Risks and Challenges in Financing and Delivery of Primary Health Care Services Under Egypt's Universal Health Insurance System (UHIS)

Background: In social and national health insurance systems, personalized primary health care services are often funded through strategic purchasing arrangements, typically financed from taxes rather than insurance premiums. This ensures equitable access to care for the entire population. These services are integral to the overall health system, focusing on personalized care that addresses individual health needs.

Other components of comprehensive primary care—such as population-based public health services, health intelligence, and enabling functions—should be supported by the Ministry of Health (MOH) through tax-based funding. However, Egypt's implementation of the Universal Health Insurance System (UHIS) deviates from this model, presenting several key risks that could potentially lower primary care service utilization rates negatively impacting Egypt's public health indicators.

Source: Christoph Kurowski, Global Lead of Health Financing, World Bank, Putting People at the Center: Lancet Global Health Commission on Financing Primary Health Care, 2022

Key Risks facing the financing, delivery and utilization of primary care services under Egypt’s UHIS

1. The Risk of Exclusion of Selective Preventive Services from the Package: The UHIS law excluded two key essential primary care services from the UHIS package, namely immunization and family planning. This resulted in partially fragmenting the financing and delivery of the package of primary care services. Understandably, the reason to do that was to preserve the long-term achievements of committing the government to allocate budgets for the procurement of vaccines and family planning methods. This was a request demanded for many years by developmental organizations to sustain the delivery of immunization and family planning services. Apparently, the utilization of immunization services during the implementation in phase I governorates of the UHIS seems to not have been affected. This is probably due to having a separate service delivery structure in primary health care units supported by well-trained and experienced MOHP nurses. However, anecdotal reporting from the Ministry of Health and Population (MOHP) at governorate level indicates early signs of lower utilization of family planning services. Budgets for the procurement of family planning methods are preserved under the control of MOHP, however, as primary care services are delivered by primary care physicians by EHA, the responsibility for the delivery of family planning services in primary health care units becomes unclear since EHA is not paid to deliver these services under the capitation system being used to pay for their services.  

2. The Risk of non-adherence to Primary Care Protocols: For decades, primary health care physicians and nurses under the MOHP have been trained and monitored to faithfully deliver primary health care services nationwide adhering to WHO guidelines, technically supported and closely monitored by organizations in the field such as UNICEF, UNFPA and notably funded by USAID covering gaps in financing primary health care. In doing so, the MOHP has gained and accumulated considerable experience in the delivery of primary health care services. With the transition of the delivery of these services to the public provider, EHA, in phase I governorates of the UHIS, we cannot observe the same level of support provided to primary care physicians under the UHIS. The primary care concepts from the MOHP don’t seem to be integrated into the delivery of primary care services by the public provider, EHA, and the future private providers under the UHIS. Without building the necessary technical capacities of primary care providers and monitoring their performance, the delivery of primary care services risks becoming narrowly focused on treatment of sickness, rather than prevention of disease and wellness services. With the transition to the UHIS, the following should be expected by the key UHIS organizations:

i) A Stewardship Role by MOHP to Develop Capacity and Monitor Performance. The MOHP, the stewardship lead agency, is expected to assume a new role to provide technical support, capacity development for public and private providers as well as to ensure adherence to following protocols for delivery of primary care services. The MOHP will need to monitor the performance of providers and monitor the achievements gained in public health indicators to ensure they are preserved. 

ii) Accreditation of Quality of Delivery of Primary Care Services by GAHAR. With the emergence of new organizations such as the General Authority for Healthcare Accreditation & Regulation (GAHAR), it is expected that a new role should be identified to go beyond accrediting service providers for structural quality to accredit them for knowledge and following of protocols for diagnosis and treatment of primary care services.  

iii) A Change in the Mindset of UHIA Officials in the Manner Primary Care Services are Purchased. A key distinction between Egypt's old Health Insurance Organization (HIO) system and the current UHIS is the approach to financing and delivering primary care. Under the HIO system, primary care was not included in the insurance package and instead was the responsibility of the MOHP, which provided primary care services nationwide. The transition to the UHIS, which aims to include primary care in the insurance package, faced the challenge of the lack of understanding among Universal Health Insurance Authority (UHIA) officials (many of whom come from insurance backgrounds) of the importance of delivering primary care services in accordance with WHO guidelines. This requires a transformational change in the mindset of UHIA staff to prepare them for a role they are not familiar with to achieve health status goals that they are not usually trained to achieve. In addition, strategic purchasing practices for primary care services will need to move to a more efficient system incentivizing providers to better delivery primary care services and pay based on provider performance.

