File photo of a patient at a public hospital in Egypt. Photo: Nasser Noori CC BY-NC-SA 2.0 via Flickr
world Bank recently published a report analyzing the Egyptian government’s efforts to improve socioeconomic outcomes through increased investment in human capital. While the report correctly points out some shortcomings such as the lack of social security, it does not delve into the root causes of the situation.
The report begins by addressing the problem of overpopulation in terms of data on total fertility rate and population growth rate. This highlights the challenges of malnutrition and stunting, despite positive developments in other health outcomes. In 2014, nearly one in five Egyptian children under the age of five were stunted. With 2.1 million, Egypt has the 12th largest population of stunted people in the world and the region with the highest number of stunted children in the Middle East and North Africa (MENA).
Nutritional outcomes have not improved significantly between 2000 and 2014. The report recommended that Egypt should prioritize child nutrition to improve its human capital and achieve better health outcomes. Global nutrition strategies can make some important contributions, but progress cannot be achieved without greater investment in social protection mechanisms.
The report presents the existing disparity between the poorest areas, mostly rural communities in Upper Egypt, and other parts of the country. Health indicators, such as infant and neonatal mortality, are higher in the poorest governorates. In addition to the poor social determinants of health that come with living in these parts of the country, the health of these communities also Marked Due to lack of investment in public infrastructure and public services.
low health expenditure
The report shows that health sector spending in Egypt is very low by international standards and is declining in real terms. It emphasizes that health system financing, which currently relies heavily on out-of-pocket payments, needs to move towards more efficient and equitable funding sources, including higher government spending. This is an interesting note coming from the World Bank, which aggressively promotes privatization of healthcare in every sector. It appears that the private sector’s massive failure to provide relief during the COVID-19 pandemic in Egypt has forced even the World Bank to reduce its support for privatization, at least at first glance.
In Egypt, an average of 5.2% of the total government budget or 1.5% of GDP was allocated to the health sector between 2016 and 2021. The budget percentage of health expenditure fell from 5.3% in 2016 to 4.9%. In 2018, the lowest in the last five years. During the height of the COVID-19 response in 2021, government spending on health reached a historic high of 1.6% of GDP, or 6.5% of all government spending. Now, the government is prioritizing loans, new capital and other sectors like the health sector, which is not good news.
As a result, the main source of funding for health care in Egypt is out-of-pocket payments by patients. The proportion of out-of-pocket expenditure in current health expenditure has increased compared to the previous period, reaching 63% in 2019.
hiding behind a technical approach
The report touches on several important problems that face health care in Egypt, but it fails to go beyond technical analysis. For example, the report relates to a shortage of physicians as they migrate to the Gulf or Europe due to poor pay and working conditions. But it offers little advice on how to rectify the situation.
At times, the reports even give contradictory advice. For example, it criticizes the absence of the private sector in primary care because the law in Egypt does not allow it. This contrasts with the report’s commentary on the sharp increase in out-of-pocket payments going to the private sector. By doing so, the World Bank continues to encourage the private sector by any means, even though its own findings speak against it.
The private medical sector played a negative role during the COVID-19 pandemic, as private hospitals refused to take many patients who were unable to pay. Only a few people in Egypt were able to afford medical care in private institutions, as about one-third of citizens live below the poverty line. The recommendations in favor of the private sector, despite such strong evidence, show a gross lack of empathy on the part of the World Bank.
World Bank ignores ground experiences
In the report, the World Bank chooses to ignore the underlying political-economic reasons for the failure of the health system in Egypt. It begins with the fact that in Egypt, as in many other places, the working class does not have the right to organize, form trade unions, and go on strike. There is a complete lack of organization for the health workers which would help them to protest and negotiate with the government to improve their condition. Only formal professional associations are permitted, whose representatives are elected by the authorities. Furthermore, there is no room for the work of civil society organisations, nor for the press advocating social justice.
People in this region, in addition to ongoing conflicts, political problems and structural problems in the economy, are deprived of formal organizing and participation in public policy choices. Workers, including those in the health sector, do not have enough formal space to organize for change. This means that in practice they have little influence on the policies set out by the report.
The report fails to bring about a comprehensive political critique of the problem, sticking to a framework that does not acknowledge people’s participation in creating social systems.
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