Intended for healthcare professionals


Reforming Egypt's health system: is it that simple?

BMJ 2006; 333 doi: (Published 19 October 2006) Cite this as: BMJ 2006;333:859
  1. Wael Fayek Saleh, health specialist1 (w.saleh{at}
  1. 1 African Development Bank, Temporary Reallocation Agency, Avenue du Ghana, BP 323-1002, Belvedere, Tunis, Tunisia

    EDITOR—Egypt has witnessed several health gains during the past decades. Life expectancy at birth is increasing, 95% of the population has access to primary health care within 5 km, and immunisation coverage is about 98%. However, the quality of public health services is questionable and about 60% of expenditure on health is out of the patients' pockets.1 According to the World Health Organization, Egypt spends about 5.8% of its gross domestic product on health.2 This is lower than the countries in the Organisation for Economic Cooperation and Development (OECD)—which Egypt wants to join—which spend around 8% of their gross domestic product on health. In 2000 the African countries, including Egypt, committed themselves to increasing health expenditure to 15% of gross domestic product by 2015 (Abuja Declaration3). To date, Egypt's steps to increase budgetary allocation for health are not clear. Egypt's current government is examining ways to improve health services, including the expansion of social health insurance, and the question is how best to do this.

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    It is important to identify the main health and system challenges. Egypt, like many other countries in the region, is facing several new health challenges. Vulnerability to global health threats such as bird flu is increasing. The HIV infection rate in the Middle East and North Africa is rising rapidly. Two countries bordering Egypt (Libya and Sudan) have two of the highest rates of new infections in the region. The burden of non-communicable diseases in Egypt is increasing. Ironically, Egypt also faces challenges resulting from the improvements in its health system. The World Bank estimates that developing countries might face 2% annual increases in healthcare expenditure needs from the ageing of their populations.

    The main challenge for the health system is the lack of capacity of the different stakeholders, which is mainly, but not exclusively, linked to financial problems. With low wages, poor training in managerial skills, and few incentives for change, it is difficult for the Ministry of Health to create change. As the private sector is an important stakeholder in health it is mandatory to create a more competitive environment. The World Bank has identified principles for sound public financing for health that involve raising revenue to provide basic essential services and pooling health risks equitably. However, issues such as taxation policy, budgetary allocation, and formalising the parallel economy make these remedies more difficult to realise.

    Furthermore, health is strongly affected by the performance of other sectors: safe water, sanitation, electricity, transportation, and education directly affect health.

    Ultimately, civil society has an important role and has to act as a watchdog to protect the best interests of patients. Finally, good governance (with several reforms under way) will be a cornerstone of health reforms.


    • Competing interests None declared.


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