The Hieroglyphs of Health

Reforming Egypt’s Health Benefit Package: A Path to Universal Health Coverage

Reforming Egypt’s generous health benefit package has long been a persistent challenge, with politicians, decision-makers, ideologists, and rights groups alike advocating to shield it from reform. Since the 1960s, successive governments have been pressured to provide an unlimited package of comprehensive #health services, including at times treatment abroad. However, this comprehensive package has resulted in inequitable access, primarily benefiting the privileged few while leaving the poor and vulnerable behind.

In addressing this issue, Egypt can draw insights from the World Health Organization’s guidance on achieving universal health coverage (UHC). WHO has been instrumental in supporting over seventy countries since 2010 in their journey towards UHC, establishing a Consultative Group on Equity and Universal Health Coverage to address key issues of fairness and equity.

To achieve #UHC, countries must progress in three dimensions: expanding priority services, including more people, and reducing out-of-pocket payments. However, each dimension presents a critical choice: which services to expand first, whom to include first, and how to shift from out-of-pocket payment to prepayment. #Fairness, #equity, and respecting individuals’ rights to healthcare must guide countries in making these decisions.

A three-part strategy can aid countries in the fair progressive realization of UHC:

1. Categorize services into priority classes: Criteria such as cost-effectiveness, priority to the worse off, and financial risk protection can guide this categorization.

  2. Expand coverage for high-priority services to everyone: This entails eliminating out-of-pocket payments while increasing mandatory, progressive prepayment with fund pooling.

  3. Ensure disadvantaged groups are not left behind: This often includes low-income groups and rural populations, necessitating targeted efforts to include them in UHC initiatives.

While decisions depend on context, some trade-offs are generally unacceptable, such as expanding coverage for low- or medium-priority services before achieving near-universal coverage for high-priority services.

Public accountability and participation mechanisms are crucial for enforcing reasonable decisions in pursuit of UHC. These mechanisms can be institutionalized through a standing national committee on priority setting and informed by frameworks like Accountability for Reasonableness. Additionally, a robust system for monitoring and evaluation is indispensable for promoting accountability and participation effectively.

In reforming Egypt’s health benefit package, adopting a strategy aligned with WHO guidance can pave the way for achieving equitable and sustainable universal health coverage, ensuring that all citizens have access to essential healthcare services.