improvement in all vital health statistics, including a 50% drop in the number of children with stunted growth, a 55% drop in national maternal mortality rate and an enormous drop in maternal mortality in Upper Egypt. The ministry implemented the first national program for aiding the disabled.

The significant improvements in key health indicators allowed Egypt to rank 43^rd on the international index of health performance. The index reports how efficiently health systems translate expenditure into health wellbeing as measured by disability-adjusted life expectancy (WHO, 2000).

Having observed personally the suffering of the newly born and children made me determined to get them health insurance coverage. Despite legal hurdles and opposition inside the cabinet and the parliament, I managed to issue a Ministerial Decree in 1997 to incorporate all neonates and preschool children under the umbrella of the National Health Insurance System (NHI). This decree remains in effect until this day. NHI began taking on new responsibilities pertaining to preventive public health such as: early detection of diseases, continuous monitoring of children’s growth, nutritional status, vaccination, and disease surveillance, as well as health services for schools and their surrounding communities. Together with the government of the United States of America, the Ministry launched the Healthy Egyptians 2010 Initiative, a comprehensive agenda for health promotion, and disease prevention. The initiative covered a wide variety of issue areas relating to smoking, obstacles to a healthy lifestyle, accidents, and environmental health problems.

 

Another aspect of social injustice that the ministry had to address was the disparities in access to healthcare and in health indicates across rural and urban divides. Accordingly, the ministry awarded greater attention to primary healthcare in rural areas, where it established a network of over 3,000 health clinics. The ministry also promoted stronger cooperation between NGOs and the government agencies to support population and family medicine. The ministry initiated reforms in primary health care with a view to promote comprehensive development. These reforms included the adoption of the Family Doctor Approach in Primary Health Care along with effective registration and information systems.

A system for providing curative services for the unprivileged groups was established and was able to provide them with health services in highly specialized areas of medicine. This system relies on providing member of underprivileged groups with special financial support in the different hospitals based on their social conditions.

 

Access to Curative Care

 

The infrastructure for curative healthcare during the mid-1990s was deplorable, even in touristy regions. Some patients remained on waiting lists for years before they could get surgery. Emergency services were primitive, and many hospitals were under construction for over 20 years. To address these challenges the ministry established or renovated 635 hospitals.

 

In a few years, the ministry was able to establish a system that provided low-income Egyptians with quality specialized care in a timely and humane fashion.

This system in effect cleared long queues of people waiting for medical treatment or for financial support to obtain it. The system simply provided free healthcare any patient who was willing to wait in line to be seen by a doctor and stay in shared facilities with other patients. The program also covered renal failure patients, who were mostly poor and unable to pay for the cost of dialysis. The total cost for this curative service, which helped millions of desperate patients, constituted less than 0.7% of Egypt’s National Budget. Unfortunately in recent years, this system was abandoned  and as a result it became common for wealthy patients to receive the vast majority of these services. This also resulted in a five-fold cost increase.

 

At the center of the ministry’s success under my leadership was proper planning and a commitment to invest in human resources. The success of this reform initiative was not merely the product of the political support it received from Egypt’s leaders, but the support it received from local communities throughout Egypt, as well as committed international partners.