3. The Risk of Inadequate Budgeting for Primary Care under the UHIS: The budget for personalized primary care services, which was historically managed by the MOHP and funded through taxes, remains under the control of MOHP for primary care services provided in phase I governorates. This budget should have been transferred to the UHIA as part of the UHIS financing package. However, this critical point was overlooked in the UHIS law, leaving the MOH in control of funds for services that are now under the UHIA’s mandate in the first phase of implementation across six governorates. As a result, the UHIA will increasingly rely on insurance premiums to fund these primary care services. This reliance may lead to higher premiums or additional earmarked taxes, pushing informal sector workers to avoid enrollment in the UHIS. In turn, this could increase informality and exacerbate underutilization, as individuals may feel they are being "double-charged" for the same services through taxes and premiums.

Recommendations to Maintain and Improve the Financing, Delivery and Utilization of Primary Health Care Services

1.  Study the Current Pattern of Utilization of Primary Care Services under the UHIS: Conduct a comprehensive study on primary care service utilization in phase I of UHIS governorates, including maternal, child, NCDs and other primary care services. This analysis should be compared to ongoing utilization of similar services in comparable non-UHIS governorates in order to assess if difference in utilization exists.

2.  Establish a Monitoring System for Measuring Periodically the Performance of Primary Care Services: To better understand primary care service utilization, it is essential to monitor not only the overall number of visits per capita but also to disaggregate data by service type. Key metrics include the rate of visits for maternal care, child care, non-communicable diseases (NCDs) and others as relevant. Family planning should be added once the delivery of this service is included under the UHIA. Utilization should also be tracked by gender, urban-rural divide, type (formal vs. informal sector), income level, and governorate.

3. Ensure that the UHIA Provider Payment System is based on Incentivizing Performance. Payments to providers based on simple capitation need to shift to blended capitation mixing capitation with fee for services for selected services, while payments are paid based on the performance of providers to ensure utilization and referral of services don’t fall below targeted levels. Selected remote and underserved geographic areas should be rewarded by an incentive paying an additional percentage to serve in these areas. Incentives for maintaining quality apart from volume should also be considered.  

4. Define the Primary Care Services Package and ensure it includes family planning services: Amend the UHIS law to explicitly reintegrate preventive services, such as immunization and family planning. The package of primary care services should be clearly and explicitly defined to understand its content and delivered in line with WHO's primary health care requirements as part of the UHIS package.

5.  Define the Role of Quality Accreditation and Monitoring of Primary Care Services and Capacity Development: Define the role of both the MOHP and GAHAR in monitoring the implementation of protocols of primary care services, and that accreditation standards ensure that providers have the knowledge and capacity of these protocols. This should avoid any overlap or duplication of efforts between both organizations. Additionally, healthcare providers should be trained to deliver personalized primary care services according to WHO guidelines, with the MOH and/or GAHAR playing a crucial role in this capacity-building effort. Who will be taking the lead in capacity development of service providers, public and private, and how this will be financed should be clear.

6.  Transfer the Budget Allocated for Personalized Primary Care for MOH to UHIA per governorate included in the UHIS: Establish mechanisms to transfer the budget for personalized primary care services from the MOH to the UHIA, in line with the intentions of the UHIS of moving to strategic purchasing. This will reduce the UHIA’s reliance on premiums to finance primary care services and improve the financial sustainability of the system, ultimately leading to better access to and utilization of primary care services.

7. Stakeholder Education and Coordination: Launch a stakeholder education program targeting UHIA officials to improve their understanding of primary care delivery. Formal coordination mechanisms between the MOH, UHIA, GAHAR, EHA and representatives of private providers for profit and not for profit should be established to ensure a smooth transition and prevent duplication of services.

Conclusion: A well-financed, preventive-focused primary health care system is critical to the success of Egypt's UHIS. To achieve this, strategic reforms are needed to address the legal, budgetary, and operational challenges currently hindering the delivery of comprehensive primary care. Collaboration between the MOH and UHIA, underpinned by clear policies and financial mechanisms, will ensure that primary care functions as intended and contributes to improved health outcomes for all Egyptians.

 Egypt’s “One-Size-Fits-All” Hinders its Efforts to Achieve Health Equity

Egypt's health agenda has consistently emphasized health equality, aiming to provide the same level of healthcare access and services to all citizens, regardless of their socio-economic status. This focus on equality is evident in the design of national health policies, including the commitment to universal health coverage (UHC) through initiatives like the Universal Health Insurance System (UHIS). However, despite these intentions, Egypt has struggled to achieve health equality, unable to conceptualize health equity.  

