Addressing the Persistent Urban-Rural Health Divide in Egypt: Twenty Years Later
Over the past two decades, Egypt has made significant
strides in improving health outcomes, as evidenced by the reduction in
fertility rates, maternal and child mortality, and increased access to
healthcare services. However, a substantial urban-rural divide persists,
impacting the overall health equity in the country.
This article highlights key disparities between urban and
rural areas based on the 1998 Egypt Demographic Health Survey (EDHS) and the
2021 Family Health Survey, and outlines strategic recommendations for
decision-makers to address these challenges. It shows that improvement in urban
areas in many case equals that in rural areas thus maintaining the urban-rural
divide. To make an impact on this divide, more investments and efforts need to
be devoted to decrease the gap. A one-size-fit-all
strategy will only maintain the gap as the health indicators continue to
improve.
Key Findings
1. Fertility Rates: Although fertility rates have
declined, rural areas continue to have higher TFRs indicating the need for
enhanced family planning services and education in rural regions.
·
1998 EDHS: The Total
Fertility Rate (TFR) was 3.5 children per woman nationally, with urban areas at
2.9 and rural areas at 4.2.
·
2021 Family Health Survey:
The TFR decreased to 2.8 children per woman nationally, with urban areas at 2.4
and rural areas at 3.2.
2. Infant and Child Mortality: Despite national
improvements, rural areas still experience higher infant and child mortality
rates. Targeted interventions are required to improve healthcare access and
quality in rural regions.
·
1998 EDHS: Nationally, the
Infant Mortality Rate (IMR) was 54 per 1,000 live births, with urban areas at
40 and rural areas at 66. The Under-5 Mortality Rate (U5MR) was 70 per 1,000
live births, with urban areas at 55 and rural areas at 86.
·
2021 Family Health Survey:
The IMR decreased to 22.4 per 1,000 live births nationally, with urban areas at
18 and rural areas at 27. The U5MR decreased to 27.8 per 1,000 live births
nationally, with urban areas at 23 and rural areas at 32.
3. Maternal Mortality: The reduction in maternal
mortality is commendable, but the higher rates in rural areas highlight the
need for improved maternal healthcare services, including access to skilled
birth attendants and emergency obstetric care.
·
1998 EDHS: The Maternal
Mortality Ratio (MMR) was 174 per 100,000 live births nationally, with urban
areas at 130 and rural areas at 200.
·
2021 Family Health Survey:
The MMR decreased to 37 per 100,000 live births nationally, with urban areas at
25 and rural areas at 48.
4. Access to Healthcare Services: Continued
investment in healthcare infrastructure in rural areas is essential to ensure
equitable access to services.
·
1998 EDHS: Urban areas had
better access to healthcare services, with 80% of women receiving antenatal
care from a skilled provider compared to 60% in rural areas. Vaccination rates
were also higher in urban areas, with 89% of children fully vaccinated compared
to 72% in rural areas.
·
2021 Family Health Survey:
While access has improved nationally, with 94% of women receiving antenatal
care from a skilled provider in urban areas and 82% in rural areas, significant
disparities remain. Vaccination rates increased to 95% in urban areas and 85%
in rural areas.
5. Contraceptive Use: While the gap in contraceptive
use has narrowed, further efforts are needed to increase access and education
around family planning in rural areas.
·
1998 EDHS: Nationally, the
contraceptive prevalence rate among married women was 56%, with urban areas at
62% and rural areas at 51%.
·
2021 Family Health Survey:
The contraceptive prevalence rate increased to 59% nationally, with urban areas
at 64% and rural areas at 56%.
Strategic Recommendations
1.
Move from
One-Size-Fit-All Strategy to Targeted Investments and Interventions in Lagging
rural regions
· Enhance Family Planning and Reproductive Health Services: Expand the availability and accessibility of family planning services in rural areas. This includes community-based education programs and mobile health clinics to reach underserved populations.
· Invest in Rural Healthcare Infrastructure: Allocate resources to build and upgrade healthcare facilities in rural areas. This should be coupled with training and deploying more healthcare workers, particularly skilled birth attendants and pediatric care providers.
· Targeted Maternal and Child Health Programs: Implement targeted interventions to reduce maternal and child mortality in rural regions. This could include improving emergency transport services, providing financial incentives for healthcare workers in rural areas, and expanding immunization coverage.
2.
Leverage the Universal
Health Insurance (UHI) System: Use the ongoing rollout of the UHI system as
a platform to address regional disparities. Ensure that rural populations are
prioritized in the UHI expansion, with a focus on covering essential health
services and reducing out-of-pocket expenditures.
3.
Promote Public-Private
Partnerships (PPPs): Encourage partnerships between the government and
private sector to deliver healthcare services in rural areas. PPPs can help
bridge gaps in service delivery and introduce innovative healthcare solutions.
Addressing the urban-rural divide in health outcomes is
crucial for achieving health equity in Egypt. By implementing the above
recommendations, decision-makers can ensure that all Egyptians, regardless of
where they live, have access to high-quality healthcare services. The success
of these initiatives will be pivotal in closing the gap and improving the
overall health and well-being of the nation.
