The Hieroglyphs of Health

 2 — Before Health Insurance: How Did Egypt Try to Provide Healthcare for Its People?

Imagine a mother living in an Egyptian village in the 1940s. Her child develops a fever. She has little money, and the nearest hospital may be far away. Where can she go? Will someone be able to examine her child? Will she have to pay for treatment?

For families like hers, access to healthcare was not simply a question of having a hospital in the country. It was about having somewhere nearby to go when a family member became ill, and being able to receive treatment even when money was limited.

Egypt recognized this challenge long before the introduction of modern health insurance. One of its early responses was to bring healthcare closer to where people lived.

Bringing healthcare closer to families

In 1942, Egypt began establishing a rural health service, with the ambition of creating a health unit for approximately every 15,000 people.

For a family living in a village, this could make a real difference. Instead of travelling to a distant town for every medical consultation, people could visit a local health unit for outpatient care, maternal and child health services, vaccination, and treatment of common illnesses. Some units also had small inpatient sections for patients who needed to stay for treatment.

The network gradually expanded. It gave more rural families a place to seek care and allowed the government to reach communities with services that could prevent illness as well as treat it.

This was particularly important for mothers and children. A mother could seek care during pregnancy, have her child vaccinated, or take a sick child to a nearby health unit. These services helped bring healthcare into the daily lives of communities that had previously been poorly served.

But what if the local health unit was not enough?

A child might need hospital treatment. A mother might experience complications during childbirth. A patient might need surgery or specialist care.

A small village health unit could not provide all these services.

Egypt therefore developed a wider network of public facilities. Rural health centers, some with beds and operating rooms, provided a higher level of care. Rural hospitals and larger public hospitals served patients who needed more advanced treatment. In towns and cities, government hospitals, university hospitals, and specialized institutions provided additional services.

By 1977, the rural network reportedly included 1,681 health units, 568 health centers with beds and operating rooms, and 23 rural hospitals.

For families, this meant that there were different public facilities to turn to depending on the care they needed. The intention was to make healthcare available beyond the major cities and to provide treatment through a network of facilities rather than relying on a few large hospitals.

What about families living in the cities?

The challenge was different for families living in Cairo, Alexandria, and other towns and cities. They generally had access to a wider range of healthcare facilities, including government hospitals, urban health centers, university hospitals, and specialized institutions.

But having more facilities nearby did not necessarily mean that everyone could obtain the care they needed. Public hospitals had to serve large populations, and access to specialist treatment could depend on where people lived, the availability of services, and the resources of the facilities. Private doctors and hospitals offered another option, but paying for treatment could be difficult for families with limited incomes.

So, whether a family lived in a village or a large city, the central concern was similar: could it obtain the necessary treatment without having to pay more than it could afford?

The promise of healthcare without payment

Following the 1952 Revolution, the government placed greater emphasis on its responsibility to provide social services, including healthcare. Public healthcare was increasingly seen as something citizens should be able to obtain without paying at the point of use.

This was an important promise for families with limited incomes. A person who became ill should not have to choose between seeking treatment and paying for basic household needs. Public facilities were expected to provide an alternative to private doctors and hospitals for people who could not afford them.

The approach relied on the government financing public facilities and providing services directly. It was different from health insurance: people did not have to be enrolled in an insurance scheme to use the public healthcare services available to them.

But there was a difficult question behind this promise.

Could the government continue providing free healthcare to a growing population, at every level of care, while ensuring that facilities had enough doctors, nurses, medicines, equipment, and resources to treat everyone properly?

And what happened when the nearby health unit or public hospital could not provide the treatment a patient needed?

For an Egyptian family, these were not abstract questions. They determined whether a visit to a public facility would solve the problem, whether the family would have to travel elsewhere, and whether it would eventually have to pay for treatment.

Egypt had taken an important step toward making healthcare more accessible. But having public facilities and a commitment to free care did not automatically mean that every family could obtain all the treatment it needed, wherever it lived.

The next question is whether this promise of free healthcare worked in practice: who benefited, who was left behind, and why did families continue to face difficulties in obtaining the care they needed?