Several factors contribute to this persistent gap:

1. Historical Approach and Structural Gaps

The Egyptian health system has, for decades, adopted a centralized, top-down approach to health coverage. From the early efforts to provide insurance for formal workers in the 1960s to the gradual inclusion of other population groups, the focus was more on expanding coverage uniformly than addressing varying health needs across different communities. This “one-size-fits-all” approach ignored disparities in healthcare access, especially in rural and underserved areas. Health facilities, resources, and qualified personnel are disproportionately concentrated in urban centers, leaving rural areas with poor-quality services and access challenges.

2. Urban-Rural Divide

The geographic distribution of healthcare resources in Egypt remains a key issue. Although the aim has been to ensure equal access to services, significant differences in health infrastructure, availability of healthcare professionals, and service quality persist between urban and rural areas. The expansion of services has not kept pace with population growth in densely populated regions or remote areas, leading to disparities in health outcomes.

3. Public Sector Resource Constraints

The Egyptian public healthcare system, which serves the majority of the population, has long been underfunded, leading to limited capacity and inefficiencies. Despite attempts to extend services uniformly across the population, the public sector struggles with inadequate funding, outdated infrastructure, and shortages of medical supplies. These constraints result in long waiting times, low-quality care, and the inability to meet the population’s diverse health needs.

4. Inequities in Health Outcomes

Despite policies aimed at equal access, health outcomes vary significantly by income, region, and education level. For example, maternal and child health indicators show stark differences between wealthier urban areas and impoverished rural regions. Non-communicable diseases (NCDs) are on the rise, with limited prevention programs targeting low-income groups, exacerbating health inequalities.

5. Neglect of Vulnerable Populations

Equality-focused approaches often overlook vulnerable populations such as those with disabilities, the elderly, and low-income groups. These populations face systemic barriers that prevent them from accessing healthcare services even when they are theoretically available. For instance, informal sector workers, who constitute a large part of the workforce, have historically been excluded from formal insurance schemes, leading to gaps in coverage.

6. Policy Focus on Services Over Social Determinants

The focus on providing equal access to health services often neglects the broader social determinants of health, such as education, housing, and income disparities. Without addressing these root causes, even well-designed health equality initiatives cannot achieve their desired impact. For example, urban areas with better education, infrastructure, and economic opportunities naturally see better health outcomes even if the same health services are technically available in rural areas.

7. Failure to Transition from Equality to Equity

Health equity requires recognizing that different populations have different needs and starting points, and therefore require tailored interventions to achieve the same level of health. Egypt’s persistent emphasis on equality has led to missed opportunities in designing policies that could reduce the disparities that arise from socio-economic and geographic factors. A needs-based approach that focuses on directing resources to where they are most needed—such as underserved regions, low-income communities, and high-risk populations—remains limited in implementation.

Moving Forward

Achieving health equity in Egypt requires a shift from uniform service delivery towards more targeted interventions that consider the specific needs of different population groups. This involves:

- Adopting a needs-based approach in the UHIS rollout.

- Enhancing resource allocation to underserved areas.

- Developing tailored health programs for marginalized and vulnerable groups.

- Integrating health equity principles into the broader social and economic development agenda.

Addressing the deep-rooted inequities in Egypt’s health system would involve not only more strategic investments but also a commitment to transforming the way services are delivered, with a focus on social justice, inclusivity, and responsiveness to diverse needs.

 Introducing the Concept of Wellness Healthcare in Egypt: A New Paradigm for a Healthier Nation

Egypt's healthcare landscape could introduce a transformative shift with the introduction of Wellness Healthcare—a holistic approach that emphasizes prevention, healthy living, and proactive care. As the country continues to grapple with the dual burdens of communicable and non-communicable diseases, Wellness Healthcare presents a promising avenue to improve the health of the population, reduce healthcare costs, and enhance the quality of life for all Egyptians. It could be the base for accelerating its plan to expand its universal health insurance coverage for all Egyptians.

What Is Wellness Healthcare?

Wellness Healthcare is a comprehensive approach that goes beyond the traditional medical model, which primarily focuses on treating illness. Instead, it promotes a balanced and healthy lifestyle, aiming to prevent diseases before they occur and to manage existing conditions through lifestyle modifications, mental health support, and community engagement. The core components of Wellness Healthcare include:

1. Preventive Care: Emphasizing regular check-ups, screenings, and vaccinations to detect and prevent diseases early.

2. Healthy Lifestyle Promotion: Encouraging balanced nutrition, regular physical activity, and smoking cessation as key elements of maintaining health.

