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National Health Accounts Findings Open Health Financing Dialogue in Egypt

Jul 21 2011

Health Systems 20/20 joined Egypt’s Ministry of Health and Population (MOHP) and other government leaders in Cairo in June 2011, to release findings from a new round of National Health Accounts (NHA).

NHA, an international methodology that tracks the flow of financial resources through a country’s health system, provides key input for health resource planning. Sharing NHA findings illuminated the reality of health care spending in Egypt and opened an unprecedented dialogue between stakeholders at multiple levels seeking health financing solutions.

nameMore than 140 professionals attended the event including Egyptian government planners, hospital managers, private sector representatives, journalists, and donors. Keynote addresses were given by the Minister of Health and Population Dr. Ashraf Hatem, USAID/Egypt Mission Director James A. Bever, Deputy Minister of Finance Dr. Mohamed Maait, Health Systems 20/20 NHA expert A.K. Nandakumar, and Dr. Faten Ghazi, Chief of Cabinet for the MOHP.

Dr. Nandakumar summarized findings from the new NHA study, which showed in part that Egyptian households bear nearly 72 percent of health care spending (up from 62 percent in 2001/02) while the government pays less than 25 percent. “The numbers speak for themselves,” Minister of Health and Population Dr. Ashraf Hatem told the audience. “How can we stand idly while things are getting worse by the day?” Deputy Minister of Finance Maait said the finding about households’ financial burden represents “disaster” for many Egyptian families. The officials said the NHA findings provide them with powerful evidence to advocate for an expansion in insurance coverage and public spending on health.

In a question-and-answer session following the presentations, local hospital managers voiced concerns about lack of funding and called for greater budget authority at the local level. Audience members and speakers pointed to the need for a shift in mindset throughout the health care system toward evidence-based planning and budgeting. Dr. Ghazi of the MOHP underscored that, saying, “Budgeting has to be part of our culture.”

Minister of Health and Population Dr. Ashraf Hatem, second from right, listens to the presentation of NHA findings with USAID/Egypt Mission Director James A. Bever, third from right Credit: B&B Company

Other findings from the 2008/09 NHA study:

  • As the population was growing by about 2.3 percent over the previous year, total spending on health care increased by 44.0 percent
  • Egyptian households paid out of their own pockets for 71.8 percent of total health spending, up from 62 percent in 2001/02. Compared with other middle-income countries in the Middle East and North Africa, Egypt had the highest financial share borne by households and the lowest share borne by government
  • The Government of Egypt (Ministry of Finance) paid 24.8 percent of total health spending, down from 30.0 percent in 2001/02
  • As a portion of all government spending, Egypt spent 4.3 percent of its government budget on health, down from 5.0 percent in 2001/02

The new NHA included a household survey conducted in 2010 in collaboration with Egypt’s Central Agency for Public Mobilization and Statistics that details how and where families spent money on health. The survey showed that the poorest Egyptians still face sharp disparities in health spending. For example:

  • Higher-income Egyptians use health care twice as much as the poorest except for preventive care, which all income levels use equally
  • The poorest spend a significantly higher proportion of household income on health as compared with the highest-income
  • Although Egyptians in rural areas still have less access to health care than Egyptians in urban areas, the Government of Egypt has successfully reduced that differential. Those in rural areas actually use preventive and acute care more often than their urban counterparts
  • Government policies appear to have greatly reduced the disparity between males and females with regard to access to services
  • Those who are insured are spending less per capita on health care than those who are uninsured

In 1994/95, Egypt became one of the first low- or middle-income countries to conduct an NHA and conducted updates in 2001/02 and 2007/08.USAID has encouraged the Government of Egypt to institutionalize NHA studies. USAID/Egypt Mission Director Bever applauded the Minister’s proposal to create a Health Economics Unit in the MOHP to provide regular briefings on costs, benefits, and potential savings, and he offered USAID’s support for the unit.