Egypt’s health care system is ailing

Friday 19/02/2016
Patients’ relatives waiting outside the Heart Institute, the largest cardiac hospital in Cairo.

Cairo - The distance between Dar El Salam General Hospi­tal and As-Salam Interna­tional Hospital — both in southern Cairo overlook­ing the Nile — is less than 2km.
In reality, however, the two hospitals are worlds apart. Dar El Salam is funded and run by the government and suffering all types of shortages, including a lack of specialist doctors, medicines and equipment. As-Salam is privately owned and run and has whatever is needed for its patients.
Dar El Salam is staffed by poorly paid, poorly trained Egyptian doc­tors. It depends on a slender budget from the government and offers free medical treatment. As-Salam is staffed by well-paid, well-trained doctors, some of them foreigners, and has a huge budget that comes out of the pockets of its patients.
The basic difference between the hospitals is about the disparity be­tween Egypt’s public and private health sectors and also about what went wrong with the country’s state-run hospitals.
“We talk here about two differ­ent things: hospitals that are totally mismanaged, which reflects on the type of services they offer and oth­ers that are managed well,” said Dr Ahmed Saafan, who until recently was Egypt’s assistant health minis­ter. “At the private hospitals, there are trained doctors and nurses as well as medicines and equipment, whereas the state-run hospitals do not have any of this.”
More than 80% of health services in Egypt are provided by govern­ment-run hospitals but Egypt’s state-run health system is blighted by mismanagement.
Egypt allocated approximately $5.7 billion to its health sector in 2015, with $4.5 billion (79%) going to the salaries of administrative workers, nurses and doctors. The rest of the budget was spent on treating patients.
Kasr El Aini Hospital, the largest state-owned hospital in Cairo, is a case in point. Out of the hospi­tal’s monthly income of $3.2 mil­lion, $2.1 million (66%) goes to the salaries of administrative workers and doctors’ salaries amount to $750,000.
The number of administrative workers at the hospital is almost ten times the number of doctors. All state-run hospitals have similar workforces.
Doctors working for state-run hospitals are paid almost ten times less than those working for private hospitals.
“A doctor [in the public sector] has to do more than one job to feed his family,” said Dr Khaled Samir, a member of the board of the Medi­cal Association, the independent guild of Egypt’s doctors. “There is a wrong perception in decision-mak­ing circles that spending on health is a waste of funds.”
Out of 250,000 doctors registered at the Medical Association, 45,000 work in Egypt. Most of the rest have opted for more lucrative positions elsewhere.
The lack of adequately trained doctors can have dire consequenc­es. Thirteen people reportedly lost their eyesight at a Nile Delta state-run hospital recently because an untrained doctor diagnosed and treated them incorrectly in one of the seemingly endless list of medi­cal errors.
Samir attributes such mistakes to what he describes as “deteriorating medical education”.
Health Minister Dr Ahmed Emad Rady agrees. On February 7th he said almost all the 8,000 people who graduate from Egypt’s medi­cal schools each year are not fit for the medical profession. Also trou­bling is that Egyptians have to pay for their medical treatment in the absence of a universal health insur­ance system.
About half of total health ex­penditures comes out-of-pocket at the point of service in public and private facilities, according to the World Health Organisation. Uni­versal coverage, which the govern­ment is contemplating, would take $11 billion to fund.
The government says it has only $1.1 billion in its coffers to go to such a system.
“Our health system goes from bad to worse,” Saafan said. “Egypt, which used to be a Mecca for medi­cal treatment-seekers from other Arab states, now lags behind most of these states.”