3. Mental Health and Wellbeing: Addressing mental health issues through counseling, stress management, and social support, recognizing the integral role mental wellness plays in overall health.

4. Community and Environmental Health: Fostering healthy environments and communities by promoting safe public spaces, access to healthy foods, and pollution control.

5. Chronic Disease Management: Providing education and support for individuals with chronic conditions to manage their health proactively and prevent complications.

The Need for Wellness Healthcare in Egypt

Egypt faces significant health challenges, including rising rates of non-communicable diseases (NCDs) such as diabetes, heart disease, and cancer. These conditions are often driven by lifestyle factors like poor diet, lack of physical activity, and smoking. Additionally, the country's healthcare system has traditionally been reactive, focusing on treating diseases after they occur rather than preventing them. This approach has led to high healthcare costs and a strain on resources, as the system struggles to keep up with the growing demand for medical care.

Wellness Healthcare offers a solution by shifting the focus from treatment to prevention. By addressing the root causes of ill health, this model can help reduce the incidence of chronic diseases, lower healthcare costs, and improve the overall well-being of the population.

Benefits of Wellness Healthcare

1. Reduced Healthcare Costs: Preventive care and healthy living can significantly reduce the need for expensive medical treatments and hospitalizations, leading to lower overall healthcare costs.

2. Improved Quality of Life: By promoting healthy lifestyles and early intervention, Wellness Healthcare can help Egyptians live longer, healthier lives with fewer health complications.

3. Increased Productivity: A healthier population is a more productive one. By reducing the burden of disease, Wellness Healthcare can contribute to a stronger, more vibrant economy.

4. Strengthened Healthcare System: By alleviating the pressure on hospitals and clinics, Wellness Healthcare can help create a more sustainable healthcare system that is better equipped to handle both existing and emerging health challenges.

How to Deliver a Healthcare System That Provides a Wellness Package

To effectively deliver a healthcare system that encompasses a wellness package, Egypt must adopt a strategic and coordinated approach that integrates wellness into all levels of care. Here’s how this can be achieved:

1. Primary Care as the Foundation:

   - Role of Family Physicians: Family physicians and primary care providers should be the cornerstone of the wellness package, offering continuous and comprehensive care. They should be trained not only to treat illnesses but also to guide patients in making healthier lifestyle choices and preventing disease.

   - Routine Wellness Checks: Implement regular wellness checks and screenings as part of primary care visits. These should include assessments for common risk factors like high blood pressure, obesity, and smoking, alongside mental health evaluations.

2. Integration of Wellness Services:

   - Wellness Clinics: Establish wellness clinics within existing healthcare facilities where patients can access services such as nutritional counseling, physical activity programs, and stress management workshops.

   - Mental Health Integration: Incorporate mental health services into the wellness package, ensuring that psychological well-being is addressed alongside physical health. This could involve on-site mental health professionals in primary care settings and community-based support groups.

3. Public Health Initiatives and Community Outreach:

   - Health Education Campaigns: Launch nationwide campaigns to raise awareness about the benefits of wellness and preventive care. These campaigns can utilize media, schools, workplaces, and community centers to reach a broad audience.

   - Community Health Workers: Deploy community health workers to deliver wellness education and services directly to underserved populations. These workers can provide valuable support in managing chronic diseases, promoting healthy behaviors, and connecting individuals with healthcare services.

4. Incentives and Support for Healthy Living:

   - Workplace Wellness Programs: Encourage businesses to implement workplace wellness programs that promote physical activity, healthy eating, and mental well-being. These programs could offer incentives such as discounted gym memberships, healthy meal options in cafeterias, and mental health days.

   - Government Incentives: The government could provide tax breaks or subsidies for individuals and organizations that adopt and promote wellness initiatives, such as purchasing healthy foods, participating in fitness programs, or establishing smoke-free environments.

5. Technology and Digital Health Solutions:

   - Telemedicine and E-Health Platforms: Leverage telemedicine and e-health platforms to extend wellness services to more people, especially those in remote or underserved areas. These platforms can offer virtual consultations, wellness coaching, and online support groups.

   - Mobile Health Applications: Develop mobile apps that help individuals track their health metrics, set wellness goals, and receive personalized recommendations for improving their health.

6. Policy and Regulatory Support:

   - Healthy Environment Policies: Enact policies that support healthy environments, such as regulations on food labeling, restrictions on the sale of unhealthy foods, and initiatives to reduce pollution and improve public spaces for physical activity.

   - Comprehensive Health Insurance Coverage: Ensure that the wellness package is covered under Egypt’s Universal Health Insurance System (UHIS), making preventive and wellness services accessible and affordable for all citizens.

7. Monitoring and Evaluation:

   - Outcome Tracking: Implement systems to monitor the outcomes of wellness initiatives, tracking improvements in public health metrics such as reduced incidence of chronic diseases, lower healthcare costs, and increased life expectancy.

   - Continuous Improvement: Use data from monitoring and evaluation to continuously refine and improve the wellness package, ensuring that it remains responsive to the population’s needs and delivers the best possible outcomes.

Conclusion

The introduction of Wellness Healthcare in Egypt, supported by a healthcare system that delivers a comprehensive wellness package, holds the potential to revolutionize the nation’s health. By focusing on prevention, healthy living, and early intervention, Egypt can build a more resilient, equitable, and sustainable healthcare system. With the right strategies in place, Wellness Healthcare can lead to a healthier, more productive population, ultimately contributing to a brighter future for all Egyptians.

 

The Path to Universal Health Coverage: Understanding the Layers of Essential Health Packages

Achieving Universal Health Coverage (UHC) is a crucial goal for any nation committed to ensuring that all citizens have access to the healthcare services they need without suffering financial hardship. However, the path to UHC is not straightforward, and it involves making strategic decisions about which health services to prioritize and how to structure the delivery of care. It does not mean providing all the services citizens demand, thus risking excluding priority vulnerable populations when all citizens can be covered for the services, they need the most.

This article explores the concept of health service packages, as represented in the image, and discusses how they can guide a country's journey toward UHC.

The Core of Universal Health Coverage: Essential Health Packages

At the heart of UHC is the idea of providing a core set of health services that are deemed essential for maintaining the health and well-being of the population. These services are typically grouped into "packages," each addressing specific health needs or conditions. The image breaks down these packages into three main categories:

1. Reproductive, Maternal, Newborn, and Child Health (RMNCH) and Infectious Disease:

- This category represents the foundation of essential health services, focusing on critical areas like maternal and child health, as well as the prevention and treatment of infectious diseases. These are the services that most directly impact the survival and well-being of vulnerable populations, such as pregnant women, newborns, and children under five. Investing in these areas is often the first step in building a robust healthcare system.

2. Non-Communicable Diseases (NCDs) and Injury:

- As a country's healthcare system matures, the focus expands to include non-communicable diseases such as diabetes, cardiovascular diseases, and cancer, as well as injuries. Addressing these conditions requires a more complex and resource-intensive healthcare infrastructure, including specialized care, chronic disease management, and rehabilitation services. These packages are critical for reducing the burden of diseases that, while not immediately life-threatening, can significantly impact quality of life and economic productivity.

3. Cross-Cutting Services:

- This category includes services that cut across different health conditions and are essential for the overall functioning of the healthcare system. These might include emergency care, mental health services, health promotion, and preventive care. Cross-cutting services are crucial for ensuring that the healthcare system is resilient and responsive to the full spectrum of health needs.

The Expanding Circle of Coverage

The image also illustrates the concept of expanding coverage in layers, starting with a core set of essential health services and gradually expanding to more comprehensive coverage as resources and capacity allows.

The World Development Report 1993 (WDR 93) played a pivotal role in shaping global health policy by advocating for the prioritization of cost-effective health interventions. The principles outlined in WDR 93 continue to influence how countries approach the expansion of health services, emphasizing the importance of investing in interventions that offer the greatest health benefits for the cost.

- High-Priority Packages (HPP): These are the critical services that should be prioritized first. They represent the most urgent health needs that, if addressed, can significantly reduce mortality and morbidity rates. These packages are typically the first focus in low- and middle-income countries working towards UHC.

- Essential Universal Health Coverage (EUHC): As the health system strengthens, the scope of coverage expands to include a broader range of services. EUHC represents a more extensive set of health services that go beyond the high-priority packages, ensuring that a wider range of health needs are met.

- Universal Health Coverage (UHC): The ultimate goal is to achieve full UHC, where every individual has access to the complete range of health services they need. This encompasses everything a citizen needs, implying a healthcare system that is comprehensive, equitable, and fully inclusive.

Making Fair Choices on the Path to UHC

As countries work towards UHC, they must make difficult choices about which services to prioritize and how to allocate limited resources. The World Health Organization (WHO) provides guidance on making these choices, emphasizing the need to focus on equity, efficiency, and sustainability.

- Equity: Ensuring that the most vulnerable populations have access to essential health services is a fundamental principle of UHC. This means prioritizing services that address the most significant health disparities and ensuring that no one is left behind.

- Efficiency: Health systems must use resources wisely to achieve the maximum possible health benefits. This involves prioritizing cost-effective interventions and avoiding wasteful spending on services that offer limited health gains.

- Sustainability: Expanding health coverage requires careful planning to ensure that the system can be sustained over the long term. This means balancing the immediate needs for health services with the capacity of the health system to deliver and fund them consistently and reliably.

Conclusion: Navigating the Path to UHC

Achieving UHC is a complex and challenging process that requires careful planning, strategic decision-making, and a commitment to equity and sustainability. By understanding and implementing essential health packages in a phased and prioritized manner, countries can build strong healthcare systems that provide comprehensive and equitable care for all citizens.

The journey toward UHC is not a one-size-fits-all approach; it requires adapting strategies to the specific needs and context of each country. However, by following the principles outlined by WHO and learning from the experiences of other nations, countries can make meaningful progress toward a future where everyone has access to the health services they need.

Understanding the WHO Progression Pathway for Private Sector Engagement in Health: Focusing on Deliver Strategy

Incorporating the private sector into national health systems is crucial for achieving universal health coverage (UHC) and enhancing health outcomes. Recognizing this, the World Health Organization (WHO) developed a progression pathway for private sector engagement in health. This framework outlines six governance behaviors, each essential for effective integration of the private sector. Among these behaviors, Deliver Strategy stands as the foundation for all subsequent actions. This blog provides insights into Deliver Strategy, highlighting its importance and the criteria used to assess progress.

What is Deliver Strategy?

Deliver Strategy is the first governance behavior in the WHO’s progression pathway. It involves the government clearly articulating strategic goals for the health system and defining the roles of the private sector in achieving these goals. This behavior ensures that the private sector is an integral part of the national health strategy, contributing to broader objectives such as Universal Health Coverage and Health Security.

Key Elements of Deliver Strategy

For Deliver Strategy to be effective, the government must develop comprehensive national health policies, strategies, and plans (NHPSPs) that take a system-wide perspective, inclusive of the private health sector. Key elements include:

§ Up-to-Date Policy Statements: The existence of current documents, such as legal documents or policy statements, that define clear objectives for the private sector in line with health system goals.

§ Strategic Roles: Clear articulation of the roles of the private sector (for-profit and not-for-profit) in achieving strategic health system objectives.

§ Policy Mechanisms: Specific mechanisms outlined to influence the operation and performance of the private sector.

§ Implementation and Resource Allocation: Explicit understanding and support for realizing strategic goals through policy mechanisms, including financial resource allocation.

§ Tracking and Monitoring: Arrangements for tracking the effects of policy mechanisms, evaluating changes, and measuring their impact on health system outcomes.

Progression of Grades

The Deliver Strategy behavior is assessed across four stages:

1. Nascent: At this stage, there are no up-to-date policy statements articulating the government's strategic health objectives and the role of the private health sector. The focus is primarily on the public sector, with the private sector's role framed outside of UHC.

2. Developing: Up-to-date policy statements exist, outlining the government’s strategic health system objectives and the role of the private health sector. The private health sector is beginning to feature in the government’s strategic vision, with specific roles defined and a notional understanding of implementation.

3. Progressing: Policy statements articulate the government’s strategic health objectives and the role of the private health sector, with specific roles defined and accompanied by a clear implementation plan. The government’s strategic focus includes both public and private health sectors, with a clear plan for influencing the private sector’s operation and performance.

4. Developed: Clear strategic objectives for the private health sector are articulated, with explicit policies in place. Robust mechanisms for tracking changes in performance and the broader effects of policy changes are established. The government has a clear plan for influencing the private sector and has the capacity to monitor and measure the impact on health system outcomes.

Deliver Strategy is essential for effectively integrating the private sector into national health strategies. By establishing clear strategic goals, defining the roles of the private sector, and implementing robust mechanisms for monitoring and evaluation, governments can harness the potential of the private sector to achieve their health objectives.

As countries like Egypt work towards progressing through the stages of Deliver Strategy, the WHO’s progression pathway provides a valuable roadmap for ensuring that private sector engagement contributes meaningfully to national health goals.